January 20, 2007, 1:10 am

Hitting the Nail on the Head: Nurse Meets Evidence Based Medicine

This post first appeared on Emergiblog back in March of 2006. Given that the theme of Grand Rounds this week is “Evidence Based Medicine”, I thought I would submit this post as a perfect example of how EBM affected my practice (and my personal life!).


Well, here it is!

The health coverage we’ve been waiting for!

$540 for hospital expenses for sickness or accident!

That just about covers your first hour.

$135 to your doctor!

This covers the first telephone consult with the hospitalist. Thank goodness! Your own doctor won’t be caring for you so it has to go to somebody!

Loss of work is up to $300! Well, for a nurse in the San Francisco Bay Area, that is a whole six hours! Ah….peace of mind!

And your life is worth $1000. Wow – I thought mine was valued at around $689.99.

It is not available for those over 70. Because you have, like, ten seconds to live.

War coverage is available.

Nah, I get that free on TV.


I am a compulsive nail biter.

When other babies were sucking their thumbs in the womb, I was bitting my nails off.

I’m not talkin’ itty bitty nibbles now and then. I’m talking down to the very last morsel and then peeling the rest to the cuticle, making sure it’s even, without any curves or stray pieces to distract me. My nails grow so fast, there is always something for me to “groom”.

I am sure this behavior is listed somewhere in the DSM-IV (or is it V now?) as an obsessive, compulsive, neurotic behavior with sociopathic overtones.

(Stay with me, this is going somewhere….)

And then I discovered the greatest invention of all time.

Acrylic nails.


I am the only person on the face of the earth who got acrylic nails just to have their nails reach the end of their fingers.

There were times when my own nail remnant was so small they were glued onto the nailbed itself.

Finally, I had, dare I say it…..pretty hands! They grew so fast I actually had to have them redone once a week!

I was cured!

Then I blew it.

I opened my mouth to “Nurse Nasty”.


She trained under Florence Nightengale.

She was there in the Garden when Adam and Eve caught the first virus known to man.

She treated Fred Flintstone for gout.

Michael Crighton used her as a technical consultant when he wrote “Jurassic Park”.


One early morning after a horrifically busy shift in a horrifically busy ER known as “County Hospital Wannabe”, Nurse Nasty approached me with an ongoing issue. I was off the clock, but I had been Charge Nurse that night and my input was needed.

We had been working with a registry nurse who had fingernails two inches long from the end of her fingers. Two long, curved inches.

I’m sure she paid good money for them, but they looked obscene and how she managed to do patient care was a concern.

Nurse Nasty thought it would be best if Nurse Long-Nails didn’t return to the ER as long as she had what looked like ten lethal weapons on her hands. I agreed.

And then I made the fatal mistake.

I had to open my mouth.

I held out my hands with their tiny stubs of acrylics that just reached the ends of my fingers and said, “It will be a cold day in hell before I ever give up my nails.”

No one realized I had acrylics on my stubby fingers.

She wrote me up. Just for making the comment.

Off the clock, one woman to another.

She wanted my manager to know about my “insubordination” regarding the “new nail policy”.

I didn’t even know we had a nail policy!


The “new nail policy” was that acrylic nails were no longer allowed in hospitals.

I was more than angry.

I decided to research what was behind the policy.

I discovered that infection control officers in various hospitals around the country had traced groups of nosocomial infections to nurses with acrylic nails. Specifically, a pseudomonas outbreak in a nursery and a fungal infection in post-op bypass incisions.

Serious stuff.


I was allowed two weeks to let my acrylics grow out so that I could remove them.

And I did.

You can’t really argue with policies derived from evidence based medicine.

I’m pretty sure I could put them on again without anyone knowing now that I no longer work in that ER.

But I won’t.

I don’t want to be passing infections to my patients – the danger is bad enough without having ten bacterial incubation chambers on my hands.


…the very day I retire, you’ll find me in a nail salon, getting a full set of stubby little acrylic nails. Then again, I may even add an eighth of an inch, just for fun.


  • d

    March 15, 2006 at 7:16 pm

    Our hospital has the same policy against acrylic nails. I’ve always kind of wanted to try getting them, but I’d probably get caught (and it’s not like I could feign not knowing the rules, since my boss has had the conversation with EVERY traveler we’ve had come through, and I’ve always been in the same room). See the thing is, my nails are pretty long, and I’m not a biter, but my nails are so THIN that they bend and fold and peel.

  • Jodi

    March 16, 2006 at 1:52 am

    I know how you feel. Pre-nursing school, I did have acrylic nails and often I had them done to the ends of my fingers. I did this because my nails are so incredibly thin and brittle that they were constantly tearing and chipping. I got them short because I always found a way either via a car door or doing laundry to rip one away from my nail bed.
    I miss them…it’s what broke me of the habit of biting my nails in the first place.
    It’s a shame that when I chose my career it also doomed me for a lifetime (at least before retirement) of ugly short splitting nails and cuticles.

    They have antibacterial everything else, why can’t someone invent antibacterial acrylics?!

  • Judy

    March 16, 2006 at 7:08 am

    Evidence based practice – good for you, but isn’t it a shame that there aren’t antibacterial acrylics!

  • Tara's World

    March 16, 2006 at 7:25 am

    What about Silk Wraps? Not acryic and I think they are alot healtier for your nail beds

  • John Cowart

    March 16, 2006 at 1:13 pm

    Befor you remove your nails, you may want to consider scratching somebody’s … No, you’re too nice a person for that. Forget I suggested it.

