Think you know safety and infection control? Think again. In this episode we break down the Top Safety Traps on the NCLEX—and how to avoid them. From charting mistakes and restraint rules to PPE doffing errors and fall prevention mnemonics, you’ll learn how to think like a nurse, not just memorize. Perfect for nursing students preparing for the NCLEX or new grads who want to build real-world confidence and protect their license.
1. Safety Culture: From Blame to Learning
Non-punitive reporting → encourages learning from near-misses.
Focus on system improvement, not punishment.
Incident reports:
Internal risk-management tools—never document “incident report filed” in the chart.
Chart only objective facts and nursing actions.
2. Fall Prevention: Mnemonic FALLS
F – Floors clear and dry
A – Ambulation aids within reach
L – Lighting bright, especially to bathroom
L – Low bed position
S – Shoes/non-skid socks
Top priorities: Bed low, non-skid shoes, call light accessible, frequent rounding.
3. Pressure Injuries
Braden Scale ≤ 18 = High risk.
Reposition every 2 hours, offload heels completely.
Use pressure-relief surfaces.
4. Emergencies
Code Blue: Call for help, start CPR—CAB sequence.
Rapid Response: Activate team, stay with patient, reassess continuously.
Code Stroke: Time = brain. Prepare for stat CT, frequent neuro checks q15 min.
5. Fire Safety
RACE: Rescue → Alarm → Confine → Extinguish.
PASS: Pull pin → Aim low → Squeeze → Sweep.
6. Hazardous Materials
Chemo: Double gloves, chemo gown, black chemo-waste container.
Radioactive Implants: Time, Distance, Shielding; restrict visitors < 30 min; lead containers for waste.
7. Ergonomics / Zero-Lift Method
Bend knees, keep load close, push > pull.
Use hoists/slide sheets if > 50% assist needed.
8. Infection Control
Standard Precautions: Apply to every patient; hand hygiene before/after contact.
Airborne: N95 mask + negative pressure room (TB, measles, chickenpox).
Mnemonic: My Chicken Has TB.
Contact: Gown + gloves (MRSA, VRE, C diff).
C diff: Soap and water only—no alcohol sanitizer.
PPE Donning: Gown → Mask/Respirator → Goggles/Shield → Gloves.
PPE Doffing: Gloves → Goggles/Shield → Gown → Mask (outside room) → Hand hygiene.
9. Restraints
Last resort—never PRN.
Violent: Order valid 4 hrs, check q15 min.
Non-violent: Order valid 24 hrs, check q15–30 min.
Remove q2h for skin check, ROM, fluids, toileting.
Use quick-release knots only.
10. Security & Home Safety
Infant abduction: Matching ID bands + security tags.
Elopement: Wanderguard bracelets, room away from exit.
Home safety: Remove throw rugs, add grab bars & lighting.
Crib safety: No soft bedding, slats < 2⅜ in apart.
Hot water heater: < 120°F to prevent burns.
When things go wrong, think system, not individual.
Was staffing safe? Was the environment optimized? Reporting and analyzing these issues strengthens safety culture.
Safety culture > blame culture
Incident report = risk management tool
FALLS & RACE/PASS mnemonics
Airborne vs Contact precautions (PPE sequences)
C diff → soap and water
Restraint rules and time limits
Home safety teaching points
A patient with C diff requires wound care. Which PPE combination is correct?
A) Gloves only
B) Gown + Gloves
C) Mask only
D) Gown + Mask
✅ Answer: B.
Rationale: Contact precautions require gown and gloves. Use soap and water after care.
Welcome everyone to Think Like a Nurse. This is where we take those really complex nursing topics and well, we try to make them much easier to understand. Especially if you're getting ready for the NCLEX, right? We want to help you really get the why behind the protocols. Exactly. It's about understanding, not just memorizing, so you can start genuinely thinking like a nurse. And today we're tackling a huge one, safety and infection control. Foundational stuff. Absolutely foundational. And it's a big chunk of the exam too. Uh something like 10 to 16%. So mastering this is key, not just for the test, but for protecting your patients and honestly yourself.
Definitely. And before we jump in, just a quick note. This show is created by Brooke Wallace. She's got 20 years as an ICU nurse, organ transplant coordinator, clinical instructor, and she's a published author, too. Yeah. Incredible background. And if you want more great resources after this, you should definitely visit think like nurse.org. Okay, so where should we start? Safety culture seems like the right place. I think so. It's kind of the bedrock for everything else we'll talk about. The shift away from well blaming individuals.
