GilaRRT 1 Article; 1,905 Posts Feb 4, 2010 Agreed, not a huge deal IMHO. I am personally not all that keen on mouth to mouth and would take the time to utilise a barrier method. Perhaps the nurse manager was simply supporting this new nurse in front of peers? Would you have felt better if this new nurse had been called out in front of his/her peers by the manager? The risk of contracting an illness such as TB is actually quite rare. I can only find rather limited evidence of transmission. So, I would be willing to let this one slide and help this new nurse out. I do not believe in taking one for the team and risking potential exposure in spite of the low risk; however, I am not going to make a big deal over a newbie doing mouth to mouth.
Kyrshamarks, BSN, RN 4 Articles; 627 Posts Feb 4, 2010 This actually is a huge deal, and if for some reason the state or OSHA walked in a that precise moment, the hospital or nurse could have and rightly should have been fined. She put herself and others at risk for many diseases. A couple of extra seconds in a code to get the ambu bag does not make a difference as now the new rules are that you have to have circulation anyways for the breathing to work. She should have done the chest compresssions while someone was getting an ambu bag. She screwed up.The only time I ever did mouth to mouth (and I have been nursing 20 years now) is when I was in the military and one of my buddies was shot in a firefight and I had to mouth to mouth while waiting for evac. I knew him and knew what I was doing at that time.
GilaRRT 1 Article; 1,905 Posts Feb 4, 2010 This actually is a huge deal, and if for some reason the state or OSHA walked in a that precise moment, the hospital or nurse could have and rightly should have been fined. She put herself and others at risk for many diseases. A couple of extra seconds in a code to get the ambu bag does not make a difference as now the new rules are that you have to have circulation anyways for the breathing to work. She should have done the chest compresssions while someone was getting an ambu bag. She screwed up.The only time I ever did mouth to mouth (and I have been nursing 20 years now) is when I was in the military and one of my buddies was shot in a firefight and I had to mouth to mouth while waiting for evac. I knew him and knew what I was doing at that time.It was a new nurse who was stressed out and reacted. The risk of transmission was remote. I can bet this nurse was most likely squared away behind closed doors. Mountain out of a mole hill IMHO because OSHA did not walk in at that exact moment and sometimes stuff happens.
Kyrshamarks, BSN, RN 4 Articles; 627 Posts Feb 4, 2010 It was still an error and it only takes a moment, a single drop of blood, a single microbe for a transmission to occur. It may sound like I am a stickler, but in my side business of biohazard cleaing I have come to realize just how important PPE is and the consequences of not using it are way to severe not to use it. If I caught opne of my employees not using the safety equipment (and an ambu bag is safety equipment) I would have his hide and he would be fired, on the spot.
col3 19 Posts Feb 4, 2010 If i had a nurse that was willing to do what it takes- i would be eternally gratefull. If I caught a disease rather than die- I would be grateful. If I have ever been a new nurse- I would recognise and appreciate the nerves and inexperience she would have. If I had done the same thing in my past- nomatter what excuses i would like to put on it- I would be less judgemental.
Kyrshamarks, BSN, RN 4 Articles; 627 Posts Feb 4, 2010 I can guarantee you that when she went thru CPR they told her and taught her to NEVER do direct mouth to mouth. If they did, the teacher would have their teaching certificate revoked.
getoverit, BSN, RN, EMT-P 432 Posts Specializes in ER/ICU/Flight. Has 18 years experience. Feb 4, 2010 Like others have said, it's a learning experience on the part of the new nurse and she obviously was trying to do her best to help. You are correct that doing compressions while waiting a few seconds for an ambu bag would've been the right thing to do and I wouldn't do mouth-to-mouth.But on the other hand, I don't think OSHA would fine an individual for doing that. They might scold them, but the fine would incur if your facility wasn't providing some sort of barrier device. Also, a CPR instructor wouldn't have their certification revoked if they didn't say "NEVER" do mouth-to-mouth. I've taught CPR for a long time and always discouraged it but never made it a an absolute teaching point.
GilaRRT 1 Article; 1,905 Posts Feb 4, 2010 I can guarantee you that when she went thru CPR they told her and taught her to NEVER do direct mouth to mouth. If they did, the teacher would have their teaching certificate revoked.Ok then, if you really want to be a safety stickler how about focusing on problems that are, well really bad problems? We are loosing the plot over some pretty dodgy evidence, yet we have nurses getting ghosted in shootouts. In addition, the nurses with drop foot who are lined up for a decompression of their L5 are quite numerous. Bigger fish to fry than a frightened new grad IMHO.
XingtheBBB, BSN, RN 197 Posts Specializes in OR, peds, PALS, ICU, camp, school. Has 20 years experience. Feb 4, 2010 I'm just proud of the new nurse for not panicking and fleeing the room. Maybe it's a good time, though, to review to everybody that the best practice is to start compressions only until a barrier BVM arrives. Remember that even community CPR (in the absence of equipment) stresses compressions and mouth-to-mouth is a thing of the past. Evidence is now interpreted as without compressions, the O2 goes nowhere anyway.If you're manager truly thinks that nothing is wrong with nurses doing mouth-to-mouth, I'd be a bit concerned but unless she's sending a memo stating the policy is for all nurses to do m-t-m, i wouldn't fret. Maybe BVMs should be more accessible.
bajamedic 20 Posts Specializes in Hyperbarics. Has 15 years experience. Feb 4, 2010 We have AMBU bags in every room. I agree with the poster. Not the way to go. Nurse should have used UP, BSI. Remember the new BLS guidelines.......compressions. Those 2 breaths probably did nothing without compressions. Like I said I agree with the poster......not a good practice.
liebling5, MSN, RN 1 Article; 143 Posts Specializes in Stroke Seizure/LTC/SNF/LTAC. Has 9 years experience. Feb 4, 2010 I'm a CPR Instructor, too. I teach how to give m-t-m but also recommend carrying a pocket mask. I think that when the new guidelines are issued this year, giving breaths is going to be diminished. I started CPR on a patient not long ago (first responder) and did compressions only until the code team arrived. I wasn't putting my bare mouth on anyone, and I do know that the risk of transmission from saliva/vomit is minimal. BTW, the patient was revived.
sissiesmama, ASN, RN 1,897 Posts Specializes in ER, TRAUMA, MED-SURG. Has 22 years experience. Feb 4, 2010 Oh, raindrop!! This thead brings back some "unsettling" memories from when I was working on a LTAC vent unit. I have been a nurse for 19 yrs and learned this pretty early in my schhol. This shift I am referring to made me think I would be sick, just ready to puke. We had a patient, pt "A" ALL the way at the end of the hall, and was alone. Her family rarely came. A CNA was just outside this patient's room when her vent started alarming. She was in a room with visual monitoring for pt safety. I saw that on the monitor she was kind of flailing around in the bed when I started down to the room. The CNA called out for the code team, and then started chest compreeions. I got ready to bag, and she bent down by the patient, right when RT entered the room, so RT saw it too. When the CNA bent over the patient, she actually PUT HER MOUTH to the patient's trach and started to ventilate the patient with NO protection whatsoever. GAG ME!!!And this patient ha been on our unit for 3 weeks or so, and she had VRE and MRSA that we knew of, so gosh only knew what else she would show up positive for. YUCK!!Anne, RNC:smackingf
