Things I noticed as a patient...

[theantichick]

I just got home from an overnight stay at a prominent facility in my area. I had a cardiac ablation procedure, and because they didn't have a Tele bed available, I got to spend 24 hrs in the CCU.

Overall, my experience was a good one, but I kept noticing things that I probably wouldn't have noticed before I became a nursing student. And I have to wonder why some of them are allowed since they're obviously against the hospital's policies, and if some of them are as big a deal as they seemed to be to me.

1. At least 3 different people who stuck me for bloodwork did the following actions in this order: Put the tourniquet on, felt for a vein, swabbed the area with alcohol, put on their gloves, RE-FELT THE AREA OF THE VEIN WITH THE GLOVED FINGER, and then stuck the needle in. Part of me thinks this isn't as bad as it seems to be, and part of me is squicked by it.

2. Four of the six nurses and two of the techs I encountered from pre-op through CCU (though not anyone in the cath lab) had on multiple rings with gemstone settings.

3. Two of the six nurses and three of the techs I encountered (again not in the cath lab) had LONG fake nails on, and one of them had badly chipped fake nails.

4. I developed phlebitis from the IV, not too horribly, but I had a marked reddened, hot, and hard area extending about 2 inches up from the catheter site and out about 1/4 inch on either side. When I showed it to my nurse she didn't even palpate it, and said my skin was just so fair that everything shows up on it, and not to worry. I didn't make a fuss since I was at that time waiting for my doc to come and release me, but I would have thought she'd have at least examined it and personally I think it should have been d/c'd immediately.

I know that things aren't always "best practice" like they teach us in school, but aren't some of these pretty blatant violations of infection control procedures?

And given some of these issues, should I contact the hospital administration with any of my observations? I don't want to score them badly on the surveys because I know hospitals are going to be living and dying on those scores.

[theantichick]

I'm sorry some of you seem to think I'm on some sort of witch hunt or have some nefarious purpose in posting this.

I tend to be more than just a bit of a germaphobe. I realize that I'm more sensitive about some of this stuff than most people are, which is why I wanted to get some feedback from experienced nurses about the things I saw and whether it warrants any kind of feedback to the administration. Kind of get a reality check.

I also recognize that I have a vibrant, robust immune system, and nothing that happened to me there is likely to cause me any problems to speak of. Which is why I didn't say anything at the time, and have not said anything to administration without getting that reality check. So as far as advocating for myself, I don't think I was at any risk to speak of.

Frankly, it's more that I was just surprised by some of it, (the long, chipped fake nails, mainly) especially on *nurses*. All of the hospitals I've done clinicals at, I've never seen a nurse with extensions. Lots of techs with extensions, but no nurses. And I know for a fact that this hospital system has policies against fake nails. For this to be happening in *CCU* just surprised me more than anything. And they make such a big deal about phlebitis in school, I expected the nurse to at least assess it and she didn't even look at it. It didn't occur to me to point it out to the doc who discharged me.

As far as contacting someone in administration, I mainly was asking because if I were the infection control nurse, I'd want this kind of information. But if I were an infection control nurse, I'd use this information as an indicator that this particular unit warranted some inspections and closer oversight, *not* to pull the chart and reprimand everyone who touched me. And I'm more than slightly concerned that the latter is exactly what would happen. These were all good, competent caregivers who gave me excellent care, and may just need some education and reinforcement about procedures and policies - I don't want them getting reprimanded for this. Also, I have concerns about contacting administration because this was so wide-spread throughout my stay that I can't believe the managers and infection control aren't aware of it. Which means that THEY have not gotten serious about enforcing the policies.

I don't intend to ding them on the survey because I know that the surveys are going to be used against hospitals instead of informing them and providing an avenue for needed changes.

Also as a side-note - I find it amazing (not that I don't believe the poster who said it, I just am amazed) that rings with gemstone settings aren't as much of a reservoir for germs as fake nails. We cultured gemstone rings in micro, and they grew all sorts of colorful stuff, much like the nailbeds.

Oh, and as for the "re-feel" with the glove... I know that it's sometimes necessary to re-feel the stick site. I've seen this handled many different ways before such as swabbing down the gloved finger before "re-feeling", or by feeling above the actual point where the stick is happening. I just don't think it's good practice to be feeling all over the area you just cleaned and are about to stick with a non-sterile glove, and I saw it *a bunch* which makes me wonder if anyone watches the tech's techniques after they're trained.

Thanks for all the constructive feedback.

[Lynx25, LPN]

Why do people not bring up their concerns at the time that they become concerned?

