To tell or not to tell!

[XNavyCorpsman]

I am orientating on an intermediate care unit and can't believe what I am seeing. I have seen blood transfusions started without gloves, meds being pulled and set on top of the cart and left unattended, computer screen left on with patient data clearly visible and left unattended, no gowns being used in patients rooms that are on contact precautions. I can go on and on. I am a strong patient advocate and feel the need to tell someone so that these things do NOT continue. What do I do?

[sissiesmama, ASN, RN]

Pick and choose your battles wisely.

Definetly - I've seen it backfire - someone going in with good intentions and it not go well at all.

Anne, RNC

[cayenne06, MSN, CNM]

I am not a nurse yet, but my instructors have described seeing nurses start urinary catheters without gloves- hello spike in UTIs! That has a bit more potential for harm than a blood transfusion.

OMG. what?!?!?!!

[ShelbyaStar]

OMG. what?!?!?!!

Yeah, no kidding. I think everyone's jaw hit their desk. I can't imagine ever being so rushed or ANYTHING to feel the need to do that. Ew ew ew.

[Gooselady, BSN, RN]

So I could be fired for being a patient advocate? Well I guess this is a small price to pay for looking out for what is best for my patients.

No, it's waaayyyy to high a price to pay.

You are experiencing a kind of culture shock between 'nursing as you expect it to be' and 'nursing as it really is'.

That doesn't excuse people from not following protocols, not at all. They are simply wrong for not wearing PPE, leaving meds unattended, and not signing out of the computer. Period.

But there is a continuum of 'wrong' that goes from stuff like sneaking into a patient's room without sanitizing your hands just to grab your forgotten pen all the way out to the big, scaries like giving the wrong meds. What you are describing are relatively small potatoes, in the great scheme of things.

What can YOU do? Be the person you are, who adheres to all the protocols and policies, be an example. You are unlikely to be well received by ANYONE if you go to them with this list. This is a lesson in 'politics' as much as it is culture shock.

It's not really fair, but if I was your manager, and you came to me with this list, I would (rightly or wrongly) peg you as a kind of troublemaker, a tattle tale-r. No, it's not fair and it's not right, YOU are right, these are definitely wrong things on your list.

We're telling you this to save yourself the hassle of making a bad first impression.

What you listed is unlikely to directly cause patient harm if they are relatively isolated, not a pattern. What you want to pay attention to (and you will) is what DOES directly harm patients, and some of that stuff might surprise you.

You definitely do not want to lose a brand new job 'for the sake of the patients' who aren't being hurt anyway, nor do you want to be branded as making trouble for other nurses.

You need to be paying attention to what YOU are doing. In many ways, you have no business focusing on what other nurses are doing wrong. You can note it, perhaps bring it up with your preceptor, that's fine. But pay attention to your own work or you'll miss something by paying too much attention to what everyone else is doing.

Believe me, this is meant in the kindest possible way. I remember being aghast at the 'doings' of experienced nurses when I was new too. Like I said, culture shock. Keep your eyes on yourself and your work, and unless there are nurses setting fires or hanging their patients from the chandeliers, just focus on you :)

[LittleCandles]

Couldn't you have shut the computer if you saw it up? Could you not have said "oh I'll stay by the cart since the meds are still out?"... How much of a Pt advocate are you when you get all the nurses fired? Nothing is harming the patient.

If you saw a patient being abused. Okay that's another story but you're seeing silly things we all do for short cuts if we know we won't get introuble.

[jadelpn, LPN, EMT-B]

I guess I am a little taken back by these comments. I thought we, as nurses, are patient advocates and look out for what is in the best interest of our patients.

You can only control your own practice. Be sure YOU always handwash, wear gloves, use precautions...all those things that you know you are to do.

If you are feeling as if you would like to advocate, risk management or infection control would most likely be the avenues I would take for what you are describing as infection control and risk issues.

And be mindful that in this day and age of the informed consumer, chances are that the patients are noticing this, and will say something about it. There are more patients than I can count who discuss the lack of infection control on their surveys,

Otherwise, thankfully, you know the right thing to do by your patients. And that is the only thing you can control. If you have a meeting of "how is it going" with the NM, I would point out that there are some processes that are not being followed that are universal precautions, and you are making him/her aware, as it sets up poor practice habits for orienting nurses who don't know better.

It is all fun and games until the unit comes down with c-diff or hepatitis.....

[jadelpn, LPN, EMT-B]

How does not wearing gloves when starting a blood transfusion adversely affect the patient? Just curious....

Basic infection control? Let's mix up a bunch of people's blood on a nurses sometimes cracked and chapped hands, and hope for the best that we all don't spread bacteria? Hepatitis, any other blood borne pathogen, phlebitis at the site......sepsis......I dunno how likely, but it can happen. And it doesn't matter if it is blood, fluids.....I think it not great practice to be mixing an IV site with bare hands.

[XNavyCorpsman]

I was going to go to the Nurse Manager and just tell him/her what I saw, NO names or times. My point in all this is I believe more training is needed and NOT to get someone fired. It could be something as easy as putting a training module for ALL employees to complete.

[XNavyCorpsman]

"Firing" staff is not what I had in mind. I was thinking more on the line of additional training through training modules that each employee would need to complete. This way, no one would know if anyone said anything. They would just think it was another module to complete.

[jadelpn, LPN, EMT-B]

And you may find that it is not the lack of knowledge, it is the lack of time. However, it is gross to think that a nurse takes care of someone with precautions without precautions and then goes about the day taking care of other patients after--scrubs are not germ resistant.

Ugh, and don't get me started on the amount of nurses that came down with the noro-virus due to poor infection control....spreads like wild fire.....

[XNavyCorpsman]

If I say something, but withholding names, the facility may put a training module for the employees to complete to further the nurses educations or at least reenforce the needed training. I would never, or at least have not seen a situation, where I would have to spill the nurses name. I don't see anything wrong with trying to get additional training through the use of training modules.

[XNavyCorpsman]

You addressed what I am sure is going to happen, meeting with the NM and being asked how it is going. That is what I meant about "telling or not telling". Thanks for your comment.