July 20, 2016

Breaking Protocol

Sometimes you break protocol.

As most of you know, I am a nurse. My job is to put patient's health and well being first. They may not always understand or like what I am doing, but I will always do what is best for my patient.
And sometimes break protocol in the process.

For instance,..

I may have peeled off my glove to do a difficult IV start so I could get a better feel and taken off my glove to hold someone's hand, among other things. Like every other nurse in the world. None of this happens because I am a hero or because I am stupid and don’t know about precautions. It happened because I am a nurse.

Yes, we should use protective equipment and precautions and yes, we do exactly that 99.9% of the time. But most of us will never turn away from a person (patient or not) in need for lack of personal protective equipment.

I remember when Nina Pham was diagnosed with Ebola after caring for the patient. The CDC cited a breach in protocol as the source of her infection. It may have happened. But we as nurses don't know everything and like every other human on the face of the earth, cannot be perfect. She was gloved, masked, gowned and wearing a face mask just like she was supposed but there is a long complicated process of donning, caring, and then disposing of equipment. For all of us, no matter what infection we are treating, it is so easy to have something go wrong.

I have also been exposed when not breaking protocol. I have been in a patient's room after a procedure called a cardiac catheterization and their groin site "popped" spewing blood. I put on gloves which is standard precaution, but nothing about a cardiac cath says wear a mask. But never the less, some of the blood squirted to my face.  I did not worry about the blood on me, I worried about the patient. Then after, yes, I scrubbed and was relieved I didn't have any open areas on my face.

It is hard to know when to pass judgement on a breach in protocol. If I saw someone not wash down equipment after going into a person with clostridium difficile, and then using that same equipment in a room with someone without the infection, that is a breach in protocol I would not forgive.

Protocol is there for a reason, but sometimes we have to lose it to make an impact on a patient or save a life. That is what makes breaching protocol so hard. You don’t want a world of nurses who will leave your child in need for lack of gloves. You want us to be careful and yet, willing to take risks on your behalf.

But who makes the determinations on which protocols are okay and not okay to break?
That is the question.

1 comment:

  1. Such a hard call to make! Good for you for caring so much about your patients!


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