Why wait until a survey is passed around? What good does that do?

[Ruby Vee, BSN]

oh honey,

i know my post sounds nasty, and yes i have been in your shoes as a student getting health care, so i really can recall my own misgivings.

be well aware, you will be held to the same standards you are expecting others to uphold, and contacting administration to these concerns to a hospital you may very well wish to work at in the future... welll.....

i'm sorry, but in my humble opinion and many experienced nurses may disagree... you are trying to use the bit of knowledge you have to find fault, when there are so many other things that went right that you couldn't see through. when we are in school we are critical and astute to find errors, and that is great. you will look back at this post in 5 years and laugh. that i promise you.

personally, i would not contact anyone, aside from thanking them for the good care you received. cookies are a nice touch too

i'm well known as a crusty old bat, but i didn't think your post was nasty. the op was clearly using her little bit of knowledge to look for something to complain about -- and i'm wondering if it made her feel superior somehow. maybe it helped alleviate some of her fears about being a patient. if that's so, i hope it stops there rather than gets "reported" somehow. the op may want to work in that hospital in the future.

it's telling the the only significant complaint was the last one . . . .

[duckyluck111]

Fake nails are just ick, in or out of the hospital. I think they scream "bad judgement". The wearer is exposing themselves to fungus and infections (which they could transfer to an immune compromised patient) as well as carcinogenic chemicals used in the solvents and adhesives. Plus, I'm sorry, they just look really tacky and cost a fortune.

I remember watching one of those "Life in the ER" shows and there was an ED resident who had ridiculously long fake nails. I was already thinking to myself that I wouldn't want her treating me when she proceeded to elevate the head of the bed of a possible spinal fracture patient, which elicited screams from the patient, at which point she lowered it again. I guess this is where my "fake nails = bad judgement" bias comes from.

[FORTHELOVEOF!!!!]

I know that extentions are bad and nasty, what are your feelings about just an overlay, just acrylic over your own short nails? Is this still just as bad? I have a horrible time with thin and brittle nails especially with all the alcohol we use so I like to have a little acrylic on my nails to keep my own nails from chipping and breaking. Most people at my hospital don't bother me about it because I'm a nurse intern but I just wonder if I can keep my nails this way after graduation.

[merlee]

In two past hospitalizations I have contacted hospital admins and/or infection control about certain things.

I had a cardiac cath, and docs would take their stethoscope to listen to the fem artery - you know, the one in your groin - and then toss that scope around their neck again! YUUUCCCCKK!!! I pointed it out to one doc - my sweaty groin, your lab coat, and when will you clean that scope?? And change your coat?? An alcohol pad just to wipe the diaphragm is not sufficient.

Also - - the phone handset falls on the floor, and someone just picks it up and puts it back on the bed....we've done that for years but now it seems sooooo gross! Somehow we have all survived.

In 4 hospitalizations in 3 years I have yet to receive a survey of any kind.

But better you should voice your concerns to the appropriate people in management then on a survey.

BTW - - I noticed posters in the hospital reminding everyone to clean their stethoscopes every time they are used!

[wooh, BSN, RN]

I know that extentions are bad and nasty, what are your feelings about just an overlay, just acrylic over your own short nails? Is this still just as bad? I have a horrible time with thin and brittle nails especially with all the alcohol we use so I like to have a little acrylic on my nails to keep my own nails from chipping and breaking. Most people at my hospital don't bother me about it because I'm a nurse intern but I just wonder if I can keep my nails this way after graduation.

Germs grow IN the acrylic. It has nothing to do with length or washing your hands. It's IN the acrylic. So if you use anything with acrylic, it's disgusting.

[FORTHELOVEOF!!!!]

Thanks for response, I will take them off

[sauconyrunner]

OP, you are correct about rings with Gem stones. They do harbor a ton of bacteria. And most places actually do have somewhere in the policy that you can only wear certain types of rings. Some will allow one stone, others only a wedding band, plain. But regardless of the policy any Gem stones that are worn day in and day out by a nurse are usually contaminated with lots of stuff. It is a VERY hard policy to enforce.

Most of the stuff you mentioned in your post has the potential to cause harm. A lot of people will think it's ok to do something because they never see the consequences. Most things are not directly traceable to one person.

I have occasionally followed up with people who consistently contaminate Blood cultures. The person is amazed to find out that all those contaminated cultures cost patients an extra 2-5 days in the hospital and loads of antibiotics they never needed. They are usually in denial that their practice was what caused the contaminant. And they are usually really unhappy to find out it was really them that "caused it". No one working in health care (In the broadest general terms) wants to harm patients.

