to tell or not to tell?

tlhubbard · Nov 7, 2005

I agree that we are not "under" the license of our instructors when we are nursing students. However, you are still their responsibility. They can't have students who are unprepared out there trying to care for patients. So that still would fall in the instructors lap.

Also we had very strict guidelines as to what we were able to do/or not. Of course, everyone was assigned a "mentor" in their area for clinicals. So you shadowed or did what was delegated to you by your mentor. If you had a good mentor who enjoyed teaching, they would allow you to do things with their guidance. Those kind of mentors are amazing, few, but amazing.

I know as a student nurse I could do more than I could at the hospital. I was hired as an RN (waiting for my board results), I did little but shadow until my license came through. Very frustrating. I wanted to jump right in.

I posted to this thread before. I also was thinking, if a "lay person" or a nurse from another facility was to witness such a thing, they would tell. You only have an obligation to the patient, not the the institution. Your instructor should realize that if we live in fear of advocating for our patients (as a student or a licensed nurse) that we are giving up a BIG piece of our role as a nurse. Also you are saving the facility a lot of grief, if they address this, they can avoid a lot of problems that may develop from this lack of proper procedure.

Good luck in school.

NAR NOBLE · Nov 18, 2005

Well, i will be frankly honest with you...and perhaps my honesty will be to much to a degree...if it effects your patients health you must...loyality and

being loyal to a hospital that doesn't except the fact that patients have rights and responsibilitys while in the hospital for the time they are being treated in my opinion...cannot be operational...for we count on them in life and death circumstances...oh though sadly i must admit...some hospitals and nursing homes...are like this...

I have seen this happen during my clinicals and if the state is doing a good job checking out some of the hospitals that do not care for their patients in a way of professionalism then this problem would not exist. I suppose there could other factors not considered by you or i that we may know of...

ray2512 · Nov 18, 2005

I would say something directly to the offender. You have every right to.

nurse4theplanet, RN · Nov 18, 2005

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?

wrong. you CAN complain because the nurses that were involved in this type of behavoir should be evaluated and possibly terminated. No backlash would come to your school because it is the hospital's job to maintain competent personnel...it would cost them alot more should they be sued for several incidences of iatrogenic infections. Many things in nursing school are taught "in theory" but seem to be unpractical in real world nursing...Aseptic technique is NOT one of them.

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

Yes. You are an advocate for the pt once you are a nurse. So this is part of your training...you see unsafe practices and you must take action. Do NOT turn your head the other way. This is probably scary/intimidating to you as a nursing student. Start with talking to your instructor.

NAR NOBLE · Nov 18, 2005

Would u rather have a caring nurse or a caring nursing assistant...that helped you out...be the kind of nurse or nursing assistant you'd want to other people that need that type of care...you are there also to protect the patients and yes if nessecary " advocate" for them...

You are the one they turn to for their care!:)

WAZZA · Nov 18, 2005

Of course you should tell but try to ascertain if the hospital has a protocol for continuous improvements and I suggest, if they do, you complete a continuous improvement form and send it into the quality department. Most places I know will be happy to follow up your concerns without you having to divulge your name or identity.

epiphany · Nov 18, 2005

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

There is no such a thing as hospital's confidentiality, only patient's confidentiality. That word, connected to HIPAA, has been corrupted by people. The hospital has no more confidentiality than a corrupt wall street firm has confidentiality about their internal business.

hldmyhnd2 · Nov 23, 2005

I as a liscensed nurse for many years reported some serious problems in our operating room and the new directors harrassed me until i resigned. Last was I would not take a patient to the OR until the surgeon told her she was pregnant. I was written up for insubordination. I told the surgeon he could not use epi because it would restrict blood flow to the placenta I was written up for giving medical advice. Whistle blowing in this field should be done with great caution. I don't know what the answer is. I personally would do the same thing over again because I am a patient advocate and my liscense can be suspended for not being a patient advocate. Unfortunatley it has caused me a great deal of hardship. With the power these big hospital corporations have no one will speak up including ANA. As a member I could not even get them to return my phone call.

mayzeegrl · Nov 23, 2005

I guess you just have to pick your battles. It would not break the hospital's confidentiality if you reported abuse or neglect going on with a patient. You are a mandated reporter. As far as other nurse's techniques you may find more and more of this going on when you become a nurse. There are alot of things in this world that aren't right, but just do the best that you can do and report "the major" things when you get out there. Best of luck..

bloviate · Nov 23, 2005

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

That must have been a heady feeling. A lowly student getting an RN "escorted" off the unit and property. Showed her didn't we! Wow, am I impressed!

To the orginal poster. Probably a good idea not to raise a stink. If you think sterile technique is that degraded in the OR call the state and make an anonymous complaint. They'll respond and certainly risk management and management of the hospital will respond to the state's inquiry.

I can appreciate the tough situation that your school and instructors are in regarding not making waves at a clinical site.

chris_at_lucas_RN, RN · Nov 23, 2005

I don't know what the answer is. I personally would do the same thing over again because I am a patient advocate and my liscense can be suspended for not being a patient advocate.

