clinical at hosp telling me NOT to use BSI. NEED HELP NOW

[Altered Mental Status]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

I'm in Alabama and my EMT/EMT-B protocols dictate Standard Precautions for all pt contact. I don't want to make waves but I don't want to lose my Basic license. This is also a matter of interity. Yes, I know I probably won't get "caught" but that's not the GD point.

Should I politely leave? Insist? They're saying wearing gloves for VS will make the pt feel funny.

HELP! ADVICE?

 

[Veneficus]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

I'm in Alabama and my EMT/EMT-B protocols dictate Standard Precautions for all pt contact. I don't want to make waves but I don't want to lose my Basic license. This is also a matter of interity. Yes, I know I probably won't get "caught" but that's not the GD point.

Should I politely leave? Insist? They're saying wearing gloves for VS will make the pt feel funny.

HELP! ADVICE?

Gloves are not the most important infection control practice, hand washing is.

many doctors I know do not wear gloves everytime they touch a patient, only when they expect contact with body fluid.

I don't wear gloves for every patient.

most things you learn in EMT school are said as absolute because nobody trusts you to make sound decisions with so little education. Not because they are absolute right or wrong practices.

I wouldn't get too stressed by it.

When in Rome do as the Romans do.

 

[Aidey]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

I'm in Alabama and my EMT/EMT-B protocols dictate Standard Precautions for all pt contact. I don't want to make waves but I don't want to lose my Basic license. This is also a matter of interity. Yes, I know I probably won't get "caught" but that's not the GD point.

Should I politely leave? Insist? They're saying wearing gloves for VS will make the pt feel funny.

HELP! ADVICE?

How about calm way the heck down? You're not going to lose your basic license*. It has more to do with irrationality than integrity. And there is really no reason get this worked up about it. There is nothing for you to get "caught" for.

Please explain from a rational scientific standpoint what the problem is. Before you reply, please consider that the practice you are basically freaking out over is common in care settings where staff are trusted to use their judgement. Please also consider that 99.9999999999% of people do not wear gloves when casually touching people or in public. Is taking a BP and pulse really that different than shaking someone's hand?


* If you do, Alabama may take over as the state with EMS more backasswards than California and you just need to get out of the state now.

 

[Shishkabob]

I'll preface this by saying people are icky / gross / disgusting and I don't like touching most of them.


However, now, you don't need ti wear gloves every time you touch them. I usually do, but I don't like fumbling with gloves when something changes from what appears to be an otherwise ok patient.

 

[Steam Engine]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

I'm in Alabama and my EMT/EMT-B protocols dictate Standard Precautions for all pt contact. I don't want to make waves but I don't want to lose my Basic license. This is also a matter of interity. Yes, I know I probably won't get "caught" but that's not the GD point.

Should I politely leave? Insist? They're saying wearing gloves for VS will make the pt feel funny.

HELP! ADVICE?

They're your hands, so you make the decision. Period.

Yes, it's true that gloves aren't necessarily needed for every pt. contact, but if it makes you feel more comfortable go right ahead. Besides the fact that EMS protocols are designed for the great unwashed, remember that providers in a clinical setting often have the luxury of knowing just how icky or not icky their patients are, whereas in EMS we often have no idea.

If you want to wear gloves, I'd say just continue wearing gloves. If challenged again. maybe just casually mention something about universal precautions being part of your protocols and leave it at that. I doubt you're going to get in trouble either way...I can't see anyone seriously writing you up for wearing gloves.

 

[usalsfyre]

I wear gloves....rarely. Usually only when I expect contact with bodily fluids, or am performing an invasive procedure. I'm a mad man about hand hygiene though. From what I can tell I'm sick less than others I work with.

As for integrity, is following a stupid protocol line that's wrong any way showing integrity in the first place?

 

[Veneficus]

I wear gloves....rarely. Usually only when I expect contact with bodily fluids, or am performing an invasive procedure. I'm a mad man about hand hygiene though. From what I can tell I'm sick less than others I work with.

As for integrity, is following a stupid protocol line that's wrong any way showing integrity in the first place?

Well, you know, I want to be recognized as a healthcare professional but also want a simple cop out answer everytime thinking or responsibility is required.

 

[medic417]

Wow way to help the new person.

To the OP as you sort thru the attacks you will find some valuable information. It is common in the hospital setting to not wear gloves because they can immediately wash hands. I do not think the hospital will run you out if you continue wearing gloves.

 

[Veneficus]

Wow way to help the new person.

To the OP as you sort thru the attacks you will find some valuable information. It is common in the hospital setting to not wear gloves because they can immediately wash hands. I do not think the hospital will run you out if you continue wearing gloves.

My reply is not an attack, it is true for many jobs.

Initial education is: "this way is always right any other way is always wrong."

You should hear some of the stuff STNAs have tried to "call me out" on in the past.

 

[shfd739]

I'm to the point of hardly ever wearing gloves once I've seen body fluids aren't present; even starting IVs at times without them.

When you go to the doctor do the techs wear gloves when taking your vitals? No they don't.

The state won't know and won't care. This isn't that big of a deal.


Sent from my electronic overbearing life controller

 

[BLS Systems Limited]

Another aspect is the wearing of gloves to provide a psychological barrier to counter issues of sexual impropriety between the healthcare provider and patient/previous victim of abuse. It has been suggested that just the act of glove wearing may reduce additional stress to patients that carry these concerns (being touched by others, especially those of opposite sex, race, size, age...pick your phobia).
This was suggested to us as we were drafting up Sexual Abuse Prevention PPG's about 20 years ago.

