to tell or not to tell?

[ablynn]

Hi everyone.

I am a nursing student. I have two questions to ask that is disturbing yet frustrating. While I was in observation in the OR, I observed several nurses not complying with sterile technique or even washing their hands between patients, cleaning, etc. NO HANDWASHING was observed at all. Another instance was a nurse dropped a syringe onto the floor, but still used it.

1) You can't complain to the hospital because our school would not be allowed to continue clinicals in upcoming semesters. Do you observed this 'out in the real world'? Do you tell?

2) What about the patient's rights? Or being an advocate for them? Do you tell?

What do you do? as a student? as a nurse? as an instructor?

Thanks for taking the time to read and respond!

[texas_lvn]

I can understandable see your POV, but if a case went to trial, and a student nurse, with the understanding of what a steril field is, or knowing not to use a needle dropped on the floor, did not say something to hinder the incident at the exact time it happened, but choose to tell her instructor later, could, and would be held liable in a court of law if this person got celluitis, or something else that they could directly have gotten in that situation. It is not only morally, ethically correct to tell, but you have to CYA in more than one way. Texas

[pebbles1977]

Well Texas, I have to respectfully disagree. I fully realize that SN's have some degree of responsibility, but they are unlicensed; therefore their instructors have their licenses on the line. So in my opinion and knowledge, if it went to court, it would fall on the instructor's shoulders if it even got that far. The SN told the instructor what she observed. Any nurse with a license has a responsibility to report such things. And also in my experience with students, they are not hands on in the ORs, just observing. So although the student does have a moral (and potentially professional) responsiblity to report it, as she did, the ultimate liability is with the licensed persons involved in the case, as well as the instructor who knew about it.

[texas_lvn]

Well Texas, I have to respectfully disagree. I fully realize that SN's have some degree of responsibility, but they are unlicensed; therefore their instructors have their licenses on the line. So in my opinion and knowledge, if it went to court, it would fall on the instructor's shoulders if it even got that far. The SN told the instructor what she observed. Any nurse with a license has a responsibility to report such things. And also in my experience with students, they are not hands on in the ORs, just observing. So although the student does have a moral (and potentially professional) responsiblity to report it, as she did, the ultimate liability is with the licensed persons involved in the case, as well as the instructor who knew about it.

There was a case, in which a jury agreed, (not sure when, where, I would need time to look it up)(we used the case as a mock trial for CEU"S) where a sn was only observing in the ER. The preceptor told the sn to take a patient to his car after discharge. While the wife was getting the car, the sn was with the patient outside of the hospital door, with the patient in a wc. The preceptor called the sn and told her to come in, they had a really interesting case and did not want her to miss it. She said, just a minute, I have to wait for Mrs. John before I can leave Mr. John. Nurse said, just do it, it will be ok. SN left Mr. John by himself, in the wc. After sn left, Mr John got out of the wc, fell, and ended up dying from the head injury. All trials (real, mock, and all appeals) made the hospital pay retribution, and held both the sn, and the nurse accountable for their actions. How, in this situation, can the sn run and tell her instructor, and still not be held accountable? She had to tell the instructor after the fact. She should have either 1) made the nurse stay with her, refusing to be with Mr. John by herself, or 2) refused to go with the nurse. Hospital policy states that when a patient came in to ER, a nurse would remain with said pt until they were out of wc and in the car. I think that you can agree with me that it is probley somewhere in every hospital policy that states not to use a dirty syringe, and in policy that states not to cross sterile field. Therefore, how can a sn just tell the instructor, and not be held accountable, especially when everytime you report to an instructor, it is something that has happened after the fact? (the instructor was not a defendant nor even called to testify.)

[Fluff01]

You were correct in letting your clinical instructor know what has happened and the concerns you have. I wouldn't be afraid of telling, someone needs to. This is how so many patients get nosocomial infections because nurses aren't compliant with using the necessary precautions. I feel the DON or the OR supervisor would certainly like to know in order to try and put a stop to this type of behavior.

[pricklypear]

There was a case, in which a jury agreed, (not sure when, where, I would need time to look it up)(we used the case as a mock trial for CEU"S) where a sn was only observing in the ER. The preceptor told the sn to take a patient to his car after discharge. While the wife was getting the car, the sn was with the patient outside of the hospital door, with the patient in a wc. The preceptor called the sn and told her to come in, they had a really interesting case and did not want her to miss it. She said, just a minute, I have to wait for Mrs. John before I can leave Mr. John. Nurse said, just do it, it will be ok. SN left Mr. John by himself, in the wc. After sn left, Mr John got out of the wc, fell, and ended up dying from the head injury. All trials (real, mock, and all appeals) made the hospital pay retribution, and held both the sn, and the nurse accountable for their actions. How, in this situation, can the sn run and tell her instructor, and still not be held accountable? She had to tell the instructor after the fact. She should have either 1) made the nurse stay with her, refusing to be with Mr. John by herself, or 2) refused to go with the nurse. Hospital policy states that when a patient came in to ER, a nurse would remain with said pt until they were out of wc and in the car. I think that you can agree with me that it is probley somewhere in every hospital policy that states not to use a dirty syringe, and in policy that states not to cross sterile field. Therefore, how can a sn just tell the instructor, and not be held accountable, especially when everytime you report to an instructor, it is something that has happened after the fact? (the instructor was not a defendant nor even called to testify.)

