Today at work I noticed that it looked like a nurse didn't use alcohol pads when doing accu checks, but I just thought maybe I seen wrong, so I didn't say nothing, but later on this same nurse went to give a patient a shot, once again no alcohol pads again, but the needle was already bent, of course I said something to her about it and she just tried to act like she didn't hear me and hurried up and jabed the bent needle in the patient causing the patient to scream and cry. When she pulled to needle out it was bent way more then it was when it went it, I once again said something to her, her responce to me was' I'm the nurse, your the aid, mind your own business'. Of course I don't want any problems at work, but it isn't fair to the patient, any suggestions on what I might be able to do?
Our facility policy is to clean off the finger with alcohol, wipe it off with a 2 x 2 gauze, then stick.
And i'd report the nurse for her remark. That was extremely rude, not to mention very unfair to the pt. involved. The nurse was snippy because she was caught and didn't like it.
At my hospital, the protocol is to clean with an alcohol pad then wipe dry with a small piece of gauze or let it air dry before you stick with the lancet.
Yup, we've had the same problem!! I can't remember if the needles are B-D or some other brand. I used to bend needles a lot more often, I've slowed down when capping it now, just to avoid the aggravation of drawing up again!!
I used to teach for BD. From what I have observed--and I have observed it many, MANY times--the problem is not in the PRODUCT, but in the way the nurse OPENS the product. Hear me out here, and see if you can examine your own practices, to determine if you are guilty of doing what I saw nurses doing, over and over and over, at facility after facility---
Any syringe made by BD, but particularly the TB and insulin ones that have permanently attached tiny 27 or even 30 g needles, needs to be opened PROPERLY--by peeling the peelpack OFF the syringe, using both thumbs and both index fingers in opposing directions.
Instead, what nurses tend to do---saying that they are in a hurry--is to POKE THE SYRINGE THROUGH either the plastic or paper part of the peel pack, self-capping needle first. Not only does this have the potential to bend or cause burrs on the needle, it can cause microfragments of paper or plastic to adhere to the now bent or burred needle-and those tiny fragments are carried into the patient's skin and subcutaneous tissue when you give an injection.
Most needles, to comply with OSHA and federal law, are safety needles--that is, they are self-capping, often via a slide up mechanism that you activate with your thumbnail. You can see how in the package, since they no longer have the old fashioned solid cylindrical plastic "cap" over them, they could be easily damaged by poking them through paper or plastic.
If your facility is STILL using old fashioned non-safety TB and insulin syringes--the type that would require MANUAL capping, (That is; if you were ALLOWED to recap---You WOULDN'T ever recap, would you? :uhoh21: Just checking....)--then they are at risk of being fined and even shut down by OSHA.
That is NOT to say that the single NON-safety needles--i.e., 18 g for drawing up meds--are not allowed in a facility, as long as you are only using that needle on a vial to draw up meds, or to inject those meds into an IV bag. if you use them for THIS puropose and this purpose only--no patient contact--you are allowed to recap. But, they are NOT to be used to give a patient an injection and thus expose yourself to blood and a potential needlestick--for those, you MUST use safety needles.
Again, the self-capping 27 or 30 G safety needles (particularly the ones pre-attached to TB and insulin syringes) are VERY delicate, but, if opened properly, will not bend or burr. Trust me--try it in your own practice. It WILL make a difference if you take the extra second to PEEL the wrapping off-NOT poke the syringe, needle first, THROUGH the wrapper.
Alcohol pad are correct procedure for taking accuchecks. The important part is how you use them so that they do the job of cleaning the area properly, but yet do not interfere with the accuracy of the blood sample. The correct procedure is to allow the alcohol to dry, or to wipe it with a gauze pad or cotton. Because you are breaking the body's first line of defense, you need to use the alcohol pads to protect the patient.
Last time I checked, alcohol pads should not be used prior to accuchecks due to an alteration in the Blood Glucose levels (due to mixing with alcohol from the pad)...we don't even stock alcohol pads anywhere near accucheck machines
This nurse is putting patients at risk. If I were in your place, I would keep a very accurate log with complete descriptions of incidents similar to these. Yes, you want to be respectful when you ask about procedures, but protecting the ego of this nurse is NOT YOUR FIRST PRIORITY!!! You have a moral obligation to present your findings to the proper authorities in your facility. Of course, the more detailed your documentation is the better. Also, remember that what you are revealing in the documentation is a pattern of negligence. It is important to establish a pattern. Unfortunately, this may mean that you gather information over a period of time during which patients will suffer. If this nurse is as callous and as willfully incompetent and I percieve her to be from your description, she will continue this pattern until someone stops her from hurting patients. However, give this nurse an opportunity to instruct you about what she is doing. You can do this without seeming as though you are questioning her, but, again, this is not your first priority. If your observations are well documented, they cannot take action against you without really causing a problem for themselves. If the people at your facility that should be concerned about this are not concerned, you might want to speak to someone higher up. It might be very risky to speak with this nurse's immediate supervisor because the supervising nurse may be too close to the situation or the nurse. But you may find that her supervisor is in the dark and would be outraged to know that this nurse is behaving this way.
