I started a new job about 2 weeks ago at a residential program for the mentally ill. The place has two units. One for long term mentally ill patients, and a unit for those in transition from an inpatient hospital stay back to the community.
So far, orientation has been . . . . interesting.
There's been a couple things that are happening, and I'm just so unsure if I should bail because these are signs of things to come or voice my concerns to the DON and possibly be known as, "that nurse."
1) I haven't seen a single nurse do blood sugar checks and insulin injections the same way. In fact, on several occasions I have witnessed nurses giving insulin without ever wiping the vial with an alcohol pad nor the injection site. I asked if there was a protocol for doing insulin administration, and was just told, "Everyone does it different."
I was taught to always use alcohol to wipe the vial and the injection site. Is there something I don't know?
2) I've witnessed OMT's and nurses dropping resident's medications on the floor, and still giving that medication to the patient to take. This totally grosses me out, and is against everything I've learned in school. What gives?
There have been other issues, more personal in nature, such as established nurses bad mouthing me to the DON when I've done nothing wrong. In fact, I was called into the DON's office last week to discuss these non issues. It was embarrassing and upsetting.
So nurses with more experience than I, what's your take on this??
You are 100% right you always use alcohol wipes to clean vial and a new alcohol wipe for the injection site. I don't understand why many people skip it...it takes a second.
I am in the SAME predicament. During orientation the nurse I shadowed, would literally say, "this is not the way you are supposed to do it" "do as i say, not as i do" "if jahco is here be sure to NOT do this"
I was told by another senior nurse, whose been a nurse for thirty years and STILL does everything by the book, to cover my butt and the rest will fall into place. Yes, it may take them 30 minutes to pass meds to 30 pts and it takes me 1 1/2 hours. But, I know my pt's are taken care of and I will never have to doubt the safety of my pt or my license.
You are 100% right you always use alcohol wipes to clean vial and a new alcohol wipe for the injection site. I don't understand why many people skip it...it takes a second.
When I went to nursing school many many years ago I was told to always use alcohol wipes for the injection site. At one of my last jobs I swear I think I was the only one. The only thing I could think of is that perhaps certain hursing programs are now teaching nurses not to use alcohol wipes??? It was mostly young nurses who worked at my old job who never used alcohol wipes. They looked at me as though I was the "weird one" for using alcohol wipes.
Due to there being only so many of a certain med available, yes, you might have to get a pill off the floor and give it to the patient. Ever heard of the
"5 second rule"? If it's been on the floor 5 secs or less, give it. But if you have to call in a pharmacist from home or run down to the pharmacy to get a replacement pill every time you drop 1 on the floor and discard it, you are going to waste a lot of time and raise the eyebrows of the pharmacy staff. If the pill got wet or landed in dog doo, don't give it. If it's dry, not melted, appears clean, you saw where it landed and picked it up, it's ok to give it. Distasteful yes, against our natural instincts yes, but ok.
As far as the alcohol wipe of the vial and the site, I never use alcohol on vials or myself for my own personal shots, but that's at home. At work, I always use alcohol on vials and patients. Always. That said, you run the risk of being resented and worse if you question or critique coworkers, however innocently.
Should you quit now? No, unless things are a lot worse than you've stated.
You are 100% right you always use alcohol wipes to clean vial and a new alcohol wipe for the injection site. I don't understand why many people skip it...it takes a second.
Why do you have to use a new wipe for the site? Did the vial contaminate the wipe? If so, the alcohol isn't worth much, is it?
I agree with previous posters, and would add that not all facilities are like this. Certainly, you may run across individual nurses in any facility who don't follow procedures as you learned them in school, but if nearly every nurse in a facility ignores certain infection control procedures (like using alcohol on vials and patients), then you can assume that management is already aware of the practice and does not care. You reporting to the DON will not do any good.
I've found that the practices and vigilance of staff nurses often reflect the values and supervision of management. If managers really care that you follow infection control procedure and understand why you are doing it, then the nurses will do so, either to avoid punitive action, because ultra-safe nurses might be more attracted to working for ultra-safe managers, or because the ones that didn't follow procedures no longer work there.
