Who should place a Foley catheter?

A nurse who understandably asks to remain anonymous writes, “In our hospital, we have an increased catheter-associated urinary tract infection (CAUTI) rate related to poor skills by medical residents. The surgical nurses want to insert the caths, but the residents jump in and do not perform the skill correctly. Feedback please.”

Thanks for the interesting query. Several thoughts come to mind. I can understand a new resident wanting to learn how to perform this procedure. But after doing a few, I think that the novelty would wear off, especially at 3:00 in the morning. Also, it is likely that the nurses would be able to do it in a much more timely way.

In my current hospital, which is non-teaching, nurses place Foley catheters without incident or opposition. I don’t know our rate of CAUTI, but I doubt it is high.

You might try the direct approach and speak to the residents when they don't do it right, but unless they've read my "Hints for new residents" blog where I mention that you can learn a lot from nurses, they may become indignant.

I assume you have some data to back up your assertions that your CAUTI rate is high and can document that the residents are not doing it correctly. Having dealt with teaching hospital politics for many years, I suggest the following to you.

Speak with your nurse manager and the nurse who does clinical education and tell them what the specific problems are. For example, are the residents not adhering to sterile technique? Are they not following the steps properly?

The nurse manager and clinical specialist should talk to your infection control nurses and their supervising physician, who should then discuss the matter with the residency program director. This will keep you out of the line of fire and not jeopardize your relationship with the residents.

This process is good way to handle any sort of conflict. In the military, it is known as following the chain of command.