But for the most part, we all think we didn't do it, it must have been: night shift, day shift, the other nurse, that traveler nurse, respiratory, the aide that helped me one day, etc etc etc. So it is hard to get anyone to change practice, especially when we all think it is someone else's practice that is the one causing the issue....

[tewdles, RN]

I am a firm believer in addressing infection control issues IN THE MOMENT when in the hospital as a patient or visitor.

For instance, when my dh was hospitalized I made the unit aware immediately that the soap dispenser in his room did not work. I would not let ANYONE touch him without washing their hands in our presence...that included the surgeons in that teaching university hospital. I complained loudly to the unit management when a nurse dropped a package of 4x4s on the floor and picked them back up with her gloved hand and then opened them onto her clean field. I refused to let a resident continue with his dressing change when he whipped out a pair of scissors from his pocket to cut the gauze packing for my dh's open abdominal wound.

The infection control practices of the staff, in general, were sub-standard in my opinion and I addressed each and every one.

I also brought them pizza and cookies (each shift) when he was well enough to go home with a card expressing our appreciation for their care and concern. Most of them thought I was a PITA...ah well.

[PetsToPeople]

There is so much wrong with this I couldn't pass on it...!

1. Yes, this was a violation of proper technique. But when you learn how to do venipunctures, you'll learn that it's sometimes necessary to feel for the vein immediately before sticking. Many patient's have veins that move and roll, and if you just stick for the spot you felt the vein a few seconds ago, you might end up having to do multiple venipuntures. Ask your patients what they prefer: 1. several needle sticks, or 2. for a clean, gloved hand to touch their skin before they are stuck. Also realize that the chance of infection from a clean, gloved hand touching your skin and then a venipuncture being performed is extremely, extremely small.

How about one stick, done correctly w/o lame excuses, using a technique such as one of the other posters mentioned?

2. Most units don't have a policy against wearing rings and there is no evidence that they spread infection in non-sterile environments.

Of course they are sources of infection (ever heard the term "fomite" lol). People can not even be trusted to wash their hands correctly, so I have no doubt that those people who do not wash their hands correctly and have several rings are walking petri dishes.

3. There was probably a policy about no fake nails/no chipped nails in patient care areas. Yeah, long fake nails kind of gross me out too. But consider that, as long as the nurse is washing their hands appropriately or wearing gloves during patient contact, you're probably protected. Still, if you find it warranted, you could send a letter to the department head and explain about this violation of policy.

Uh, same as above concerning the rings...when you wash your hands correctly you have to pay attention to getting under your nails using the little stick...which I am guessing really no one does outside of a surgical suite, so unless they do like me and use one of my nails to clean under my other nails while I wash my hands, then they are leaving potential pathogens under their nails even after having washed their hands.

4. If there was anything infusing into the IV, then yes, the infusion should have been stopped immediately and the IV shouldn't be used. But if it was a saline lock with no infusions and I knew the patient was going to be discharged and I'd have to take out the IV anyway, I would be okay with leaving the IV in for a short period of time until I got the DC order. Like a PP said, some floors have a really strict IV policy- where a patient must have an IV while they are admitted. So removing that IV might have meant the nurse needed to put another one in. Which if you were going home anyway, would have been a waste or time, supplies, and one of your veins.

This is true, but perhaps a better response from the nurse stating her rationales would have reassured the pt that the nurse wasn't just blowing her off or worse, had no idea of the importance of the situation.

You'll soon realize that the way you are taught in school is not at all like the real world.

I hate hearing this phrase almost as much as I hate hearing "it is what it is"! Yeah, the difference is that the lazy people in school can't get away with being lazy because the instructors are up their behinds, but once they are free to run wild in the hospital, laziness and improper short cuts become the lazy persons "real world". I wouldn't make a habit of pointing out these discrepancies to the nurses you meet during your clinical experience. Just notice them and ask yourself if there is really a potential for harm here. If there is, then report it to your instructor. But if it won't cause harm and is just a difference in practice, make the decision to perform the task "by the book" when you're in practice. But be prepared for a little bit of a rude awakening once you actually enter practice.

Don't bother trying to point out the way things should be done, this will get you no where quick. Lead by example or join up with the infection control people.

[wooh, BSN, RN]

Yeah, the difference is that the lazy people in school can't get away with being lazy because the instructors are up their behinds, but once they are free to run wild in the hospital, laziness and improper short cuts become the lazy persons "real world".

It's interesting how much you know about the real world when you're still in nursing school yourself.