Today at work I noticed that it looked like a nurse didn't use alcohol pads when doing accu checks, but I just thought maybe I seen wrong, so I didn't say nothing, but later on this same nurse went to give a patient a shot, once again no alcohol pads again, but the needle was already bent, of course I said something to her about it and she just tried to act like she didn't hear me and hurried up and jabed the bent needle in the patient causing the patient to scream and cry. When she pulled to needle out it was bent way more then it was when it went it, I once again said something to her, her responce to me was' I'm the nurse, your the aid, mind your own business'. Of course I don't want any problems at work, but it isn't fair to the patient, any suggestions on what I might be able to do?
Of course, we have only heard "lil miss attitude's" side of the story. We haven't heard the nurse's side. With that said and since she's the nurse and has the training, I think we should give her the benefit of the doubt....until we hear her side, which is doubful in this forum. {Personally, I use alcohol pads....I wipe tip of finger, and let it airdry, then stick. And no, I would never use a bent needle, but some needles come out looking like they might be a little "out of alignment" with the rest of the syringe, but are not actually bent. Are you absolutely sure that this was not the situation...?} I also tend to think that your title says alot about you. And no, I don't think you need to be logging details and watching this nurse at every turn and every shot or pill given. You weren't hired as the nurse watchdog...you were hired as a CNA. That's just my opinion, don't anyone flame me for it. Others post theirs, I've posted mine.
I would much rather risk humiliating another nurse a bit (or have someone humilate me a bit) by pointing out a problem in front of a patient than put a patient at risk. Sure, I would probably be a little put out that someone had to call me on a mistake in front of a patient, but I think that is much better than harming a patient.
I know that CNAs are not there to be a watchdog, but I firmly believe that they deserve a lot of respect. They are often the ones who have the most contact with patients and they take a huge load off the licensed nurses workload. I don't think that anyone should go out of their way to find someone elses mistakes (I don't think this CNA was!), but we should all be in this for the patient...that is what counts and if a CNA (or another nurse, a housekeeper, or just Joe Blow off the street) can prevent me from making an error, then I appreciate their help.
I used to teach for BD. From what I have observed--and I have observed it many, MANY times--the problem is not in the PRODUCT, but in the way the nurse OPENS the product. Hear me out here, and see if you can examine your own practices, to determine if you are guilty of doing what I saw nurses doing, over and over and over, at facility after facility---
Any syringe made by BD, but particularly the TB and insulin ones that have permanently attached tiny 27 or even 30 g needles, needs to be opened PROPERLY--by peeling the peelpack OFF the syringe, using both thumbs and both index fingers in opposing directions.
Instead, what nurses tend to do---saying that they are in a hurry--is to POKE THE SYRINGE THROUGH either the plastic or paper part of the peel pack, self-capping needle first. Not only does this have the potential to bend or cause burrs on the needle, it can cause microfragments of paper or plastic to adhere to the now bent or burred needle-and those tiny fragments are carried into the patient's skin and subcutaneous tissue when you give an injection.
Most needles, to comply with OSHA and federal law, are safety needles--that is, they are self-capping, often via a slide up mechanism that you activate with your thumbnail. You can see how in the package, since they no longer have the old fashioned solid cylindrical plastic "cap" over them, they could be easily damaged by poking them through paper or plastic.
If your facility is STILL using old fashioned non-safety TB and insulin syringes--the type that would require MANUAL capping, (That is; if you were ALLOWED to recap---You WOULDN'T ever recap, would you? :uhoh21: Just checking....)--then they are at risk of being fined and even shut down by OSHA.
That is NOT to say that the single NON-safety needles--i.e., 18 g for drawing up meds--are not allowed in a facility, as long as you are only using that needle on a vial to draw up meds, or to inject those meds into an IV bag. if you use them for THIS puropose and this purpose only--no patient contact--you are allowed to recap. But, they are NOT to be used to give a patient an injection and thus expose yourself to blood and a potential needlestick--for those, you MUST use safety needles.
Again, the self-capping 27 or 30 G safety needles (particularly the ones pre-attached to TB and insulin syringes) are VERY delicate, but, if opened properly, will not bend or burr. Trust me--try it in your own practice. It WILL make a difference if you take the extra second to PEEL the wrapping off-NOT poke the syringe, needle first, THROUGH the wrapper.
