Nursing Case Study
Case Study 1
Charlie is a tech on the midnight shift at a 124-bed rural community hospital. He has worked at this hospital for 25 years, always on the midnight shift. He is known for taking short cuts to get his work out faster, but he is reliable and management is reluctant to counsel him. It is difficult to find qualified employees on the rural areas. For short-cut Charlie, he thinks the way he manages his work is just fine. The work gets out quickly and he has ample time to work in a stress-free environment.
A typical night for Charlie is as follows.
Charlie arrives at 10:55 p.m. to clock in for his shift that begins at 11 p.m. He is wearing his usual clothes: jeans, a red plaid flannel shirt with the long sleeves rolled up to just below the elbow, heavy white socks and sandals that he has worn for years. He has a 2 inch beard that is unkempt and dirty fingernails. His hair is thinning and often smells as he only washes it when he gets his hair cut. He puts on his lab coat, but removes it as soon as the evening shift is gone. He is responsible for collecting blood from patients in the emergency department (ED), as well as STATs on the nursing floors. He has been assigned additional PM tasks to perform during the slow times at night.
Tonight, he is updating the chemical inventory, and his supervisor has asked him to collect any chemicals that are out-of-date or no longer used. He is to box them up for disposal. As he scans the shelves, he notices that there is a liter of glacial acetic acid on the top shelf that has been in the lab for years. He is not sure when it was opened because the date is missing, but he knows the chemical is no longer used. He places it in the box for disposal. He also finds a small bottle of sodium azide and puts it in the disposal box. He continues to check the inventory, and all chemicals on the list are accounted for in the upper cabinets in the lab. He finds two new chemicals that come with the chemistry kits, but he does not add them to the inventory list.
Evaluation time is next month, and Charlie wants to make a good impression on his supervisor. She made a few comments on his appearance, which he has chosen to ignore and he wants to be on her good side. Charlie decides to save the lab money and dispose of the acetic acid and sodium azide himself. He pours them down the drain. He knows lab packs are expensive and the stuff just goes into the septic tank used by the hospital.
Charlie receives a call from the ED. A 17-year-old girl has been brought in by her mother with severe abrasions about the head and face. The doctor orders a CBC and BMP. When Charlie goes to collect the blood, he does not wear any PPE. He never wears gloves to draw blood. He says it interferes with his ability to find the vein. The night nurse insists he wear gloves, and he reluctantly puts them on. After she leaves the room, he pulls the index finger off the glove on his left hand so he can feel the vein. After he gets the samples, he discards the needle in the sharps container by unscrewing the needle and places the single use needle holder in his jeans pocket. After drawing the blood, he places the unlabeled tubes in his shirt pocket, grabs the paperwork, and hurries of to the lab to begin the tests.
Back at the lab, Charlie opens the EDTA tube with the CBC and checks for clots before placing it on the instrument. He puts the sticks used to rim the tube on the counter. He runs the CBC without running any controls. He knows the evening shift just left an hour ago and the controls they ran were OK. He puts the sticks in the trash can and then cleans up the spill with a dry paper towel. He does not notice that his shirt sleeve near the elbow absorbed some of the blood before he cleaned the counter.
Charlie’s supervisor left him a note to change the gas tank on the incubator. He removes the valves and replaces the tank. He leaves the empty tank sitting beside the newly installed tank. The supervisor also asked him to check the eyewash station. He was supposed to do that 2 weeks ago but forgot. He removes the eyewash cats, turns the water on and off quickly, and replaces the caps.
Now that the ED work is over, Charlie decides to have his dinner. Just as he is about to eat, the phone rings, and it is a STAT in the ICU. Charlie puts his lunch on the counter and goes to collect the samples. When he returns, he puts the samples on the centrifuge. While the samples spin, he uses the restroom and finishes his food. He puts the specimen on the chemistry analyzer and drinks his soda in the section while waiting for the results.
At 6:45 a.m., Charlie puts on his lab coat just as the day shift arrives. At 7:30 a.m. he hangs his coat up with the clean coats and hurries out the door happy to be heading home.
1. Appraise Charlie’s safety performance.
2. Identify any safety issues or violations created by Charlie and the lab.
3. Recommend safety improvements. Be sure to cite the safety guideline or rule for each violation and recommended improvement.
(Hint: Don’t forget to research the MSDSs for the chemicals Charlie disposed of.)