This episode covers the highest-value real estate on your NCLEX exam—Safety and Infection Control, which makes up a full 10–16% of your score. Too many students overlook it because it feels like “common sense,” but this section is packed with hidden rules, documentation traps, and points that can separate pass from fail. Join us as we break down the essential safety moves every nurse must master—from incident reports and fall prevention to RACE, PASS, PPE order, and restraint limits. You’ll learn how to: Recognize and avoid the most common NCLEX safety pitfalls Apply real-world infection control principles (without memorizing endless lists) Protect your patients—and your license—with systems-level thinking Lock in guaranteed points with mnemonics you’ll actually remember If you’re serious about maximizing your score, this episode gives you the edge on one of the most heavily weighted sections of the exam. Listen now, take notes, and claim that 16%.
This episode, created by Brooke Wallace, dives deep into one of the most tested and essential areas for nursing students—Safety and Infection Control (10–16% of the NCLEX). Listeners learn how to apply a “safety culture” mindset, document correctly, prevent injury, respond to emergencies, and follow infection control principles that protect both patients and staff.
Move from blame to non-punitive culture—errors reveal system issues, not individual failure.
Encourage reporting near-misses; they identify system cracks before harm occurs.
Incident reports: Document objectively, never mention in the patient’s chart (keeps it non-discoverable legally).
Chart only facts and interventions (e.g., “Patient found on floor, vitals stable, neuro checks initiated”).
Use tools like Morse or Hendrich II to identify high-risk patients.
Mnemonic FELLAS:
Floors clear, Equipment within reach, Lighting adequate, Low bed position, Assistive devices ready, Shoes non-skid.
Delegate rounding but maintain RN accountability for safety setup.
Braden Scale ≤18 = high risk.
Interventions: Reposition q2h, use pressure-relief surfaces, offload heels (“float the heels”).
Code Blue (cardiac/respiratory arrest): Call code, start CPR—CAB: Compressions, Airway, Breathing.
Rapid Response: Call early; stay with patient and continue assessment.
Code Stroke: Activate immediately; prep for CT scan, perform neuro checks q15min.
RACE: Rescue → Alarm → Confine → Extinguish.
PASS (using extinguisher): Pull → Aim → Squeeze → Sweep.
Containment is key—close doors/windows to block smoke.
Chemotherapy: Double gloves, chemo gown, black chemo waste container.
Radioactive implants: Follow Time, Distance, Shielding. Limit exposure time, keep distance, use lead containers for waste.
Bend knees, not back; push rather than pull.
Use mechanical lifts when the patient exceeds 50% of your weight.
Standard Precautions: Hand hygiene, gloves for blood/body fluids, add mask/eye protection if splashing possible.
Airborne: “My Chicken Has TB” (Measles, Chickenpox, Herpes Zoster, TB).
N95 respirator, negative pressure room, surgical mask on patient for transport.
Contact: MRSA, RSV, C. diff.
Gown + gloves, dedicated equipment, soap and water for C. diff.
PPE Sequence:
Donning: Gown → Mask/N95 → Goggles → Gloves.
Doffing: Gloves → Goggles → Gown → Mask (outside room if N95).
Last resort, never PRN.
Violent/self-destructive: Order valid 4 hrs (adult). Provider eval within 1 hr.
Non-violent: Order valid 24 hrs max.
Check/document q15min; remove q2h for circulation, ROM, toileting, skin check.
Use quick-release knot only.
Infant safety: Matching ID bands, alarms, never leave unattended.
Elopement: WonderGuard bracelets, close observation near nurses’ station.
Home safety teaching:
Remove throw rugs, install grab bars.
Crib: firm mattress, no pillows or bumpers, “Back to sleep.”
Water heater <120°F to prevent burns.
Safety culture = systems thinking.
Never chart “incident report filed.”
Know RACE, PASS, PPE order, and restraint limits.
For C. diff, always wash with soap and water.
Advocate for system fixes, not blame.
A nurse notes a patient slipped but was uninjured. What’s the next best action?
A. File an incident report
B. Document “incident report filed” in chart
C. Notify risk management only
D. Chart “patient slipped, no injury” and notify provider
✅ Answer: D
Rationale: Chart only objective data. Incident report is separate, internal.
