Uncomfortable with practices at new job

Oldmahubbard · Mar 10, 2019

Good Lord. Your story makes me think of multiple famous whistleblower cases.

Not that many years ago, a physician in my state was blinded in an MVA. He continued to operate, and nothing would have ever been done if the nurses didn't complain.

Sassy-RN · Mar 10, 2019

Yikes...

Patient safety is definite # 1.

As the RN circulator its YOUR room. You are the patient advocate. It is up to you to make sure the consents are accurate and complete, timeouts are done properly, be the validator of the counts, and to speak up if there is any contamination or break of sterile technique.

Make sure these things happen I can’t believe anyone would go against Them!

Jory, MSN, APRN, CNM · Mar 11, 2019

14 hours ago, Lostinmyownthoughts said:
Consents- messy and illegible, procedures crossed out, things written in margins, confusing

They need to be careful with these. Procedures can be crossed out, but must be initialed by both the witness and the patient. You cannot write things in the margins. Consents are typically reviewed by the physician team and reviewed by the legal department and risk management. I would ask your manager if there can be a line added to the consents

14 hours ago, Lostinmyownthoughts said:
Timeouts- not taken very seriously, people doing other things and not really listening/participating

Report this to your manager. Where I work there had better be dead silence during a time out. This is how mistakes are made. I first assisted a unilateral oophorectomy on a 27 year old woman and the wrong side was caught during the time out. It was a mistake in the OR paperwork. This would have left her permanently infertile and in surgical menopause...not to mention massive liability.

14 hours ago, Lostinmyownthoughts said:
Counts-staff don’t usually watch the scrub person count items, there are a lot of miscounts,

You only need one witness. If you are participating, take charge, "I need you to watch this and refuse to co-sign anything you didn't witness. If you are circulating, it is your responsibility.

14 hours ago, Lostinmyownthoughts said:
Sterile technique- staff don’t check packages/wrappers to make sure it’s intact and therefore instruments are sterile

Before anyone crucifies me...textbook sterile is very different from probably sterile. This is the reality of an OR that has a short time to turn over a case. When a large number of instruments are being opened it can be impossible to look over for every tiny hole or tear. Unless it's something big..it's probably sterile and will present no harm.

14 hours ago, Lostinmyownthoughts said:
This one might just be me but I absolutely hate when people grab stuff off the back table. Here everyone gowns from the back table and I feel like the chance of contamination is so much higher!

If you are in charge of this...set the gowns out in advance on a separate table. If there isn't one, ask for one. However, we gown from packages set on top of the back table that is covered. Cover is removed just before the procedure or if there is no cover (rare), one of the scrub techs will open the gowns/gloves for you.

14 hours ago, Lostinmyownthoughts said:
Anyways, so I don’t really know what to do. I have only worked at this hospital for a few weeks and being new here is hard enough, I don’t want to make it worse by bringing all of this up with the manager or educator. At the same time, I want to stop feeling so morally distressed. I don’t know if I am overreacting. I keep telling myself to stop comparing the new job to my previous one, but I can’t help it when there are so many unsafe practices. Has anyone had a similar experience? What did you do? Please help.

While I agree that it may be too much to bring up to your manager after being there only a few weeks, but you do have full control over what you actually touch/witness. Set the standard, "This is how I do it".

When I worked in floor nursing, I refused to pull meds for several patients at once. I didn't care how busy I was. Yup, I was ridiculed as a newer nurse, I also didn't get written up as some of them did for mistakes because they gave the patient the wrong med.

guest940422 · Mar 14, 2019

While leading the charge and advocating for evidence based practice sounds like a fabulouse romantic though, its a great way to piss off your coworkers and put a bulls eye on your back. You will get pushed out of there so fast youll wish you had just quit.

1. Lead by example, if they want to ignore patient safety when they are working you cant change them, but you can refuse to do it when you are working. Insist on proper time outs and consents when its your patient, you'll still make enemies but not as quickly

2. Use trigger words, " case delayed due contamination of sterile field" "for patient safety requested MD consent pt prior to procedure" "hostile Negligent..." Some things (if they are in writing) are too big of a liability to ignore for mngt

3. Change can't happen overnight, incremental nudges work better than massive shifts in culture. Try to get a unit quality council started or find another way to empower your team members to be part of the process.

4. Find another job, this isn't a step by step process just a list of ideas. If the culture doesn't look like it can be influenced and the practice is against your ethics than do you really want to work there anyway? Decide if you willing to fight this battle... because its going to be a long time before things are the way they should be.

5. evaluate what is most appropriate for this facility. Not everything can reasonably be changed, concider resources and pt population...

Good luck hope that helps