30 seconds is the amount of time it takes to wash hands. Lets say I have 4 patients in a given 8 hour shift, and I enter the room an average of 10 times per shift. This is realistic, because we have something called hourly rounding. The aid does one hour; I do the next. Each time I enter a patient room, they ask for something, so each room entrance generally requires two visits to the room. Blood sugars generally require 2 to 3 room entrances. 30 seconds x 20 hand washings (washing in, washing out) = 600 seconds. 600 x 4 patients = 2400 seconds, or 40 minutes. I think it is realistic to say that I spend 1 hour of my 8 hours on duty washing my hands. They have brown spots on them from 10 years of this.
So I now have 7 hours left. A good nurse can assess a patient head to toe, thoroughly, in 15 minutes. For 4 patients, that takes an hour. Oh, somebody wants to use the bedside commode, and it takes 30 minutes to transfer them to it because they just had surgery. Make your beginning of shift assessments 1 1/2 hours. But wait. Another patient is irate because they haven’t been told the results of their tests. It takes 30 minutes to call the doctor, and calm the irate patient. That makes your beginning of shift assessments 2 hours.
You have 5 hours left. It takes 10 minutes per patient to get the right medications scanned, verify they are the right patient, and give them their pills. Add to that, that all the medications are not up from the pharmacy, requiring computer entry or a phone call; someone wanting water while you are in their room; someone needing put on the bedpan (requiring 2 more handwashings and a gloving), and you have taken up another full hour or more, just for a med pass.
You have 4 hours left. There are at least two med passes per shift, so make that 3 hours left.
A patient needs a dressing change. A doctor wants an update. There are checklists to fill out before surgeries; papers to put on charts before a patient goes to x-ray so other staff in the hospital know what to do if they stop breathing; patients needing transferring to or from a stretcher (2 more handwashings each). All of this takes 2 of the 3 hours you have left.
Of the one hour left now, 1/2 of that is your lunch. But someone wants to tell you their health history, or a story or a joke, and they take up the entire hour.
Add to all of this the fact that you work on a cardiac floor, where people are on cardiac drips that require vital signs every 15 minutes; but also happen to be on Lasix, and take off their blood pressure cuff each time they use the bathroom, which is more often than hourly. (Remember, 2 handwashings and a gloving for each of these you help with). Add to this that you are on the code team today, and an hour-long code was called in another wing of the hospital. Add to this that one of your patients puked up blood and had to be transferred to the intensive care unit which required an hour of phone calls, paperwork, and keeping the patient alive until they got there. (I won’t go into detail about what all keeping someone alive who is slipping entails, but I will say that 1 hour is a conservative estimate). Add to this a patient in isolation that requires not just handwashing, but gloving and gowning upon each entrance. Nowadays that is anyone with a HISTORY of MRSA, C-Diff or VRE, until they have 2 negative cultures. Add discharges, admissions which involve reviewing every medication a patient is on and getting it right. Add patient education.
Someone wrote in another blog (not my blog) in the comments section a question to me, asking if I was aware that hands were supposed to be washed both upon entering and exiting a patient room. This comment was in response to the recent publicity on MRSA infections in hospitals. When she stops breathing, if she is my patient, if I remember, I will wash my hands before touching her. It may compromise her ability to live however.
Yes, I am being sarcastic, and yes I am angry. I’m happy to fluff someone’s pillow, but don’t blame this entity of our society – this entity of what has transpired in healthcare on me. And don’t patronize me. I don’t have to be a nurse, and I just might quit being one. It won’t save her from MRSA. Blaming hospitals and drug companies won’t save her from MRSA either. Her immune system, and a smart doctor might. That is, if there are any doctors left.
I have to chart all of the above. Remember, if it wasn’t charted, it wasn’t done, even if you did it. Tomorrow you have 4 entirely different patients. 5 months down the road, you run into a familiar face in the hall; the person talks with you as if you are an old friend, and for the life of you, you can’t remember them. They remind you…you saved their life. You still don’t remember them. You really, really wish you did.
What does it have to do with washing your hands? Nothing. Nothing at all. Do I have MRSA? I don’t know. I like to think that I colonize myself with enough non MRSA bacteria, and stay away from antibiotics enough to provide any that might hang out on or in me, with some healthy competition. Covering myself with my barn dirt is a great way to do this.