Yeah. The old culture of blame. It's fascinating how much that's changed or at least how much we're trying to change it. You know, historically if an error happened, someone got blamed the finger. Right. Exactly. Find the nurse who messed up. Maybe discipline them. But like you said earlier, that just makes people afraid to speak up. Totally counterproductive. If I think I'll get in trouble, I'm probably not going to report a near miss or even may be a small error and then the system itself never learns, never improves.
Precisely. So the goal now is the safety culture. It's about non-punitive reporting. Seeing those near misses, the times something almost went wrong not as failures but as like free lessons, gold mines really. They show you exactly where the cracks are in the system, right? Which leads perfectly into um incident reports because documenting those events is crucial, but there's a huge pitfall there for nurses. Oh yeah. charting trap. This is super important for exams and for real practice. You have to fill out the report.
factually. No opinions, no blame, just what happened. It's usually an internal hospital form. Okay, so you do that part, but the key rule is you never write incident report filed or anything like that in the actual patients medical record ever. And why is that? It seems a bit secret. Well, it's about legal protection really. That incident report, it's considered risk management's property. It's for internal quality improvement, figuring out system issues. Ah, okay. So, if you mention it in the chart,
you potentially make that internal document discoverable in a lawsuit. You basically link the two. So, in the chart, you just document the objective facts. Patient found on floor next to bed at 08.30. Assessed by nurse, provider notified, vital signs stable, neuro checks initiated, that kind of thing. Exactly. Just the facts of the event and your actions. Nothing about filing a report. Makes sense when you put it that way. Okay, let's shift gears to preventing some of those common incidents, starting with fall. huge issue.
huge. We use tools like the Morse fall scale or maybe the Hendrick to figure out who's high risk. But once you know they're high risk, what do you actually do? Right? The actions. I like using pneumonics here. How about FALLS? Oh, that's a good one. Okay, break it down. So F is for floors. Keep them clear. No clutter. Watch for spills. A is for ambulation aids. Walker, cane, whatever they need. Make sure it's right there within reach. Okay. Floors, aids. L is lighting. Make sure the room is well lit, especially at night. Path to the bathroom clear. Another L is for keeping the bed in the lowest position. Super critical.
Lowest position. Absolutely. And the last S. S is for shoes or rather non-skid footwear. Those grippy socks or proper shoes, not just flimsy slippers. Flls floors, aids, lighting, low bed shoes. Got it. If you had to pick the absolute top priorities, the must dos. Bed low, non-skid footwear, and make absolutely sure that call light is right where they can reach it easily. Don't forget that one. And frequent rounding, right? Just checking in often. Oh, definitely. That proactive check-in can prevent so much. Okay. Related issue, pressure injuries. We use the Braden scale, right? Score 18 or less means high risk.
Yep. And the interventions focus on relieving that pressure. So, repositioning every two hours like clockwork minimum. And using pressure relief surfaces helps, like special mattresses. But a really key point is offloading the heels. Ah, the heels. Why are they so vulnerable? Well, the bones very close to the skin there, and it's easy for them to just rest on the mattress, cutting off circulation. You need to make sure they're actually floating completely off the surface. Sometimes pillows aren't quite enough.
Good point. Okay, let's switch to emergencies. Codes, time is everything. What's the absolute first thing a nurse does? Depends on the code, right? For a code blue cardiac arrest, first thing is yell for help and start CPR. Remember, CAB compressions first. Call for help, start compressions. Got it. What about a rapid response? The patient's crashing but not arrested yet. Activate the team, hit the button, call the number, whatever the system is. And then stay with the patient, keep assessing, keep monitoring until the team arrives.
Don't leave them. Okay. And the really time-sensitive one, code stroke, that treatment window is so short, less than four and a half hours for thrombolytics usually. So, so time is literally brain. Yeah. The nurse's first actions. Get them ready for a stat CT scan like immediately and start frequent neuro checks. often every 15 minutes because that CP tells you if it's eskeemic or hemorrhagic which dictates treatment. No delay is allowed. Absolutely critical. Okay. Moving from medical emergencies to environmental ones like fire. There are two key pneummonics students have to know. First the overall response RACE.
right? R is for rescue. Get anyone in immediate danger out. Then A is alarm. Pull the fire alarm. Call the hospital car. Let people know. C is confined. Close doors, windows. Try to contain the fire and smoke. And finally E is extinguish, but only if the fire is small, you're safe, and you know how to use the extinguisher. Otherwise, just focus on RAC. Okay. Rey, rescue, alarm, confined, extinguish. And if you do use an extinguisher, there's another pneummonic, PASS. Yep. How to use it? Pull the pin.