 

[FourLoko]

I was just thinking yesterday how we seem to over use gloves. Just helping the patient stand up off of the gurney and we're reaching for gloves. As mentioned, docs often touch patients without gloves and I've seen nurses remove hep locks without gloves (mmm needles and blood).

 

[lawndartcatcher]

I'll often not wear gloves in the field if I feel there's no direct issue with bloodborne contaminants. I feel like it's akin to wearing a mask with every patient because they could have TB / SARS / Hamthrax (Swine Flu) / etc. Obviously you could be safe and wear gloves and a mask (or, for that matter, a level A suit) with every patient but the majority of your patients would be pretty freaked out. As someone else pointed out there's definitely a psychological component to gloves - I would posit that _not_ wearing gloves (when it's safe) can be helpful with many patients. The little old lady who needs her hand held will wonder "what's wrong with me - this must be bad if they won't even touch me" if you do so while still wearing a glove.

Clearly, there are times when you should be gloved (and masked) up. I don't approve of touching anything involving bodily secretions without gloves; even if you're just pulling a cath if you get splashed or have an open wound (hangnail anyone?) it's a direct path of entry. Basic EMT classes stress "wear gloves all the time, every time. Even when you're just going to the bathroom. Or eating dinner." because the clinical experience to know the difference hasn't been learned yet. If you're ever in doubt you should err on the side of caution, but remember an empathetic human touch is sometimes powerful medicine. Just make sure you wash your hands between every patient contact. If you're nice to the nurses they may even tell you where the good hand soap is hidden.

Part of clinical rotations (possibly one of the most important) is learning to interact with patients and other healthcare providers. Unfortunately some medic students (and nurses, and doctors) view it as simply skills-based. Use this as an opportunity to add to your clinical skills; remember that nurses _aren't_ taught like prehospital providers and their whole professional culture is different. They aren't taught "Scene Safety / BSI" from day one and don't have to repeat it back in parrot fashion, so they may not appreciate the emphasis on PPE you have.

 

[nwhitney]

As others have said they are your hands so if you feel the need to wear gloves then wear gloves. Before I got into EMS (I don't have much experience in EMS, OK pretty much zero experience) I always preferred any healthcare provider I encountered as a PT to wear gloves. First they don't know me and the dirty things I do. Second I don't know them, where they've been, the last PT they saw before me or the dirty things they do. My point is it's not always about protecting yourself it's also about protecting the PT from you. I think as you go along in your EMS career you'll refine your sixth sense about when to wear gloves and which PT's will benefit and appreciate skin on skin contact.

 

[Sasha]

Do you wear gloves when you go to the store? Out with friends?

Seems rather silly to wear them for every single contact at work. Most people who wear gloves for every interaction forget when you should be changing gloves and cross contaminate things more than anything.

I wear gloves only when there is going to be lots of fluid. Even if the patient has MRSA or some other icky... I don't glove up if I'm touching clean unbroken skin.

But on the flipside I wash my hands at least twice a call and sanitize between those.

Don't stress. No one is gonna take your cert for not using gloves.

Sent from LuLu using Tapatalk

 

[FourLoko]

Do you wear gloves when you go to the store? Out with friends?

Seems rather silly to wear them for every single contact at work. Most people who wear gloves for every interaction forget when you should be changing gloves and cross contaminate things more than anything.

I wear gloves only when there is going to be lots of fluid. Even if the patient has MRSA or some other icky... I don't glove up if I'm touching clean unbroken skin.

But on the flipside I wash my hands at least twice a call and sanitize between those.

Don't stress. No one is gonna take your cert for not using gloves.

Sent from LuLu using Tapatalk

+1 on the

forget when you should be changing gloves and cross contaminate things more than anything.

Newbie partner. Pulling out the pager and fondling it for no good reason after helping a patient into the bathroom. Touching the clipboard with the same gloves.

Defeats the purpose.

 

[medichopeful]

I'm currently doing clinical rotations at the hospital's Pre Op department for AEMT. The nurses want me to make pt contact without gloves and use gloves only for IV sticks.

I'm in Alabama and my EMT/EMT-B protocols dictate Standard Precautions for all pt contact. I don't want to make waves but I don't want to lose my Basic license. This is also a matter of interity. Yes, I know I probably won't get "caught" but that's not the GD point.

Should I politely leave? Insist? They're saying wearing gloves for VS will make the pt feel funny.

HELP! ADVICE?

When you get your physical, do the doctors/PA/NPs/etc. wear gloves for everything? Absolutely not, and they'res no reason to. Wouldn't you feel a bit weird if someone came in to take VS on you and was wearing gloves? I know I would!

If you're going to be in contact with fluids, or there is the possibility you will be, then yes, wear gloves. If you have an open cut on your hand, or the skin's not intact in some other way, then check with your clinical leaders or contamination advisor and see if you can even work for that day, and if so you should wear gloves. Otherwise, just wash your hands after (and before!) each patient contact.

 

[mycrofft]

Before each pt, use alcohol or alcohol hand sanitizer.

If the stinging tells you that you have an open wound, don gloves and smilingly explain you got a paper cut that morning or something. THen wash your hands after each pt as you are supposed to do anyway.

Leave out the MRSA or Ebola stuff it just confuses them and your point is already made!.

 

[nwhitney]

don gloves and smilingly explain you got a paper cut that morning or something.

I think this is a great way to go about the glove situation. The message is "I have a cut" not "I think your icky". Quick, easy and no further explanation needed.

 

[usafmedic45]

If you do, Alabama may take over as the state with EMS more backasswards than California and you just need to get out of the state now.

Nah.....California may be administratively screwed up and massively oversaturated with EMTs, but it's a long way from the most messed up state for EMS. Maryland from an operational standpoint has everyone beat hands down.