Welcome to Think Like a Nurse. This is where we take those really complex nursing topics and well break them down, make them easier to understand. Absolutely. We want to help you really get it, especially if you're gearing up for your lensure exam. It's about understanding the why. Exactly. And today we're tackling something truly foundational. Safety and infection control. This isn't just important for the exam. It's huge. We're talking what 10 to 16%. That's right. It's a big slice. Mastering these protocols patient safety, your safety. It really locks in those critical points.
And we should mention this show is created by Brooke Wallace. She's got 20 years as an ICU nurse, transplant coordinator, clinical instructor, and she's a published author. So the insights here are top-notch. Definitely. And if you want even more resources, check out think like nurse.org. Lots of great stuff there. Okay, let's jump in. First big idea, the shift in thinking about safety, moving towards what's called a safety culture. Yes, this is uh probably the most crucial mindset shift. We used to operate for a long time really under a culture of blame. Something goes wrong, find the nurse responsible.
right? The fingerpointing approach. Exactly. But now we understand that errors, they're usually symptoms. Symptoms of a system issue. So the goal is a non-punitive safety culture. Non-punitive. So what does that actually look like on a unit? It means we actively encourage reporting, not just the big errors, but every single adverse event and maybe even more importantly, the near misses. Ah, the almost happened moment. Precisely. Those near misses aren't failures to be punished. They're like gold binds. They show us where the cracks are in the system, the processes, the environment, things we need to fix.
That makes so much sense because if reporting means trouble, you hide it. But if reporting means improvement, you speak up. Okay, so this brings us to incident reports. Always a tricky area, right? Definitely a high stakes documentation point. You know, falls, med errors, even those near misses we just talked about, they all require an incident report. It needs to be actual detailed objective. But here's the catch. The absolute must not do, right? You never mention the incident report in the patient's actual medical record ever.
Why is that separation so critical? Because the chart is the patient's legal medical document. The incident report that belongs to risk management quality improvement. It's internal. If you chart incident report filed, you just legally link that internal document to the patient's record, making it discoverable in say a lawsuit. Ah, okay. So in the chart sticks Strictly to the facts. Strictly facts and interventions. Patient found on floor at 1400. Vitals checked. Stable. Assisted back to bed. Side rails up. Neuro checks initiated. Q15 minutes. Provider notified. Just the objective data. No mention of the report itself.
Got it. That's a vital distinction. Okay. Let's pivot to preventing common risks. Patient falls always a huge concern. We use tools like Morse or Hendrick II scales. Yes. To identify who's high risk. And then the priority is consistent action. There's a helpful pneummonic fella. LS. Okay, let's break it down. F is for floors. Keep them clear. No clutter. Ambulation. A haze walker. Cane. Make sure they're within easy reach. Wow. Lighting needs to be adequate. Another L. Low bed position. Crucial.
Absolutely. And S. Shoes must be non-skid footwear. No slippery socks. Exactly. So, if you have a patient flagged as high risk, what's the number one thing you ensure? Bed lowest position, collite within reach, non-skid shoes on, and uh frequent rounding. checking on them often. Perfect. You can delegate some of the rounding checks, but that initial assessment and ensuring those key things are in place. That's nursing responsibility. Okay. Related to false pressure injuries, we use the Braden scale, right?
Yes. The Braden scale assesses risk. A score of 18 or less generally means high risk. It looks at things like can they feel pressure? Are they mobile? Nutrition status, moisture, friction, and shear. So, if someone is high risk based on that score, key interventions, two main things, repositioning, turn them every two hours religiously and use pressure relief services, special mattresses, heel protectors. Really focus on offloading the heels. We'll float those heels off the bed. They break down so easy.
Makes sense. Okay, that covers routine safety. But what about emergencies? When things escalate fast, let's talk codes, right? Time is critical here. Code blue, cardiac or respiratory arrest, first action. Hit the code button, yell for help, start CPR. Exactly. Call for help and start compressions immediately. Remember, CAB compressions, airway, breathing. Okay. What about a rapid response? Patient's declining but not coding yet. Activate the rapid response team. Call them but then and this is key. You stay with the patient. Continue assessing. Provide support until the team gets there. Don't leave them.