Aim the nozzle at the base of the fire, not the flames way up high. Right. Aim low, then squeeze the handle. And sweep the nozzle side to side across the base of the fire. Pull. Aim. Squeeze. Sweep. Pass. Got to know that sequence. Definitely. Okay, still on hazards. What about handling specific dangerous materials like uh chemo drugs? Special handling required there. You need specific PPE double gloves. The special chemo gown, not just standard precautions. Yeah, disposal. Goes in a dedicated chemo waste container, usually black, clearly marked, not the regular red biohazard bag.
Okay. What about radioactive implants? Less common maybe, but important if you encounter it. Key principles are time, distance, shielding. Limit your time in the room. Increase your distance when possible. Maybe chart just outside the door. Use lead shielding if available like lead apron sometimes. In visitor, usually restricted, often limited to maybe 30 minutes per day. And they need to maintain distance too. Any waste or the implant itself, if removed, goes in a lead container. Got it. Time, distance, shielding. Before we hit infection control proper, one more safety piece. Ergonomics. Yes. Protecting ourselves.
Yes. So important for career longevity. Basic body mechanics. Bend your knees, not your waist. Keep the load, whether it's a box or a patient close to your body. Use your legs, the big muscles. Exactly. And push rather than pull if you can. But the biggest thing now is the zero lift culture. Meaning meaning use assistive devices, hoists, slide sheets, hover mats. If the patient needs significant help, more than maybe 50% of your effort, you should not be lifting manually alone. Get help. Get the equipment. Protect your back.
Absolutely non-negotiable. Okay, let's dive into infection control. Standard precautions first, the baseline, right? This applies to every single patient all the time, regardless of diagnosis. It's your default setting. And it basically means hand hygiene. Hand hygiene is huge. Yes. Before touching a patient, after touching them, after contact with fluids, after removing gloves, and wearing gloves whenever you anticipate contact with blood, body fluids, mucous membranes, or non-intact skin.
your basic shield for everyone. Exactly. Then if you know or suspect a specific in infeious agent, you add transmission-based precautions on top of standard. Okay, let's break those down. First up, airborne precautions. The serious ones like TB, measles, vericella, or chickenpox. These pathogens are tiny, float in the air, so you need higher protection. That means a fitted N95 respirator mask for you entering the room, not just a surgical mask. Correct. N95. And the patient needs to be in a negative pressure room, an AIR airborne infection isolation room.
and that negative pressure just means air flows in but not outright. Mhm. To keep the germs contained. Precisely. And if the patient has to leave the room, say for a test, they wear a regular surgical mask. Then source control. Right. To help remember which diseases are airborne, that classic pneummonic. My chicken has TB. Measles, chickenpox, vericella, herpes, zoster, but only if it's disseminated or widespread. And TB tuberculosis. Good one. Okay. Next level. Contact precautions for stuff spread by touch like MRSA, VRE.
CIFF. Yes, CIFF is a big one here. For contact precautions, the minimum PPE is a gown and gloves. Put them on before entering. Take them off before leaving. And you often use dedicated equipment for that room. Like a stethoscope stays in there. ideally. Yes. To prevent carrying germs out on equipment. Now you mentioned seiff. There's a critical point about hand hygiene there. Ah right. Alcohol sanitizer doesn't cut it. Doesn't kill the spores effectively. So for CIFF you must use soap and water. Physically washing the bores off your hands is key. Alcohol- based rub is fine for MRSA or VRE, but not CIFF.
Soap and water for C diff. Got it. Okay, this brings us to the really high spakes skill, putting on and taking off PPE correctly, especially taking it off doawing. That's where you can contaminate yourself. Absolutely. Let's do dawning. Putting on first. You generally go from protecting your core outwards. So, gown first. Okay. Gown. Then mask or respirator N95 if needed. Then goggles or face shield. Gown. Mask. Goggles. And finally, gloves. And make sure the gloves cover the cuffs of the gown. Create a good seal.
Gown, mask, respirator, goggle shield, gloves. Got it. Now, the tricky part. Doffing taking off. Remove the most contaminated things first. Right. Exactly. Think about what touched the patient or environment most. That's usually your gloves. So, gloves come off first. Okay. Gloves off. Then your goggles or face shield. Next, the gown. Untie it. Peel it away from you, touching only the inside as you roll it into a ball. Gloves, goggles, gown, inside out. What's last? Your mask or respirator. And critically, if it's an N95 for an airborne room, you typically take that off after you've left the patient's room and close the door.
