to tell or not to tell?

pricklypear · Oct 4, 2005

Have you talked to your clinical instructor? That, I think, would be the best place to start. Let your instructor take it from there.

MissJoRN, RN · Oct 4, 2005

Coming from an OR nurse... you tell!

Not that any instance makes it OK to use a dropped syringe (esp from an OR floor!) but I really hope it didn't end up on a sterile field!

If those are the things you as an observing student noticed... how many things didn't you have the experience to pick up on? Were sterile packages opened correctly onto the field, passed off correctly, etc? What about the surgeons technique- I know surgeons that would rip them a new one!

There is no room for anything but meticulous sterile technique in the OR and it's every bodies job to keep an eye out. We live by "when in doubt throw it out" and we've ripped down multi-thousand dollar tables on th "suspicion" that there was a break in technique (and believe me... our patients rarely pay for one table set up, let alone two- the hospital eats that cost) My job, as scrub but especially as circulator is to be a pt advocate! Wonder what that RN told you her job was? What's possibly left to do if you aren't going to worry about infection (injury)??

So I'm sure that hospital would be interested in hearing about it! And if they aren't... I suggest your nursing school be interested in finding a safer hospital to observe anyway.

Who do you tell?? Not sure- I'm in a position to directly tell the person I see :nono: Never had an argument, that's just not accepted in our OR, a surgeon will always take the side of the person who saw the break- even if the person in question is a personal "pet" That's his safety record, too. His patient. If there was a problem I guess I'd involve the OR manager. Write an incident report. That gets the attention of the safety officer and risk committee. They definitely need to know. As a student always let your instructor know when you see questionable behavior. At worst she can help you work through the reporting process. At best simply explain why an action might have been OK- say... you saw a nurse touch instruments on a blue draped table with only gloves on because it's a cysto case, a "clean" vs "sterile" procedure

As for the handwashing... that's a whole 'nother topic! It should be done. I've forgotten, too. It's still not acceptable, just like it isn't on a med-surg floor (where I'm sure you've seen the same thing) Thank-the-gods for alcohol gel! If the scrub person didn't scrub between cases (an old fashioed brush scrub or an alcohol gel scrub) that's ultra unacceptable.

Sorry you're in such a rough spot. Sounds like you have a strong conscience... your patients will be glad to have you!

ablynn · Oct 4, 2005

I did speak with my instructor. We talked about the situation. As I stated in the email, for my instructor to tell, that may get us kicked out of the hospital for clinicals.

Thanks.

PS. When we were discussing this, I was told it breaks the hospital's confidentiality, for us to report.

Have you talked to your clinical instructor? That, I think, would be the best place to start. Let your instructor take it from there.

texas_lvn · Oct 5, 2005

If I were a nursing instructor, having my license covering 10 students, and did not feel comfortable enough to contact a represenative (case manager, nursing manager, ect.) I would not want to go back to the clinical setting at that hospital. That is ridiculus. I am sorry that you are in that position. I do not see how that would break confidentiality. What state are you in?

While in our clinicals, I saw many bad things. I know it offends licensed personel when you "correct them", so what I always said was "knowing I am learning, would you please help me to understand why you choose to continue to use that syringe, because I would have thought it would have needed to be properly disposed of. Thanks for helping me out!"

There was an incident where a nurse refused to give a hospice patient an ensure, simply because she was on hospice and "would probley die in a week, so what will an ensure do", my classmate contacted our instructor and immediately had the situation remedied. The pt got her ensure, the nurse was mad for a few weeks, but did get over it eventually.

Yet another incident, at a LTC, I, myself witnessed a nurse(RN) hand a CNA a morphine pill to give to a patient because the nurse had to call her daughter to see howher date went with a new boyfriend. I instructed the CNA to return the pill to the nurse, and called my instructor, who contacted out department chief, and guess what? that RN was escorted off the unit within an hour.

