Description I was working on a surgical ward, I

In a placement during my second year when I was working on a surgical ward, I
was working under the supervision of my mentor, caring for a seventy-two year
old gentleman, Mr Khan (pseudonym), who had undergone abdominal surgery. I had
been asked to remove his wound dressing so that the doctor could assess it on
the ward round.

I removed the dressing under
my mentor’s supervision, using a non-touch procedure, and cleaned the wound, as
requested by the doctor. My mentor was called to another patient at this point,
so at her request I stayed with Mr Khan while we waited for the doctor to come
to see him.  

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The doctor had been with another patient, examining their wound, and I noticed
that she came straight to Mr Khan to examine his wound, without either washing
her hands or using alcohol gel first. I also noticed that she was wearing a
long-sleeved shirt, and I was concerned that the cuffs could be contaminated. I
thought for a moment about what to do or say, but by the time I had summoned
enough courage to say something, I thought it was too late as she was already
examining Mr Khan.  

I was alarmed by this, as I had expected the doctor to wash her hands or use
alcohol gel before examining Mr Khan. However, I felt intimidated because I
felt that the doctor was more experienced than me as a second year nursing
student; and I didn’t want to embarrass her. Also, I didn’t want to make Mr
Khan concerned by confronting the doctor in front of him. 

Later, I spoke to my mentor about the incident. She suggested that we speak to
the doctor together about it. My mentor took the doctor aside, and asked her
whether she had washed her hands before examining Mr Khan. She looked quite
shocked. She said that she had been very busy and hadn’t thought about it. My
mentor discussed the importance of hand hygiene with her, and the doctor
assured her that she would wash her hands before examining every patient in the

The incident was extremely challenging for me. I regret that I did not act to
challenge the doctor’s practice before she examined Mr Khan. However, I am
pleased that the doctor responded so positively to the feedback of my mentor,
and I have observed that she has now changed her practice as a result of this
incident. I too have learned from the incident, as it has taught me the
importance of acting assertively with colleagues, in a sensitive manner, in
order to safeguard patients’ well-being.  

The Royal College of Nursing (2005) states that hand hygiene is the single most
important activity for reducing cross-infection, and points out that many
health care professionals do not decontaminate their hands as often  
as they should. Recent guidance published by the Department of Health (2007)
highlights the possibility of staff transmitting infections via uniforms, and
the need to review policies on staff dress. The Nursing and Midwifery Council
Code of Professional Conduct (2004, section 8) states that as a nurse ‘you must
act to identify and minimise the risk to patients and clients’. As the student
nurse caring for Mr Khan under my mentor’s supervision, this also applies to my
own practice as a student nurse.  

Looking back on this incident, I can see that I should have acted sooner, and
that I should have ensured that the doctor washed her hands before examining Mr
Khan. I can now see that my inaction in this incident put Mr Khan’s well-being
at risk. After discussion with my mentor, I recognise that I need to develop
the confidence to challenge the practice of colleagues, putting the well-being
of clients at the forefront of my mind. I realise that I need to be supportive
to colleagues, understanding the pressures that they may be under, but ensuring
that their practice does not put clients at risk.  

Action Plan  
In future, I will aim to develop my assertive skills when working with
colleagues, in order to ensure that the well-being of clients is maintained. In
my next placement, I will make this a goal for my learning, and will discuss
this with my mentor to work out strategies for how I can achieve this.