Witnessed unsterile procedure and feeling terrible about it

[cblake4293]

I am a new grad and have been working as an RN for 5 months. Everyone I work with is very experienced and I am definitely the newbie. Yesterday I witnessed an LPN with 30 yrs experience straight cath a male without using sterile gloves. I asked if she had sterile gloves and the iodine that is necessary (we didnt have a kit so all items had to be gathered seperately). I found the iodine and brought it to the bed side. She then asked for a packaged wipe on the bedside to clean the insertion area. I asked her if she wanted me to do the iodine and she replied that she was just going to do the wipe but I could if I wanted to. I did and realized that she never put on sterile gloves only clean gloves. She completed the procedure without ever applying sterile gloves and I am feeling absolutely awful that I didnt stop her and tell her she needed sterile gloves. The whole procedure was totally against what I learned in nursing school. I am thinking about going to the nurse in charge of training and telling her what happened in confidence. Thinking maybe she can hold in inservice on proper techinique. I do not feel comfortable talking to the nurse who did the procedure about it. It would not go well. I have been stressed about this for the last 24 hrs! Any advice? I'm afraid I could be held responsible for not intervening as well.

[joanna73, BSN, RN]

Just out of curiousity, what do you use for foley insertion? You're gathering separate supplies up? I thought most facilities had catheter kits, but apparently not.

[cblake4293]

Thank you to all who responded to my post about the unsterile cath I witnessed. After a couple of sleepless nights, I did what I felt I could live with. Talking with the nurse directly was not an option for me. I was not going to see her for another week and I felt that too much time had passed. She is somewhat confrontational and I predict it would not have gone well. I should have said something in the moment but you know what they say about hindsight. Lesson learned. Some nurses I have developed a good relationship and we often txt outside of work asking how pts are or bouncing things off each other. I would have definitely gone to one of these nurses if they had done it. So....I went to the nurse educator and asked her about the facility policy and if there were any exceptions. She said no. Straight cath is always sterile. I told her what happened and suggested an inservice without pointing anyone out. I also said we dont have kits which would have made the gloves readily available. She didnt realize we were out of kits . The end result is she is ordering kits, attaching a memo about correct technique and has no plans to single this nurse out in any way and my name stays out of it! To those who talked about being a tattle tale....yes I do feel like one! But this is about safety, and if this is how she always caths someone is going to get sick and I wouldnt want it to be my grandmother. I see shortcuts taken everyday at work, we have to somehow get a million things done in 8 hrs! I had clinical instructors say "this is how we do it in school but this is how its done in the real world". Loved those clinical instructors! Trust me I get it...

[DebblesRN, ASN, BSN, RN]

My grandmother is in LTC and had to have a straight cath done. It was done clean instead of sterile (per documentation) and that sample grew nothing. 4 days later after the straight cath, she became confused, febrile, and she had a raging UTI that grew out antibiotic resistant bacteria (this was from a second sample as the first never grew anything). She ended up in the hospital for 2 weeks in ICU on BIPAP with urosepsis. Had a PICC put in and was on IV ABX for quite a while due to their "clean straight cath." So yeah--all of them should be done using sterile technique as far as I am concerned. And the policy changed at that facility after my mother and I had a meeting with administration.

[Liddle Noodnik]

I am a new grad and have been working as an RN for 5 months... I am thinking about going to the nurse in charge of training and telling her what happened in confidence. Thinking maybe she can hold in inservice on proper techinique. I do not feel comfortable talking to the nurse who did the procedure about it. It would not go well. I have been stressed about this for the last 24 hrs! Any advice? I'm afraid I could be held responsible for not intervening as well.

Ahh new grads lol

Yes this was poor practice but seriously? Lol

cblake, I am so sad that you have to be faced w/ this, your coworkers are supposed to be showing you the way things should be done, not the risky path. I would go to the supv and ask to see the proper procedure in the proc. manual and then tell her it is not being done that way. I am not impressed lilaclover w/ your response and that of some others. I KNOW new grads can be noodgy, I was one once, and I know after 30 years of experience I might take some shortcuts, but you don't independently decide to make a sterile procedure a clean one, oh my goodness, esp. a cath! w/ the kinds of bugs we have nowadays? No wonder there are superbugs if this kind of thing is going on routinely

and yes I know we are stressed and short staffed but you are taking one short cut and potentially adding new tasks (collecting samples, adding antibiotics, additional monitoring, you know that sx of infection can become critical, cause confusion, etc etc etc... and maybe have to add a PRECAUTION room to the list of interventions... to say nothing of the discomfort of a UTI...).

