To tell or not to tell!

OrganizedChaos, LVN · Mar 23, 2015

1. Do you have a lot of time on your hands to notice what OTHER nurses are doing?

2. You must be perfect & never mess up.

3. It sounds like you hate your job.

Libby1987 · Mar 23, 2015

From inserting caths without gloves to washing hands everytime for a timed two minutes, where does this exist?

brownbook · Mar 23, 2015

AFTER you have worked there a while, gotten off of orientation. Come up with solutions. Deal with one problem at a time.

Go to your manager with solutions......I've noticed sometimes nurses are in such a hurry they leave medications unattended on top of the med cart in the hallway. I thought maybe we could buy some small plastic bins with lids so at least these meds are not left out in the open where anyone (visitors?) passing by could take them.

A few weeks, months later....Several times I have found computers left on with patient data easily accessible to anyone. I researched a computer program what automatically logs you out when there is no activity for 60 seconds.

A few weeks, months later.....I am confused about our isolation policy. Sometimes nurses wear gowns, then the next shift, they are not wearing gowns. I found some printed up isolation precaution signs and bins to hold all the supplies needed I thought we could put in front of the door.

Libby1987 · Mar 23, 2015

You realize these widespread problems (if that's what they are) are a reflection on management, right? And what reporting widespread deficiencies on the manager's unit will imply? What kind of reaction do you think your manager is going to give being slammed by a newbie?

It's either a few random breaks in protocol or a widespread problem, I don't think you reporting to the manager at this point in time will accomplish anything positive towards patient care. I think you should either leave this poorly run facility (you could report to DHS) or wait until you have finished your orientation and are working on your own with a better assessment of the overall situation.

heron, ASN, RN · Mar 23, 2015

@Juliagulia: NO ONE has pooh pooh'd the OP's concerns. What we are trying to do is introduce a sense of proportion. If the OP is "appalled" at the errors s/he described, what's s/he gonna do when s/he sees real malpractice like piggybacking tpn on a transfusion or plugging a tube feed into a central line - rupture an aneurism?

OP, your attention to detail is admirable and the incidents you describe are certainly worthy of attention, but dropping a dime on an anonymous corporate tip line? Really?

Tunnel vision is just as dangerous as carelessness. An awareness of context and how it affects priorities is a necessary component of critical thinking. As my ACLS instructor put it when describing the concept of "fuzzy" logic, "Is this situation more bad than good or more good than bad?"

Leaving my computer without logging off because it's time to clock out is a very different offense from leaving my computer because someone shouted down the hall that my unstable patient just turned blue.

Frankly, without more context it's impossible to even define the problem, let alone figure out how to fix it.

Just an aside: when I start a transfusion the IV is already in place with a saline KVO running before I even get the blood from the blood bank. Starting the transfusion is a matter of a 2-nurse check of pt ID against the blood label, spiking the bag, opening a roller clamp and staying at the bedside for the first 15 minutes to monitor the pt's condition and VS. None of that requires gloving up.

LobotRN, BSN, RN · Mar 23, 2015

Just because they do it doesn't mean you must perform the same way. Enough of "hey, not everyone is suiting up to come in here? Why is that?" from a patient and your response is, "on contact isolation the policy is that staff must suit up." And then the pt pushes the issue, offer to have the unit manager or supervisor visit them. You are practicing safely and the situation will eventually be made known to the leaders. And you didn't pick a battle or die on a sword. That's how I have handled it, and it worked. We are not perfect by any means on my floor, but our PPE costs have increased

Mr. Murse · Mar 23, 2015

Please don't be one of THOSE nurses (see the long thread about "snitches" a while back). If you see something you really believe is putting the patient at risk (I don't just mean bending the rules, I mean literally putting a patient at risk), then say something to the offender first. Chances are management is aware of most of what you listed because frankly (as some people have said) it happens at every facility.

By going straight to management over much of what is petty stuff you will not be doing yourself or your patients or anyone else a favor.

I know I know, you're thinking, "petty stuff?!? what kind of rule breaking terrible nurse are you?", but let's go through the list of awful offenses you mentioned and see if there is any situation where bending those rules really might not be putting anyone at risk, or why those nurses might have been bending them.

1) blood transfusions started without gloves......okay......so I can't think of scenario that could be justified, but instead of going behind nurse x's back and telling management, why don't you bring it up in a non confrontational way? like when you leave the room say, "hey, I'm just wondering, are we not supposed to where gloves anytime we're starting blood?" or whatever. There are ways to bring it to your coworker's attention without throwing them under the bus. Unless you've seen that particular nurse do it multiple times, you may have caught them having one of those "slipped the mind" moments when you're really busy and she just grabbed the blood without thinking about it. Maybe she is in the habit of wearing gloves but just forgot for some reason that particular time, and now you've gone and whined to management about it and made yourself out to be one of those sneaky nurses to work with who goes behind your back instead of coming to you with issues.