That is all to say, that while it is important to be safe yourself and feel comfortable in the level of care you provide, in cases where you are the only one doing so, it can be isolating. I'd consider looking around for other options.
Specializes in Community Health, Med-Surg, Home Health.
I don't think that reporting it to the DON will result in a positive resolution. While nursing school states this is the step to follow, the real world is much crueler. Someone mentioned that you remind them, or even hand them an alcohol wipe. That is better, because you are keeping this between you and that nurse.
In addition (and I hate to say this)...you were already called to the DON's office behind complaints. I am sure that your complaints were valid...it is shocking to see real world nursing versus textbook, but, these nurses probably gathered together, compared notes, and decided to target you.
I also believe it is a reflection of management when too many things are done incorrectly, especially infection control and safety issues. However, my strong suggestion is to watch your personal practice when you care for patients...sometimes, we have to teach by example-like non-verbal communication. People will get to see that you work best when following the books, and as the tech said, they may tease you, but at least it won't be met with hosility. Good luck.
The first thing I do in the morning is get a handful of alcohol wipes, ns flushes, caps for IV (since many patients go for procedures during the day I like to put a clean cap on their IV tubing if the original cap is not available), and 4x4s for needle sticks and d/c ivs. I use these items throughout the day and sometimes have to go and get more. I would never give patients medications that fell on the floor (I don't even wear my hospital shoes in my car or house because I know what I possibly step in throughout the day, so why have someone eat that?). Infection rates are going up for patients and staff in the hospitals, and staff taking shortcuts instead of doing the right thing is partly the cause of that. We are taught what we are taught for a reason, and people should remember that!
Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.
Why do you have to use a new wipe for the site? Did the vial contaminate the wipe? If so, the alcohol isn't worth much, is it?
I don't think the purpose of alcohol wipes is to sterilize but just to "clean" ...If you wiped off the top of a vial of insulin with a alcohol wipe to clean off some dust or dirt, and then used that same wipe on the patient you would transfer the particles to the patient, right? I don't know.... in school I was taught to use two wipes. I still do this. The policy where I work is to clean the surface(s) with alcohol wipes and allow to dry. If the policy was soap and water I'd do that. At work I'll do things per the infection control policies. If it was home care or personal cares I might do things a different way.
Specializes in MCH,NICU,NNsy,Educ,Village Nursing.
Follow what you were taught. Infection control. Following standards of nursing practice---all these will help YOU in case of lawsuit. Know the hospital policies---there should be a book on the unit. Don't have time to look up policies when the task is due and you don't know the policy? Do you have time/resources for a lawsuit? No I'm not being a drama queen here---unfortunately, infection rates soar with poor hygiene, people get sick/sicker, lawsuits ensue, etc., etc.
Dont let these bastards win. I am also a new nurse and I feel that seasoned nurses sometimes want to eat their young and think they have every right to. I would be looking for something else this is leaving a bad taste in your mouth. I would not do as they do and as for being called into the DON office. Do not let that get u down speak with her in a professional manner and she will see that all of the sillyness is from her own people. unless she is as blind as can be. U will see its all a game they play just learn from that and when u become a seasoned nurse remember how it felt when someone treated u badly and help the next new nurse that comes along. Goodluck
When I was a new grad and witnessed a nurse drop meds on the ground only to feed them back to patient, I observed and reminded myself to be very careful when administering medications. When I saw the nurse administer meds via G-tube without checking for residual and checking placement per policy, I reminded myself of the CORRECT ways of doing things. When I witnessed the wound care nurse dressing wounds without using gloves, I reminded myself about universal precautions. When the day came for me to perform my duties as a solo nurse, I administered meds per protocol, dressed wounds using standard precautions, and went home knowing that I followed the agency's policies. You will see alot in "the real world" of nursing, but you have to protect YOUR license. Do what YOU know is right.
It was mostly young nurses who worked at my old job who never used alcohol wipes. They looked at me as though I was the "weird one" for using alcohol wipes.
healthstar, BSN, RN
1 Article; 944 Posts
You are 100% right you always use alcohol wipes to clean vial and a new alcohol wipe for the injection site. I don't understand why many people skip it...it takes a second.