Remember YOU ARE THE PATIENTS ADVOCATE NO MATTER WHAT. If you are intimidated by nurses who have yet to degrade you, how are you going to handle irrate Docs who do not want you to call them when a patient needs, really needs something? I gurantee you, this will happen. Will you be an advocate? or will you sit in your chair, upset because the mean Doc told you off?

I do not mean to sound horrid, just something for you to think about. Texas

barefootlady, ADN, RN · Oct 5, 2005

This is no place to be taking clinicals if standards of care are not observed. If the instructor does not report it to the Dean of Nursing, the HN/OR, and quality assurance, she is not doing her job. You will have to tell what you saw too. I do not envy you or this instructor when this can of worms is opened but the patient deserves better care than you described.

I had a young male patient who ended up with a permanent colostomy d/t improper count, a surgical sponge was left inside of the abdominal cavity. Sure, he got money, but he almost died, other surgeons were reluctant to reveal the truth, and only after a bitter court battle did this young man get any compensation for all of his pain, suffering and permanent injury.

If you speak up things will get better and patients will avoid needless infections.

CrunchRN, ADN, RN · Oct 5, 2005

I think your duty is to report it to your instructor. It is her or his duty to handle it after that. You are a student, and your instructor is the licensed professional. It is wonderful to be an advocate, but your position as a student should be protected by your school. I hope that they do the right thing with the information you have given them.

ablynn · Oct 7, 2005

I appreciate your response. It helps to hear different perspectives. You are right about me/us being the patients advocate.

Now I see how to ask, without (hopefully) not offending anyone.

I now believe my advantage is being a student in the situation, which makes it easier to ask why, without accusing.

Once again, Thanks....

Marie_LPN, RN, LPN, RN · Oct 7, 2005

You most CERTAINLY tell. If people in the OR do not have a sterile conscience, they do NOT belong in the OR.

CrunchRN, ADN, RN · Oct 7, 2005

Marie of course is correct, but my point is that she should tell her instructor, and it is up to her instructor to handle it and deal with the clinical site. It should not be her role as a student to be involved in things once it is in the hands of her instructor and school. Hard enough to be a student without any additional stress.

AlexCCRN · Oct 7, 2005

An anonymous report to the DON and copy the Infection Control Director. It's up to them to initiate an investigation. You've reported to your clinical instructor so, you've likely satisfied your obligation in the eyes of the school. Please don't be intimidated. It's not an adversarial process but, instead, a concern for improvement for the sake of all. You are helping the hospital and if you handle the communication objectively -not emotionally- they will appreciate your intention. All the best.

chris_at_lucas_RN, RN · Oct 7, 2005

I did speak with my instructor. We talked about the situation. As I stated in the email, for my instructor to tell, that may get us kicked out of the hospital for clinicals.
Thanks.
PS. When we were discussing this, I was told it breaks the hospital's confidentiality, for us to report.

A) If the hospital is that lax, you don't want to be doing clinicals there anyway, since you will unknowingly pick up bad habits. B) Hospitals don't have confidentiality, patients do. You need to tell.

If the hospital is part of a large group, such as HCA, there is an ethics line where complaints can be made anonymously. Then there is also the health department.

Since you are a student, you need to cover your own backside. Heroics do not pay off when you are a student.

I had a patient in the bed next to the one I was assigned to, who was dying, moaning in half-conscious agony. I asked several times for the woman to have her pain medicated. My instructor told me it was none of my business, because she wasn't my patient. The poor thing finally passed about 4 hours into our shift.

I'll never forget that woman, and I'll never stop regretting putting my trust in that lousy instructor. BUT, as a student I did all I could do without placing my own nursing career on the line--and trust me, I could easily have been kicked out of the program, not for that officially, but for some other trumped up reason.

This situation of yours is one of ethics. Your heart and knowledge are in the right place. You are learning some important lessons. Speak up--but do so in such a way that you can continue helping through nursing. Your future patients will need you!