2) meds left unattended.........honestly, unless they're narcotics this is no big deal. get over it. the time will come that you will need to put your meds down for a second and go stop Mr. Dementia from jumping out of bed (or whatever). Sure, policy says not to leave them unattended, but I'd rather risk my metoprolol being stolen (highly unlikely) than see Mr. Dementia crack his skull wide open. If they're narcotics, then again, bring it to the attention of the nurse before going to management. Just hand it to them and say, "hey, you left this dilaudid over here."

3) computers left with info on them..........jees, then just shut them down. log off. minimize it. whatever it is you do when you walk off from yours. no big deal. Then tell them, "hey you left your screen up so I shut it down." Is this really worth taking to management? They have more important things to do.

4) no gowns in contact rooms.......what were they doing in the room? I go in my contact rooms occasionally to silence an IV pump so I can go get a bag, or to simply hand a patient a pill (with gloves for both, of course). Technically yes, every time you go into the room you're supposed to wear a gown, but would you really go tell on me if you saw me walk in a room with gloves, hit silence on a pump and then walk back out? now if you see a nurse regularly going into contact rooms and handling the patient without gloves or gowns, then it's a problem, yes, but is it worth just going straight to management or is there some way you could bring it up to the nurse without management involvement?

Here's the thing, rules are in place for good reasons, but it is important to keep focus on the reason for the rules and not the rules themselves. If you want to be a stickler for each and every specific, then go for it, but unless the patient is literally being put at risk then don't get upset about it. I repeat, IF THE PATIENT IS TRULY AT RISK, then you have reason to be concerned, but bending a rule doesn't necessarily put anyone at risk. It's their license and their job. If it really is bugging you, then at the very least have a spine and try to address it with the offender first before taking it to management.

If you feel like you're too new to approach the older nurses for this reason......then maybe you're also too new to really understand the big picture in the first place and you need to just watch and learn a little longer.

jj224 · Mar 23, 2015

OK. Aside from incorrectly nitpicking your grammar, I agree with a lot that's said above. Leave if you feel its not a good fit for you. If its this widespread of a problem there's no way you're going to change it. Find another job and you'll find poor practices there too. Maybe not as widespread, but it'll happen wherever you go. Lead by example.

Mr. Murse · Mar 23, 2015

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.

I guarantee you that lack of proper training is NOT the source of any of the problems you mentioned and training module will do nothing to correct it.

Are you a brand new nurse? or just new to the facility?

BrandonLPN, LPN · Mar 23, 2015

"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.

If you're going to your manager with a litany of violations you see on the floor, word will get out it was you. Even if you do not mention any names.

And having to do an umpteenth inservice on HIPAA will not stop people from failing to log out of charts. If the manager is concerned about these things, he will crack down if he so wants. The fact that some nurses aren't logging out all the way, or that some nurses leave pills on the med cart will not come as any great revelation to your manager.

TheNGTKingRN · Mar 23, 2015

I want to see the OPs opinion when he/she has been set loose from orientation for the first month with a full load of patients.

Sometimes things come up, bathroom emergencies, symptomatic emergencies, and so forth. I don't have the time to return meds to a pyxis in these instances. I just don't, and I'm not going to take 5 minutes to return the meds while patient xyz is lying on the floor etc.

Same thing with the screens. I'm at the nurses station charting and something emergent comes up, while it takes 5 seconds to log out ... sometimes it doesn't happen because we're human and our minds focus on the emergency. Sometimes nurses will just forget to log out because of whatever reason. These things DO happen and this is the real world of nursing.

I honestly think that the issue is NOT lack of knowledge, rather lack of time and resources.

I believe that going to the NM will place a target on your back. Word gets around. Keep those lips zipped if you want your daily allowance of food in your belly and a roof over your head.

You should ALWAYS approach your coworkers first.

Your coworkers can save you, lift you up, and keep you from sinking and trust me ... you will begin to sink at times and they will be there ... but not if you're the perfect nurse that likes to tattle tale.

And if you decide to be the tattle tale you better watch your back because your mistakes will surely be not forgiven, rather amplified and most definitely brought to the attention of management.

Be wise and cautious.

Dr.Naija_Glam · Mar 23, 2015

Snitches get stitches....

Things are getting real up in this thread lol! Seriously though OP, I would let this go at least for now. Since you are in orientation you are new to the unit, and reporting every little thing you see your coworkers do wrong won't put you in a good light. As long as the patient's aren't in danger, you will just seem petty. Yes, a lot of the things you posted about will make you look petty if you report it. Just don't pick up your coworkers bad habits.