Ah, good distinction. N95 comes off outside the room. And hand hygiene after every single step of doawing if possible, but absolutely critical after all PPE is removed. Wash hands or use sanitizer thoroughly. That sequence is so important. Practice it. Okay. Final section, restraints and security. Big principle with restraint. Last resort. Absolutely the last resort. Never ever PRN as needed. You have to try and document alternatives first. Like what? Reorienting the patient, moving them closer to the nurses station, maybe a sitter, using bed alarms, offering distractions or activities. You have to show you tried other things before resorting to tying someone down.
Makes sense. And there's a difference in the rules depending on why the restraint is needed, right? Violent versus nonviolent. Huge difference, especially for orders and monitoring. For an adult who is violent or self-destructive, the doctor's order is only good for 4 hours max. And they need a face-to-face assessment by the provider relatively quickly, often within 8 hours. And how often do you check on them? Every 15 minutes. Constant observation basically because the risk is high. Okay. 4-hour order, 15-minute checks for violent. What about nonviolent restraints like preventing pulling out an IV in a confused patient?
The order can be good for up to 24 hours. And the checks are less frequent, maybe every 15 to 30 minutes, depending on policy. Still frequent, but not constant. But regardless of why they're restrained, there's something crucial you have to do every couple of hours. Yes, every 2 hours, you must remove the restraint briefly. Check the skin underneath for breakdown. Assess circulation. Offer toileting fluids. Allow for some range of motion. Prevent complications from the restraint itself. And always use a quick release knot.
Absolutely. Something you can undo immediately in an emergency with one pull. No complex knots. Good. Okay. Quick security points. Pro preventing infant abduction. Matched ID bands on mom and baby. Always check them. Security tags on the baby, often with alarms at exits. And never, ever leave an infant unattended. Constant vigilance. What about patients at risk for elopement like wandering? Use wanderguard systems if available. Those bracelets that trigger alarms. Place them in rooms away from exits if possible. And again, frequent checks and observation, knowing your patients routines and risks.
Right. Finally, let's connect this all to discharge teach. ing home safety. Big points for elderly folks. Remove throw rugs. Huge fall hazard. Install grab bars in the bathroom. Shower. Good lighting. Clear pathways. And for infants, back to sleep always to reduce SID's risk. Make sure crib slats are close enough together less than 2 and 3/8 in apart. No soft bedding, bumpers, stuffed animals in the crib due to suffocation risk. Safe sleep environment. Got it. And there's one more big home safety check. Often an Enclelex favorite involving temperature. Ah, the hot water heater. Yes. It needs to be set to less than 120° F, which is about 49° C.
Why that specific temperature? Because water hotter than that can cause severe thirdderee burns incredibly quickly, especially in infants and the elderly whose skin is more fragile. We're talking seconds. It's a major preventable burn risk. So, check that temperature setting. Less than 120. That's a critical teaching point. Wow, we covered a lot of ground there. We did. But it's all interconnected. Isn't it? That culture of safety underpins everything.
It really does. So to quickly recap, we talked about shifting from blame to a safety culture. The tricky rules for incident reports document but don't chart about the report. We hit those key pneummonics falls, race, pass. Nailed down the differences in transmission based precautions. Airborne meeting that N95 and negative pressure room. Contact needing gown and gloves and always soap and water for C diff.
And got the PPE dawning and doawing sequence down pat, plus the strict rules around restraints, last resort, time limits, frequent checks, 2-hour removal for care, and connecting it all back to home safety. It's a lot, but it's the core of safe practice. Definitely. Any final thought for our listeners to sort of mle over? Yeah, I guess just remember that when things do go wrong, a meds, a patient falls, try to look beyond the individual involved. More often than not, it reflects a system issue. Maybe the process is confusing. Maybe staffing was unsafe. Maybe the environment wasn't set up right. So, our job isn't just following rules, but seeing those system problems.
Exactly. Understanding those barriers and importantly reporting them through the proper channels like incident reports or safety committees. That's how we actually make care safer for everyone in the long run. It's part of our professional duty. That's a really powerful way to frame it. Thank you. This has been incredibly helpful. My pleasure. Hope it helps clear things up for everyone listening. We certainly hope so, too. Thanks for joining us on Think Like a Nurse. Make sure to check back for more conversations each week.
and don't forget to visit think like a nurse.org for more comprehensive resources and support for your studies. We'll see you next time.