And code stroke where time is literally brain. Absolutely. Suspect a stroke. First nursing action. Get ready for a stat CT scan. Need to know if it's eskeemic or hemorrhagic. And start neuro checks like every 15 minutes. Push for speed. Every second counts for potential treatment options. Got it. Now, let's shift to something we hope never happens. Fire. Two pneumonics everyone needs burned into their memory. First is race. Yes, race for your immediate response. R is rescue. Get anyone in immediate danger out.
A, arm, pull the alarm. Call the code. C, confine. Close doors. Windows contain the smoke and fire. And E, extinguish. Only if it's small, contained, and you're trained and safe to do so. Right. And if you do need to use an extinguisher, remember Pass. Pass. S is pull the pin. A is aim the nozzle at the base of the fire. S is squeeze the handle. And the last S is sweep side to side. Perfect. That containment idea from racy closing doors that links nicely to handling hazardous materials too like chemo or radioactive stuff.
Oh yeah. High stakes materials, chemo drugs. Rigorous PPE. Double gloves, chem gloves, and a specific chemo gown. Disposal is critical, too. Into a designated black chemo waste container. no exceptions and radioactive implants like for break therapy. Here the principle is time distance shielding. Limit your time in the room. Visits are usually kept short, maybe 30 minutes max. Maintain distance when possible. Use shielding if available. And any waste or the implant itself if removed goes into a special lead lined container.
Okay, one more safety piece before infection control. Ergonomics. Protecting ourselves. Yes. So important. Basic body mechanics. Bend your knees, not your back. Keep the load the patient the equipment close to your body. Use leg muscles and push rather than pull. Pushing is almost always mechanically better, safer. And the big rule now, the standard we aim for is the zero lift culture. If the patient is more than say 50% of your weight, you don't lift alone. Use assisted devices, mechanical lifts, protect your back.
Absolutely. Okay, let's switch gears fully to infection control. Starting with the foundation, standard precautions. Standard precautions are the baseline. They apply to every single patient all the time, regard regardless of whether you know they have an infection. So what does that mean in practice? It means fundamentally meticulous hand hygiene before and after every patient contact and wearing gloves whenever you might touch blood, body fluids, mucous membranes or broken skin. If there's a risk of splashing, you add mask and eye protection.
Okay, that's the universal layer. Then we add transmissionbased precautions if needed. Let's start with airborne. All right, tier two. Airborne is for tiny particles that hang in the air and travel far. Think of the classic example uh measles. Fericella, chickenpox, tuberculosis. We often use that pneummonic, my chicken has TB. Exactly. Measles, chickenpox, herpes, shingles when disseminated, and TB. For these, you need two specific things. An N95 respirator, which has to be properly fit tested for you, usually annually. And second,
a special room, negative pressure. Correct. An AIR airborne infection isolation room. It pulls air into the room for the hallway and vents it safely outside, preventing the germs from caping and if that patient needs to leave the room, say for a test, the patient wears a regular surgical mask. That source control keeps their germs contained during transport. Makes sense. Okay. Next up, contact precautions. Contact is for germs spread by touching the patient or things in their environment. Think MRSA, VR, RSV, C, DIFF. Lots of common ones.
So, the PPE for contact is simpler. Gown and gloves. That's the minimum. And really important, use dedicated equipment for that patient's stethoscope, blood pressure cuff, Leave it in their room if possible. Don't carry it room to room. You mentioned Cadiff there. That one has a special rule, doesn't it? Huge point. Seiff forms spores. An alcohol- based hand sanitizer. It doesn't kill the spores effectively. For Cadiff, you must use soap and water for hand hygiene. Wash thoroughly. That's non-negotiable for CIFF. If you see Cadiff, think soap and water.
