Saturday, September 11, 2010

Now, a Personal-Drama Free Post That's Actually About Nursing!


Crazed Nitwit wrote in with a link to her blog, in which she asks one of those important questions that they never address in school:

How do I respect the older nurses I work with, and yet keep using current techniques? (I paraphrased, CN, sorry.)

That's actually a stickier question than you'd think. My first response was to think, "Well, that's not that hard. You just keep washing your hands and not mixing your drugs and ignore what the other nurses are doing."

Here are a couple of real-world examples: I work with a nurse practitioner of the Old, Old, OLD School (meaning that she's been in practice for years, not that she's ancient). She's an expert in her field: kind, knowledgable, irreverent when it's called for, fantastic in the clutch.

And she never wears gloves.


Think about that for a minute. Her practice includes things like dealing with recently-Roto-Rooted prostates and crazy-ass bladder reconstructions, but she never wears gloves when she's seeing/treating/removing things from and sticking things into patients.

What to say about that? Well, you gotta notice that her patients never get infections. I mean, they just don't come back to the clinic or the hospital with infections, period, because she's a maniac about hand-scrubbing and teaching her patients to do the same. I'd wager that her fingernails are cleaner than the gloves in the box.

So, despite the fact that I shiver every time, still, even knowing what I know about her standards of care (insanely high) and her infection rate (nil), I do not say squat.

Because frankly, it wouldn't help. She would either not wear gloves, or wear them only around me and be annoyed, and nothing would change except our working relationship.

Real-World Example Number Two: Another nurse I work with is textbook perfect. She's also of the school that studied on engraved stone tablets.

The difference between the two nurses is stark, though, when you start to look at practice: even though Nurse Number Two knows all the latest research and parrots all the latest rules, her patient care sucks rocks. Unfortunately, she's also the person most likely to have a screaming fit at the station if a younger nurse (ie, all of the rest of us) questions her or corrects something she's done.

The trick we have, then, is to keep complex patients the hell away from her interventions. Dealing with her wackiness is not our job; it's Manglement's, and I wish them much luck in the endeavor. *Our* job is to look beyond the HIPPAA (sic), TJC, AJCCN-published bullshit and make sure that everybody who's on a ventilator gets mouth care every four hours. I guess if you look at it one way, we're respecting her skill level and autonomy and giving her patients she will mesh well with; looked at the other, we're keeping the people who are either really critical or who actually need some help out of her grasp.

At the end of the day, it all comes down to tact and people skills. I mean, if you see somebody doing something (or about to do something) that's really and truly dangerous, you ought to speak up. (" that IV push supposed to be crystalline white?")

If, though, upon thought and consideration, you can balance outcomes against practice and have outcomes come up the winner, it might be best to keep your mouth shut, listen, and learn. *I* have some unconventional ways of doing stuff, as do nurses that've been in practice twenty-five years longer, and nurses who've been in practice for two months.

Styles differ. Unless there's an imminent danger, keep on wit' yo' bad self and yo' bad self's way of doing things. And if you have to correct somebody, no matter if they're older or younger in nursing terms than you are, doing it respectfully and kindly will never, ever hurt.


shrimplate said...
This comment has been removed by the author.
shrimplate said...

I swear I must go through at least a box of gloves per shift.

I hate the gel-stuff for cleansing hands. It dries me out. I prefer good old-fashioned soap and water.

And sing the alphabet song. That way you know you're scrubbing your hands long enough.

I am old. I hope to stay that way.

Crazed Nitwit said...

Great advice as usual. Thank you. I did already raise my voice at a caregiver, not a nurse, not a CNA but a 19yo moron of a caregiver.

He came sneaking up behind a resident who has MS and was going to 'scare' her. She was in the process of taking her oral meds. I told the caregiver to stop before he even got close to my patient. He tried to say he was just having fun, making excuses etc. I told him, fairly forcefully, that this woman was my patient and it was my job to advocate for her and to keep her safe. Last thing she needed was a fall or to choke on her meds.

I am sure he thinks I'm a bitch but I do not care.

FYI~he had been seen playing with all the elevator buttons a few hours earlier.

Cartoon Characters said...

re gloves: when I started nursing, gloves were only the sterile kind and were pretty much only for the MD's. Lots of handwashing took place (which should with gloves anyway, since they are porous). We were told in nursing school that wearing gloves while changing an ostomy would somehow make our patients feel that they were "dirty". (well, they were). On the down side, since wearing gloves I have become allergic to latex (working L&D you had no choice of going sans glove)-lab tested.

Anonymous said...

She must wear gloves at some point - right? Oh, please say yes! DRE, I dare not contemplate!

messymimi said...

Tact is the ability to tell someone where to go and have them be happy to be on the way.

An excellent skill indealing with people, especially in these situations.

RehabNurse said...


I get the nurse who doesn't wear gloves 'cause she doesn't like 'em, but I have enough Hep C patients to realize that a) better to be safe than sorry, b) no matter how good my skin looks, there could be a little tear and c) I just don't want Hep C.

I try not to wear gloves whenever I'm not touching bodily fluids, but I always have a pair on me just in case.

And CN, I'm all about being a good advocate, and yes, I'm the patient's nurse and if you attempt do that while I'm giving pills, you'd better hope I'm in a good mood or I just might make security automagically appear and escort your pranky butt off the grounds.

If I can run gangbangers out of clean rooms while they sit on the bed and use the phone to conduct business, you betcha I'll do the same to the pranksters.

RN in IL said...

"her patient care sucks rocks."

Sorry. I'm having difficulty understanding. Does her care suck, rock, or create some sort of vacuum seal on irregularly shaped stones?

Molly said...

Gyaaaah, the image of a nurse sticking an ungloved finger up someone's pooper is truly horrifying to me.

Hee, my verification letters are SUGAR. It always amuses me when they spell out an actual word.

Hal Dall, MD said...

Much of your post applies to OldOldOldSchool docs, too. Especially the surgeons.

On the glove issue, I remember a controlled British study of suturing wounds with gloves vs. well-washed bare hands(this was before HIV). The infection/complication rate was identical.

As to gloves for DRE, see this :)