Sure you do! The answer is you protect your patient at any cost. And you did. Letting the state health department or the board of nursing know about your observations might also be a thought.

None of this is without personal risk.

When I was at my present job about a month, I got a call from the CEO about halfway through 2nd shift, demanding that I give him personal info about a adolescent girl admitted to my unit. (I work in a psych hospital.) I refused, citing the "need to know" rule and HIPPA, as well as the girl's privacy. He became irate (he says "I can walk onto any unit and read any chart," "the safety of every patient is my responsibility," and "do you know who I am??" :rolleyes: ) and I soon feared for my job.

I finally said, OK, I'll tell you but first I have to say something. My clear understanding of my responsibility is that it is to my patient. I'll give you what you want, but it is under duress and against my better judgment. Then I began to tell him what he wanted, and he actually stopped me before I got to anything particularly "juicy."

My charge nurse said he was prone to doing such things, and often "tested" staff that way. She also informed the sup about the incident.

I went home, I told my husband what happened, and we decided that to protect myself, I needed to call the company's ethics hotline, which I did the next morning. (He could easily have said I violated HIPPA and then fired me, or he would have had something on me the next time some sitaution arose, and I could have been reported for the ethics violation at that time!)

They took my report, were very reassuring, said I had done the right thing, that he was in error, blah, blah, blah. I was sure the next day I would lose my job, or that no one would speak to me. But I didn't, and they did. I told my manager, and she agreed I had done the right thing. She agrees that the man has an obvious narcissistic personality disorder. Coworkers later clapped me on the back. Complete strangers sought me out to ask if I had really done that, and congratulated me. Mention was made of "cajones" (DH assures me he hasn't found any! :rotfl: ) (Can you tell this whoosis isn't liked?)

The next thing I know, the manager has done a 180, and she and I have to have a face to face with the CEO. He's telling me more details than I ever wanted to know or suspected :imbar , about his relationship ("but it's not a relationship") with this girl's mother. (That made his phone call make a little more sense....) Then he says that he actually wrote me a complimentary note for a little commendation because I had done such a good job protecting my patient, but he had torn it up because I had called the ethics line and so he "didn't know how would take it." We parted on good terms--I still don't have that commendation so I know he never wrote the thing up and couldn't care less!

I got a follow up call from the ethics line letting me know that it was pretty clear to them that I had blown things out of proportion, that the call had occurred, but he hadn't asked for any personal details (conditions of her admission? that's not personal?), and they hadn't found that he violated any ethical standards. (Intimidating a nurse? HIPPA? Hello? Anybody home?)

I've never seen him since--although he rarely comes on any unit, even when it is announced he is coming, for some reason he doesn't seem to show up on the one where I am working. :rotfl:

I don't know if there has been more fallout and I just don't know about it. But I'm still very proud of the deed I did--it surprised me! I didn't know I was that fierce.

And so were you. And so were all of us who saw something not good for our patient and did or said something about it.

pinefarmgirl · Dec 3, 2005

As a SN I spent alot of time in the OR, and only once did I see something questionable. It was a busy day for the surgeon, who in this small hospital also did a heavy schedule of endos between scheduled surgeries. It is rare to have an emergency or unscheduled surgery there, those are usually shipped out. This patient had what appeared to be appendicitis, but was a minor, and the mother could not make up her mind to consent to the surgery. So while she put it off, the surgeon went down the hall to do his endo's. Finally the mother decided to consent, and the surgery was quickly set up. We were all in the OR with patient anesthetised and draped, and finally the surgeon arrives from endo. He hits the alcohol hand sanitizer one time, rubs it on his hands, and gloves up and starts surgery. I was really shocked, especially thinking about the endos and colonoscopies he had just come from, adding to the risk of bringing infection in. He had not changed scrubs since he had come in that morning, either. Very gross.

I was still real new as a student, so I had no idea if I should do anything. I told my instructor afterwards, but she never did anything with the info.

I know that this was unusual for this surgeon, who I have observed many times, and every other time has done a full OR scrub. It's kinda funny to see that even the big time surgeon can get flustered when his schedule gets messed with. All I know is that it only takes one small thing to open the door to killer infections, and this was no small thing. He probably had various particles of fecal matter all over, just because it's not a visible smear doesn't mean it's not there.

My husband had surgery at a big hospital a while back, and the next day they took him to cat scan. when I asked his nurse why, she said the sponge count was off at the end of surgery, and they wanted to see if they could spot any leftovers in him! She told me it happened all the time, nothing to worry about.

To me, these are both examples of what hurrying can do to the OR. First case hurrying because of a tight schedule, second they hurry because admin wants as many surgeries ($$$$$$) as possible packed in to each day.

If the facility is allowing other things like money to be the priority over patient care, we see more and more of this. These days, the bottom line is top priority at all hospitals, and it takes a rare and talented group of administrators to keep patient care the top priority it should be.

Thanks for letting me rant!:typing :twocents: