As a nurse, you will be responsible for the safe and proper handling of patient care equipment, potentially infectious/biohazardous materials, as well as hazardous chemicals that are present in the workplace setting.
The MSDS or the Material Safety Data Sheets are handouts that describe the nature and potential hazards of all chemical agents that are present in an employment setting. You should be aware of their existence and how to access them in the event of an exposure. They are mandated by the Occupational Safety and Health Administration (OSHA).
Note that there has been a recent move to refer to these sheets as only Safety Data Sheets, so, if you see SDS, it is only the latest term for MSDS.
In addition to the MSDS (SDS), OSHA also has written standards that discuss the proper, standard precautions that should be taken to protect against blood-borne pathogen exposure. You should know what to do in the event of a needlestick, the standards of environmental infection control, and information related to latex allergy for both patients and medical staff.
Part of OSHA’s written standards include the Centers for Disease Control and Prevention or CDC’s recommendations for the use of standard precautions. These are patient care standards that detail how to protect staff from blood-borne pathogens. The use of personal protective equipment (PPE) such as gloves as well as face and eye protection should be utilized and followed in every patient encounter and especially in emergency/disaster response.
In addition to biohazardous materials, you will likely have flammable and other potentially harmful materials present in the workplace. You should have knowledge of the identification, storage, and safe handling practices of all of these materials and be able to safely demonstrate these techniques to other staff and patients if necessary.
The Needlestick Safety and Prevention Act is an important piece of legislation that was enacted to protect workers in the healthcare setting. Safe disposal of all sharps materials should be practiced with the use of mandated, marked biohazardous sharps containers in patient care areas and medication preparation stations. Never re-cap needles, and avoid bending or breaking them prior to disposal.
Nurses play an important role in the identification, recommendation, and implementation of safety practices and equipment that are necessary for patient safety in the home environment. Patients and their families will often be involved in and work with the nurse in this process. Nurses also implement home safety by teaching patients proper self care and reviewing issues relating to the safe care of children. Preventive home safety measures can also include the patient’s use of protective equipment when using potentially dangerous devices at home.
In your nursing career, you will likely be involved in the process of writing an incident report. These tools help record the events leading up to and of an accident as well as the response to it. You must develop the skills of accurately and objectively reporting the events of an incident or unusual occurrence with the overall goal of preventing further injury and/or repeating it again in the future. Each facility will likely have its own procedures for this process. While you may record the facts of an incident in the medical record, you do not include a copy of the incident report or say that one was created.
It is your responsibility as a nurse to ensure the safe and proper usage of all equipment involved in patient treatment and care. You may be responsible for regular inspection as well as proper instruction to the patient if he or she needs to use the equipment at home. If you find the equipment to be unsafe or if it malfunctions, you must immediately cease to use it, label it as unsafe to use, and make sure it is placed in a location where it will not be accessible for patient care. If possible, put it in a specially designated area for malfunctioning equipment and notify the proper personnel of the problem.
A nurse will be asked to perform the critical task of identifying patients in need of urgent care in the event of a natural disaster or emergency.
The purpose of the triage exam is to identify patients who need life-saving care and ensure they are the first patients to receive further evaluation and treatment. It will focus on the following areas in order of their importance:
Airway— Ensure the patient’s airway is clear and open if necessary.
Respiration— Assess for signs and symptoms of respiratory distress.
Quality of respiration— Assess the rate and effort of breathing and check for signs of adequate air exchange (capillary refill, color of skin, and lips). Auscultate for breath sounds.
Pulse— Identify a pulse and note its rate and strength.
External bleeding— Look for signs of significant wounds or injuries in areas with major blood vessels.
Blood pressure— Obtain a blood pressure.
Consciousness, pupillary response, and state of extremities— Assess the patient’s neurological status with his or her level of consciousness, pupillary response to light and signs of paralysis, or posturing of the extremities.
Nurses will also have critical roles in the event of facility evacuations, newborn nursery security events/lockdowns, and bomb threats. You may be part of the development of such emergency response plans for your facility. Clinical-decision making and critical thinking skills often play important parts in both the development and implementation of such plans.
Many precautions are used in medicine to prevent the spread of infection. The most frequently used are standard precautions used in every patient encounter, transmission-based precautions to prevent the spread of pathogenic microorganisms, and surgical asepsis or sterile technique, which is used in invasive and surgical procedures.
Standard precautions including the use of personal protective equipment or PPE (gloves, gowns, face shields, masks, and goggles) should be used in situations where there is potential exposure to blood or other bodily fluids, secretions, and/or excretions. Handwashing and the use of gloves are other vital actions in the prevention of the transmission of infectious pathogens. When putting on PPE, always start with handwashing, then preferably outside the patient’s room, always use this order: gown, mask, eye protection, and, lastly, gloves. The reverse order should be used when PPE is removed with handwashing as the final step.
Pathogenic microorganisms are spread in various ways. You should know the specific transmission-based precautions (airborne, contact, and droplet), and when to use each. There may be occasions when more than one is necessary. This will also necessitate you be familiar with various infectious agents and their modes of transmissions as well as specific precautions needed in the instance of drug-resistant infections.
These precautions are the practices necessary to keep areas and objects free from microorganisms. Sterile technique is the term that is often used in place of surgical asepsis. These techniques are used both in surgical procedures and other invasive therapies and treatments such as IV therapy, suturing, and the placement of urinary catheters.
These are the eight, basic principles of sterile technique:
Restraints and safety devices are tools that can be used to keep both patients and medical staff safe. There are chemical restraints (medications) as well as physical ones (bedside rails, extremity strap restraints, and jackets). You should be familiar with the use of all of these as well as when they are indicated and the safest and most effective way to use each. Restrained patients must be monitored using various methods and frequency depending on the restraint that’s used. There are legal implications with the use of restraints and you must be familiar with these as well as the specific restraint policies and procedures of your facility. Lastly, it is important to realize that some medical conditions, such as seizures, will often include the use of restraints.