This scenario is different than the original problem. The difference is, in your story, the SN was directly responsible for the safety of that patient at the time. Licensed or not, nobody leaves any patient unattended waiting to be picked up. The SN in the OR situation was simply a bystander, an observer, not a participant. She/he was not directly responsible for the sterile field that was broken, or the dropped needle. She/he could be a witness, but not legally liable. I believe (my own personal opinion) that her responsibility ENDS at informing her instructor.

[Cute_CNA, CNA]

I'm not a nurse, but I agree with the other posters about reporting what you see.

Think about it. These nurses you see are role models for the students. If the students see sterility as something that's okay to compromise, then they too will do the same thing when they acquire their licenses. In other words, the students are not learning the proper standards of care from the outset. This may to compromising other patients' health. Bad situation.

[organichombre, ADN, BSN, MSN, LPN, RN]

Absolutely not her responsibility but the point is to remember that once you graduate and YOU are the licensed personnel, it's your responsibilty. And don't worry about upsetting someone when you are in the right. That is what leads to clinially inferior nurses, who are afraid to confront docs, and other nurses when it comes to saving a life.

[msmona]

Well Texas, I have to respectfully disagree. I fully realize that SN's have some degree of responsibility, but they are unlicensed; therefore their instructors have their licenses on the line. So in my opinion and knowledge, if it went to court, it would fall on the instructor's shoulders if it even got that far. The SN told the instructor what she observed. Any nurse with a license has a responsibility to report such things. And also in my experience with students, they are not hands on in the ORs, just observing. So although the student does have a moral (and potentially professional) responsiblity to report it, as she did, the ultimate liability is with the licensed persons involved in the case, as well as the instructor who knew about it.

I am a student in KS and our CI informs us we are NOT operating under her license.

[tlhubbard]

Consider the possbility of reporting annonymously. Most hospitals have compliance hotlines that allow you to report without giving your name. There is no way they can say it was you verses any other person in that room. Compliance should approach the situation in a "what happened exactly" manner, not in an accussatory manner.

Fortunately when I was a student observing a "sterile" procedure with my mentor, when the sterile field was broken my mentor observed it also. She was also an employee (higher up) at this same facility. So I am 100% sure the info was passed along to the proper people. (I could tell she was horrified)

I also reported during school a fellow student who was going around making recommendations that we NOT USE SOAP on our nursing home residents. Logic- then you don't have to take the time to rinse them.:angryfire If that were my mother or father lying there and she pulled that.....:angryfire

Needless to say, she was outta there the next day. It's good to keep the people who do not care to do the job well away from our patients for the patients' sake.

Good luck in school!!!!

[tiggerforhim]

I am a student in KS and our CI informs us we are NOT operating under her license.

Excuse me, but then whose license are you operating under? It is my understanding that no matter what, clinical instructors put their licenses on the line so to speak and that the student nurses are operating on their licenses.

[pickledpepperRN]

I would speak up right then. Better to be called a "dumb student" than allow harm to a patient.

Then if the circulating nurse or surgeon does nothing they should be reported to their licensing boards. Perhaps one of the team would be interested in setting a good example for a student.

Whatever state agency licenses the hospital (Department of Health or Public Health) should b receive a report too IF the unsterile situation was allowed to continue. No hospital should be allowed to continue like this. Period!

As patient advocates it is our duty to do no harm and not allow others to harm our patients.

[pricklypear]

Excuse me, but then whose license are you operating under? It is my understanding that no matter what, clinical instructors put their licenses on the line so to speak and that the student nurses are operating on their licenses.

I can't give you the details (I've pretty much forgotten them :), but I can tell you that students don't practice "on" an instructor's license. If an instructor has 10 students on a few different units, how can she be hovering over each one at the same time? Only 1 person can operate on a nursing license. There are provisions especially for student nurses when it comes to clinical time. Just as there are special provisions for graduate nurses practicing before they take the board exam. They are basically operating under student privileges, agreed upon by the BON, the school of nursing and the institution.