Thanks for explaining in this post! I'm not working again until tomorrow, I'll have to see if it's actually B-D that we use, our problem on our unit wasn't with taking the cap off, the needle was never bent after taking the cap off or the syringe out of the packaging. It was fine after we drew up the insulin, too. Then we'd recap (we don't have the slide up form of the safety that you can use to cover the needle until you use it, if we slide our safety up there's no way to slide it down again to give the injection, we have to recap). I'd get to the patient's room, and the needle would be bent at a 90 degree angle right in the middle of the needle. Like I said, I slowed down and haven't really had it happen since, maybe once every few months, I'm sure it's because we were all in a hurry. It was a bit weird though! :)
AS I SAID at the beginning of my post, we haven't heard the nurse's side of this, you have only heard from the CNA. I am not advocating injuring a patient at all. I'm always for the patient. I'm just saying that in this particular forum it's hard to decide what was actually done or not done. And I still stand by my opinion that CNA's should not "watchdog" the nurses. If they are allowed to do that before you know it, they'll be picking apart everything the nurse does. This nurse has a supervisor. Don't you imagine she has been orientated and checked off on giving medications? Give her a break for pity's sake. You haven't heard HER side of the story and not likely to. This shouldn't even be discussed here, just for that reason. Advice has been given to an aide to watch this nurse or nurses and that should not be. I work in a facility where we have aides but the nurses do not supervise them. They have their own department and own supervisor. Believe me, there have been incidents where the aides think they know that the nurse has made a mistake. We've had nurses accused of giving the wrong med before. But it was the aide's misinterpretation not that a patient received the wrong med. So I know if they are allowed to be "watchdogs" they can take it too far. I was giving flu injections at my facility one day, here recently, to our staff, and one person accused me of "jabbing" everyone with the needles. I wasn't jabbing...it's just my technique to insert quickly and get it over with. Not one person complained that I hurt them, not even that particular staff member, after I'd given HER the injection. But it sure made me feel bad to have someone loudly complain there in front of several people about my technique. If she didn't like what she saw she could have requested someone else give it to her.
All I'm saying is there are 2 sides to every story and you haven't heard both sides, and not likely to either. It's a very touchy situation, for sure.
It goes without saying there's two sides to every story.
It also goes without saying that somoeone can be trained and checked off for medications, and still not know how to do them correctly.
And i do not see a reason why this CANNOT be discussed here, it does not violate the TOS, and no names were even used, not to mention it's a legitimate concern.
I would rather someone question what they think i might doing wrong, than to assume it WAS done wrong and NOT say anything about it. Patient safety, patient safety, patient safety.
(watchdogs, i'll refrain from comment on that one)
I feel it shouldn't be discussed here and advice given to someone to log, document and report everything that nurse does, BECAUSE of the fact that we don't HAVE all the facts. That's why I said that. I know that no names have been used. I can read, and I didn't read any names being posted.
I know that as nurses we should all be very prudent in giving our medication rounds, but could it be that the CNA misinterpreted some things? Did she have her eye on the nurses hands every second before the injection was given and not see an alcohol swipe? Maybe the nurse had already wiped the patient's finger with an alcohol swab and was letting it airdry....same as I do....I wipe, let airdry about 10-15 seconds. In that amount of time another person's eyes can have been focused elsewhere and not seen the actual swipe. Is she absolutely sure the needle was not just a bit out of alignment? I've removed insulin syringes many times that are not exactly straight with the barrel of the syringe. I always peel my paper off, I don't push the syringe thru. In fact, I've never seen a nurse do that. It has never entered my mind to do that....seems to me it takes alot more strength to push and tear thru than it does to peel. I try not to make things any harder on myself than necessary.
The CNA said herself, in her post she might have seen wrong.....I'd hate to know that she's making these accusations and going to log, document everything and report on this nurse, if there's a possiblity she {CNA} is wrong. I know for a fact that sometimes people misinterpret things.
And you are right about being checked off and still not know how to do it correctly.
I do agree with that. But neither does the CNA know how to give meds/injections.
I would certainly like to hear the nurse's side of the story. I'd be interested to read what she would have to say.
Please don't flame me for my opinion. It is just, respectfully, my humble opinion.
People can learn something from majority of discussions here. And for each person, it could be different lessons. It can also make them question what they might do in such a situation.
People gave their suggestions. No where is it set in stone that she has to follow any advice here.
Marie_LPN, RN, LPN, RN
12,126 Posts
Our facility policy is to clean off the finger with alcohol, wipe it off with a 2 x 2 gauze, then stick.
And i'd report the nurse for her remark. That was extremely rude, not to mention very unfair to the pt. involved. The nurse was snippy because she was caught and didn't like it.