The OP said enough things to lead the nurse to know that she (the OP) knew she was doing it incorrectly ... the nurse had the opportunity to correct herself but she didn't seem to care...

[imintrouble, BSN, RN]

It looks to me like this argument has deteriorated into two camps.

Hospital nurses/new grads who have never worked LTC.

LTC nurses who have resigned themselves to reality.

It would be beneficial if the hospital nurses, outraged over some of these posts, could work in LTC for 6 months.

[Liddle Noodnik]

It looks to me like this argument has deteriorated into two camps.

Hospital nurses/new grads who have never worked LTC.

LTC nurses who have resigned themselves to reality.

It would be beneficial if the hospital nurses, outraged over some of these posts, could work in LTC for 6 months.

I have worked LTC. Years, not months. I still stand by what I said. I do understand! But, it is still unacceptable

I will add though that I have retired from nursing, hopefully for the last time, and I'm only 54. It's a very tough profession to be in no matter what the specialty. Kudos for those who will continue to do it, and do it right. But when you can't help but take shortcuts such as these, maybe it is time to leave.

[anotherone, BSN, RN]

If sterile gloves and betadine are readily available, why *wouldn't* you use sterile technique? To be honest, I have no idea what my facility's official policy is re: sterility vs clean and straight cathing. But since I got a supply room full of sterile supplies, I'm sure as heck gonna use them.With all that said, the OP definetly should NOT report this nurse to his supervisor. For crying out loud, we don't even know if the nurse in question was violating facility policy. Everyone telling the OP to run and tell the DON is giving *terrible* advice. Do you all want the OP to be completely ostracized as a new nurse?!? Maybe, just maybe, the OP could discretly discuss it with the LPN before stabbing her in the back? Just a thought.....

as a new person i would keep my mouth shut. if it gets brought up, you better do everything by policy 100% of time or expect when you dont emails be sent to management and incident reports for every little thing . sad but true . 30years of experience doing it wrong as i like to say

[leslie :-D]

It would be beneficial if the hospital nurses, outraged over some of these posts, could work in LTC for 6 months.

here...ltc was my first job out of nsg school, worked there little less than a year.

when we straight cath'd, we'd grab a cath and a cath kit to get the needed supplies for a sterile procedure.

the only thing i'm thinking of now, is that i actually didn't need the straight cath and could have just used the cath from the cath kit. :)

in our ltc facility, it was definitely a sterile procedure and we'd get in big trouble for not following policy.

leslie

[leslie :-D]

i'm glad the situation is resolved, glad procedure should be sterile (phew!), and no one got in trouble.

you may want to post this in your original thread since it is not getting the attention it deserves.

best of everything and good job, op.

leslie

[netglow, ASN, RN]

Some nurses I have developed a good relationship and we often txt outside of work asking how pts are or bouncing things off each other...

Next on your inservice list should be the above

[imintrouble, BSN, RN]

Suffice it to say, that each of our realities are not the same.

Kudos to all of you who have never found yourself working where they don't even have alcohol preps.

May you never have to.

[cblake4293]

Thank you to all who responded to my post about the unsterile cath I witnessed. After a couple of sleepless nights, I did what I felt I could live with. Talking with the nurse directly was not an option for me. I was not going to see her for another week and I felt that too much time had passed. She is somewhat confrontational and I predict it would not have gone well. I should have said something in the moment but you know what they say about hindsight. Lesson learned. Some nurses I have developed a good relationship and we often txt outside of work asking how pts are or bouncing things off each other. I would have definitely gone to one of these nurses if they had done it. So....I went to the nurse educator and asked her about the facility policy and if there were any exceptions. She said no. Straight cath is always sterile. I told her what happened and suggested an inservice without pointing anyone out. I also said we dont have kits which would have made the gloves readily available. She didnt realize we were out of kits . The end result is she is ordering kits, attaching a memo about correct technique and has no plans to single this nurse out in any way and my name stays out of it! To those who talked about being a tattle tale....yes I do feel like one! But this is about safety, and if this is how she always caths someone is going to get sick and I wouldnt want it to be my grandmother. I see shortcuts taken everyday at work, we have to somehow get a million things done in 8 hrs! I had clinical instructors say "this is how we do it in school but this is how its done in the real world". Loved those clinical instructors! Trust me I get it...