Not sure I handled this properly... I was in the ER today with my 21 year old daughter who has kidney stones. Shift change happened while we were there and the new RN came in to give IV pain meds. She didn't check pat identifiers, didn't clean the IV hub, and didn't flush before or after.
I am a nursing student- have 3 semesters left of my BSN. I have not worked in the medical field yet. I was taken aback and thought I must have miss-seen something, but when she came back in with nausea meds she did the same thing. My daughter looked askance at me about it and I told her I would find out (this was in front of the nurse ). The nurse asked it there was something wrong and I said maybe, and asked her about cleaning the hub. She said, "oh, well everyone does it differently. "
I asked for the charge nurse and talked to her about all of it. She asked if I was a nurse and I said no. She apologized and said the nurse would be talked to.
So, did I handle this right? I feel "yucky" about the whole thing and think maybe I didn't. I would like to work at this hospital, and maybe even this dept as a tech next semester, and as an RN in a couple of years...
Specializes in Med nurse in med-surg., float, HH, and PDN.
Regarding the flush, I would've said with a pleasant look on my face, "Would you please flush that?" If she said "Why?" (which I can't imagine she would) I'd say "So she can get all of the medicine into her."
I would expect her to say "Oh. Okay." and do it.
I'd be laid back about the way I presented myself. I guess. Though you know, the more I think about it, the not cleaning the hub/port/cap is bothering me more. Guess I'd say,"Aren't you supposed to clean that first?"
I was in the hosp ER, then scheduled for surgery on a broken ankle and my last name was SPELLED WRONG on everything! I told every person who came to my bedside, because I was wanting someone to change it to read correctly. What I got from everyone was, "Oh. Well, just keep reminding/telling everybody." I reckon at that point that having consistent records (not all was computerized) was easier than changing everything mid-stream? Not angry about this; I was, however, a little frustrated. The mis-spelling of my name actually gave me a whole NEW last name and I was concerned that I'd be forever identified by who I was not!
I get that you're concerned about it - you've got 3 semesters left so you haven't even begun to see what nurses do and do not do that will leave you gobsmacked...until you get over it, that is. I spent a lot of time in ED this quarter and many nurses either used the Curos port cap (those green caps that screw on to the hub that are impregnated with alcohol and chlorhexidine -- these are supposedly the EBP standard of care) or just didn't scrub it at all. The only time I've ever seen a consistent hub scrub and an actual countdown for time was when I was shadowing in hem/onc and they were accessing a CVAD (thank god :) ). Many other nurses are like, "meh" about it because in the ED they're used to go go go go all the time. I've even asked (a fake ask as I knew better) if I should clean a port before accessing it and some preceptors were like, "If you want to." Personally, I will always "scrub the hub" because ewwww.
I always scrub the hub and I do mean always. Not that I'm some kind if goody goody... I know there are things I do wrong...but b/c it was hammered into us in nursing school and then it became a habit. It's like a reflexive thing now. I can't NOT do it. If for whatever reason I don't have a wipe, I will walk all the way down the hall and get one and come back. I'm beginning to see why I'm always running the whole shift.
So it wasn't some port that had just been hanging out. They pushed the med immediately after disconnecting IV tubing. Are we supposed to disconnect IV lines to swab them with alcohol now? Or maybe we just have positive pressure caps made of alcohol instead.
So it wasn't some port that had just been hanging out. They pushed the med immediately after disconnecting IV tubing. Are we supposed to disconnect IV lines to swab them with alcohol now? Or maybe we just have positive pressure caps made of alcohol instead.
I swab caps even if I just disconnected tubing. And in between syringes with push meds.
I swab caps even if I just disconnected tubing. And in between syringes with push meds.
If I'm the one who connected the tubing initially, I don't swab because I know I did it before I connected the tubing. I only swab between pushes if my no-touch technique has been compromised somehow.
Clinically you were definitely correct. The only thing I might have done differently is confront her directly instead of going to the charge nurse right away. However, I can understand that as a student you might have doubted if you were correct.
This nurse sounds very sloppy and I wouldn't have been happy either. I probably would have overlooked the identifiers and the scrub b/c I'm wimpy like that but the flush thing was way wrong. I think I would have said something like "don't you need to follow that with a flush so the medicine get's in there?" Kinda like a "gee, I'm not sure but it would make sense to me if...". If she still wouldn't flush it, I would have been more aggressive about it and flat out asked her to. If still a no go, I would have gone up the chain.
As a practicing nurse you will come across things like this often. With providers taking care of loved ones and with co-workers. There are some things I will overlook because no one wants a co-worker/pt. family member who is a know-it-all, calling out, tattle tale type.
However, there are some things I draw a line in the sand about. When I "correct" someone in those times I try to do it in a very non-confrontational way. If I later saw persistent dangerous behavior I would go up the chain.
You were first and foremost a mom so I can understand your need to advocate for your daughter.
You did good :-)
No one likes a tattle tale, but if a doctor or doctor's family said something about their care, no one would think they were tattling know-it-all's, would they?
No one likes a tattle tale, but if a doctor or doctor's family said something about their care, no one would think they were tattling know-it-all's, would they?
I think I would. When I say know-it-all/tattle-tail I'm talking about a person who brings up every minor infraction and actively looks for things to complain about. Things that will most likely cause no harm. I bet if you ask a group of physicians they would say they'd rather not work/deal w/ someone like that.
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No Stars In My Eyes
5,648 Posts
Regarding the flush, I would've said with a pleasant look on my face, "Would you please flush that?" If she said "Why?" (which I can't imagine she would) I'd say "So she can get all of the medicine into her."
I would expect her to say "Oh. Okay." and do it.
I'd be laid back about the way I presented myself. I guess. Though you know, the more I think about it, the not cleaning the hub/port/cap is bothering me more. Guess I'd say,"Aren't you supposed to clean that first?"
I was in the hosp ER, then scheduled for surgery on a broken ankle and my last name was SPELLED WRONG on everything! I told every person who came to my bedside, because I was wanting someone to change it to read correctly. What I got from everyone was, "Oh. Well, just keep reminding/telling everybody." I reckon at that point that having consistent records (not all was computerized) was easier than changing everything mid-stream? Not angry about this; I was, however, a little frustrated. The mis-spelling of my name actually gave me a whole NEW last name and I was concerned that I'd be forever identified by who I was not!