Critical point. Okay, last piece of infection control. Putting on and taking off PPE. The sequence matters, right? Especially for the exam. Oh, absolutely. Sequence is key for safety. Yeah. Dawning, putting it on, you generally go cleanest to dirtiest. Kind of building the barrier. Yeah. So, gown first. Okay. Gown. Then mask or N95 respirator. Then goggles or face shield and gloves are last. Making sure the cuffs of the gloves go over the cuffs of the gown. Seal it up. Got it. Gown, mask, respirator, goggles, gloves. Now, taking it off, doing. This is where you remove the dirtiest stuff first.
Exactly. Think most contaminated first. So, gloves come off first. They're the dirtiest. Okay. Gloves off then. Then goggles or face shield, then the gown. Peel it away from you, tushing only the inside to roll it up. Okay, gown off. And finally, finally, the mask or respirator. Now, quick point. If it's an N95 used in an AIR, you actually step outside the room, close the door, then remove the N95 and perform hand hygiene immediately. Ah, good clarification. N95 off after exiting the negative pressure room. Okay, super important sequence. Let's move to our last big safety topic, restraints and security. The absolute key idea with restraints,
last resort. Always, always the last resort. And they can never be ordered PRN as needed, right? You have to try other things first. Absolutely. Document those alternatives. Did you try reorienting the patient? Did you check if they need their glasses or hearing aids? Did you try a bed alarm, a sitter? You have to exhaust less restrictive options first. Okay. But if alternatives fail and restraints are necessary, the orders are really strict, time limited, very strict. And it depends on the reason for the restraint. for violent or self-destructive behavior in an adult. The order from the provider is only good for 4 hours.
Only 4 hours. Wow. 4 hours. And they need a face-to-face evaluation by the provider or trained staff pretty quickly. Usually within 188 hours depending on policy. Plus, you're doing checks on them, documentation every 15 minutes, constant observation. And for non-violent restraints, say someone pulling at tubes. If it's nonviolent, just to prevent interference with treatment, the order can be good for up to 24 hours for an adult, but you're still assessing frequently, maybe every 15, 30 minutes based on policy and patient condition.
And regardless of why they're restrained, what's the essential nursing care task every couple of hours? Every two hours minimum you need to remove the restraint. Check their skin underneath, assess circulation, offer range of motion, toileting, fluids, hygiene, address their needs, and always use a quick release knot, something you can undo fast in an emergency. Never a square knot. Okay, good points. Wrapping up with general security and then home safety, infant security, matched ID bands, mom and baby that can't easily be removed, often security tags that trigger alarms if the baby passes an exit point, and constant vigilance. Never leave an infant unattended in the room.
Makes sense. What about patients at risk for alopement wandering off? Similar ideas, maybe a wonderguard bracelet that alarms, frequent checks, knowing who's at risk often overlaps with fall risk assessment, placing them perhaps closer to the nurse's station. And finally, connecting all this safety thinking to discharge teaching home safety, right? The safety principles extend beyond the hospital. For elderly patients going home, you teach about removing throw rugs, ensuring clear paths, maybe installing grab bars in the bathroom,
back to sleep always on their back, safe crib environment, slads close enough together, less than 2 and 38 in, firm mattress, no soft bedding, no pillows, no bumper pads. Suffocation risk is real. And one last classic home safety tip, often tested. Hot water heater temperature. These to be set below 120° F. That's about 49 C. Prevents accidental scalds. Especially crucial for kids and older adult. Wow, we covered a lot of ground there. So, to quickly recap the absolute mustnoss, embrace that non-punitive safety culture. Know your racy and passer fire. Nail the PPE sequences. Understand the strict restraint rules. And always keep incident reports factual and separate from the chart.
Exactly. And maybe the final thought to leave you with, remember that safety culture lesson. When things go wrong, med errors, falls, infections look beyond the individual. Most often, it's a sign of a system problem, a breakdown in process, staffing issues, environmental hazards. So, our job isn't just patient care. It's also identifying those system flaws. It really is reporting those barriers, advocating for fixes. That's a core professional responsibility. That's how we make care safer for everyone in the long run.
That's a powerful way to frame it. Fantastic insights today. Thank you. My pleasure. We hope this helps and definitely check back for more conversations each week. Yes, please do. And for those comprehensive resources, study guides, and more to really help you prepare, head over to think likeliurse.org. Thanks for tuning in