Evaluation of a Nurse-Driven Protocol to Remove Urinary Catheters

Nurses' Perceptions

Kristi Olson-Sitki, MSN, RN, NE-BC; Geri Kirkbride, PhD, RN, CPPS, CENP; Gordon Forbes, PhD


Urol Nurs. 2015;35(2):94-100. 

In This Article

Abstract and Introduction


This article describes nurses' perceptions of the effect of a nurse-driven protocol in a Magnet®-designated hospital. Post-protocol implementation data indicate improved job ease and positive patient feedback following protocol implementation. Younger or less-experienced nurses were likely to use the protocol.


Urinary tract infection (UTI) is one of the most common hospital-associated infections, and urinary catheters are associated with 70% to 80% of those infections (Lo et al., 2014). Research data indicate that the risk of infection increases about 5% each day a catheter remains in place; thus, it is imperative that catheters be removed as soon as possible (Gould et al., 2014). The Joint Commission (2015) recognizes catheter-associated urinary tract infection (CAUTI) prevention as one of the National Patient Safety Goals for hospitals. Nursing care plays a vital role in CAUTI prevention; thus, the American Nurses Association (ANA) (2007) has classified CAUTI as one of 14 nurse-sensitive indicators, meaning the measure reflects the quality of nursing care and interventions provided. In addition, the Centers for Medicare and Medicaid Services (CMS) considers CAUTIs "never events" and will not reimburse hospitals for treatment of these events (Saint et al., 2013).

Despite attention paid to maintenance bundles and decreased utilization rates, CAUTI prevention and treatment remain a challenge. Maintaining a closed drainage system, keeping the drainage bag below bladder level, catheter care, and removing the catheter as quickly as possible are all interventions recognized by the Centers for Disease Control and Prevention (CDC) and others to decrease CAUTI rates (Association for Professionals in Infection Control and Epidemiology [APIC], 2014; Fakih et al., 2012; Gokula, 2012; Gould et al., 2009; Oman et al., 2012; Saint et al, 2009). Barriers to implementing these interventions include difficulty with nurse and physician engagement, patient and family request for indwelling catheters, and cultural habits of leaving catheters in place (Krein, Kowalski, Harrod, Forman, & Saint, 2013). In addition, evidence suggests that younger registered nurses (RNs) may be more likely to use a removal protocol than veteran RNs (The Advisory Board, 2014).

CAUTI rates at the study site were reported to be above the National Healthcare Safety Network (NHSN) benchmark (Dudeck et al., 2013) for eight consecutive quarters prior to implementation of the removal protocol. Nurse-driven catheter-removal protocols have been described as successful interventions in decreasing catheter utilization (Alexaitis & Broome, 2013; Hooton et al., 2010; Lo et al., 2014; Parry, Grant, & Sestovic, 2013; Purvis et al., 2014; Saint et al., 2013; The Advisory Board, 2014). Nurses' perceptions of the protocol are of interest because the link between nurse satisfaction and patient outcomes has been established (National Database of Nursing Quality Indicators [NDNQI], 2014). In addition, nurses' perceptions of their professional practice work environment has been linked to job satisfaction and quality of care (Lambrou, Merkouris, Middleton, & Papastavrou, 2014).