Found out that one of my coworkers was involved in her very first code blue. She is a relatively new nurse. When she called the code, the manager ran in, while a CNA grabbed the crash cart. Instead of waiting for the crashcart to arrive, the coworker gave the 85yo man (a cancer patient) 2 rescue breaths....without a mask on. The manager did not stop her, in fact, I heard she praised her....since nurses are supposed to do whatever it takes to protect their patient.
Call me what you want, but there is no way I am putting my mouth against my patients mouth wihout a mask on. Protect my patients, yes.... but I come first, too. This man was undergoing chemo, chances are, like many chemo patients, he had fungal infections in his mouth. I am very disturbed that out manager didn't intervene. If it was too late for her to intervene, she should have had a big discussion with her, and possibly write up a incident report.
OMG - I remember when we did all sorts of things without gloves, let alone masks!!! I carried a pocket mask around with me for years and never had the occassion to use it.
Raindrop - if one of your loved ones need CPR, I hope someone will do what needs to be done - even mouth-to-mouth - without waiting for the proper equipment. If they go to ground in front of me, I will be there to help.
I wear gloves now, BTW, whenever necessary. But I recall years of being on an IV team before gloves were mandated, even doing dialysis before 'universal precautions' was instituted. And I'm still alive!!! 35 years of nursing, mainly in direct patient care. :)
I was nodding along with you until this very last sentence. Not good. Does't justify anything. I would go on but I want to leave it here.
This man was undergoing chemo, chances are, like many chemo patients, he had fungal infections in his mouth.
All caused by organisms you encounter everyday- none of which are dangerous to immunocompetant people. Not to mention with proper oral care these can all be avoided, but that's a story for another day.
We keep ambu bags in every room. Good policy, imho.
I was nodding along with you until this very last sentence. Not good. Does't justify anything. I would go on but I want to leave it here.
i dont understand your issue? she said she uses gloves when appropriate now, but before that was usual and customary many years went by without a problem......so what is your issue?
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.
You pretty much skewered her. Darn it, she screwed up. Maybe saying it a couple more times will see that she gets it. Yes, she screwed up, which I am sure she knows already and is probably berating herself for that. Knowing your buddy is not enough. Could you vouch that he had nothing "catching".If you can, then I'll take my words back.
True, nursing is not a place for compromise when it comes to issues of safety, infection and what have you. But I implore you, be merciful. I wince at your words 'cos I wonder what would happen, if you could have said this face to face with said nurse.
i dont understand your issue? she said she uses gloves when appropriate now, but before that was usual and customary many years went by without a problem......so what is your issue?
If you don't see the issue, then we should not be discussing.
rather than be so freaked about the mouth to mouth, I'd be praising the new RN for her quick instincts and knowing to start CPR . . . YES, when looking from afar, it's clearly a mistake to not use the Ambu bag. However, I've seen my share on new RN's just standing there looking at V-fib on the monitor . . .
i dont understand your issue? she said she uses gloves when appropriate now, but before that was usual and customary many years went by without a problem......so what is your issue?
It implies that not using gloves was good enough, as she didn't suffer any ill effects. Meanwhile, thousands of other healthcare workers were exposed to Hepatitis B & C (and God knows what else) and suffered devastating and completely preventable illness. That's like saying "We used to reuse needles and never once had a problem with AIDS." It gives a severely wrong impression of the importance of using PPE reliably.
(Not that I'm implying that said poster really meant to dismiss PPE as unimportant.)
A new nurse after her first code needs to be told she did well unless something was truly catastrophic. They usually curl up in a linen closet and cry once the adrenaline go's away. If the manager had stopped her or said something at that point, she may have been thrown off and been unable to continue. If a new nurse gets through a code and manages to stay in the room, I usually praise them. Maybe a few weeks later I'd work something into a conversation in the guise of a story about another code on an other unit. New grads are so fragile.
It implies that not using gloves was good enough, as she didn't suffer any ill effects. Meanwhile, thousands of other healthcare workers were exposed to Hepatitis B & C (and God knows what else) and suffered devastating and completely preventable illness. That's like saying "We used to reuse needles and never once had a problem with AIDS." It gives a severely wrong impression of the importance of using PPE reliably.
(Not that I'm implying that said poster really meant to dismiss PPE as unimportant.)
obviously that is exactly what you are doing....
and though thousands may have had untoward sequelae, many millions did not. gloves dont do squat to protect you against a sryinge full of AIDS positive blood, which, if memory serves, was the way the first documented HCW (nurse) was infected with AIDS.
again, with knowledge comes improved outcomes. PPE, i would hope, has decreased the infection rate of HCWs with the diseases that you mention, but, do we have the stats to tell us?
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.
I'm glad the guidelines will change. ACLS has stressed for a number of years now that the return of circulation is what saves lives in cardiac arrest. Rescue breaths do virtually nothing in the first 1-2 minutes of a cardiac arrest.
To me there is a definite disconnect between what BLS and ACLS teach and it is a shame.
That being said, I give the new nurse credit for trying something instead of nothing.
Katie5
1,459 Posts
I was nodding along with you until this very last sentence. Not good. Does't justify anything. I would go on but I want to leave it here.