  • Dr. Deborah Serani

    March 17, 2006 at 11:33 am

    Wondering if you could stop by my blog and let me know what you think about my experience.

    Thanks, Deb

  • may

    March 17, 2006 at 2:31 pm

    this policy has been ignored in our unit for ages. and our nurse manager is not the kind who would pound an adult’s head to follow policies. i guess some people are just not able to follow policies…even if it means endangering patients to some extent.

  • Nurse Practitioners Save Lives

    March 18, 2006 at 9:20 pm

    I’m amazed that we nurses put our fingers ANYWHERE near our mouths with the increased infections out here. I too like the look of acrylics but I manage to grow my own pretty well after years of chewing on them.. After I retire, I will be running to the nail shop!

  • Student Nurse Jack

    March 20, 2006 at 8:32 pm

    I miss my acrylics, too, but when I quit the corporate world, I figured I couldn’t afford them any more. My nails suck, too.

    Which is why I find it so ironic that my fantasy job is to be the one that gets to name the colors in the OPI lines that come out each season.

  • S. R.

    January 20, 2007 at 10:42 am

    Acrylic nails are pretty sexy and feminine. Alas, I also work in a hospital where they aren’t allowed so none of the ladies wear them. Also, nurses always have kind of beat up hands as it is with all of the handwashing and general use in patient care.

  • Rachel

    January 20, 2007 at 7:06 pm

    I admit to being a habitual nail-biter and one-time acrylic nail-fan. I learned from my experience working at a well-known surgical products manufacturer. Maybe too much malpractice fear, but nonetheless, the infection rate is a little scary. Or the idea that acrylics (on a patient) could ignite fires in the OR.

  • Chele

    January 21, 2007 at 1:00 am

    Its funny…10 yrs ago when I graduated, it was kind of like an initiation of sorts. I went and got acrylic nails like all the other nurses on my floor had. I was one of them. I don’t have them anymore, not allowed. I don’t want them really, its not me, but they were pretty.

  • Dawn

    January 21, 2007 at 10:25 am

    I have to cut my natural nails on average about once a week because they grow really fast. I’ve always had long pretty nails (read on before you want to bitchslap me)and now…..oh well. Now I keep them about 1/4 of an inch above my finger tip and I still have french manicures done at the salon and you’d never know they weren’t acrylics, I get asked all the time by my nursing instructors.

    When I was a teenager my mom was told that if yo put a few drops of formaldehyde(sp) in a bottle clear nail polish that her nails would grow faster and stronger. My mom being the person that she was thought if 3 drops is good then 6 is better! Her nails grew so fast that it bruised her nail beds. When she finally put the suggested 3 drops she let all of us girls use it and I went from having thin, brittle, peeling nails to very strong nails that grew sturdy and long very quick. Good stuff and worked wonders. Not sure how safe that is or how one comes across formaldehyde but as a teenager I didn’t really care.

  • emmy

    January 21, 2007 at 12:11 pm

    Just a question; won’t natural nails carry the same germs? I mean wouldn’t hand washing and gloving be more effective to prevent passing around germs?

  • Kim

    January 21, 2007 at 12:53 pm

    Girl that is totally DSM-I! heh heh. Ok, here’s some news. I am going back to school to get my nursing degree. No specialty in mind yet. Psychiatry? Maybe. BTW, I do a bitchin set of acrylics and will be happy to do yours for free if you wanna ever make the trip. Heh heh. Yes, I got my licence, I didn’t keep it up as I was more interested in a medical career somehow, but I got it. Took my state board in San Francisco. Yes, I did!

  • A Bohemian Road Nurse...

    January 21, 2007 at 3:08 pm

    Your post cracked me up! About the nails issue–I know some nurses who refuse to work at a nearby hospital because of their policy against nails. I’m a nail-biter so I never did have the most graceful-looking fingers. But my southern-belle mother wouldn’t be caught dead without her acrylic nails.

  • marachne

    January 21, 2007 at 10:19 pm


    I hate to put this here, but I’ve tried to e-mail you twice and both times have gotten bounced back. Drop me a line, ok?

  • NPs Save Lives

    January 22, 2007 at 7:15 am

    I also was aware of the acrylic nail issue with infection. Our hospital doesn’t allow them either but people still break the rules. I used to be a nail biter in the past but my own nails now grow pretty fast. I’ve gotten so used to keeping them relatively short that I often cut them back now.

  • Candy

    January 22, 2007 at 8:36 am

    Evidence-based practice is the first rung in the ladder of professional nursing!! Yay!

  • Deacon Barry

    January 23, 2007 at 5:30 am

    What do you do if a patient going to theatre has acrylic nails? We have bottles of acetone for removing nail varnish, but if the nails are cemented on…? The nails need to be clear so that the pulse oxymeter can work accurately, and the nail beds are visible for early detection of hypoxia. So far, along with intimate body piercings, it’s not a problem I’ve encountered, but I know it’s only a matter of time.

  • Annapolitan

    January 23, 2007 at 6:01 pm

    May I suggest one product that I found has worked wonders for my thin peeling nails: Nail Envy by OPI. They have a formula for every nail problem, and good news: it costs almost as much as a full set of acrylics. But it’s worth every penny. That and Burt’s Bees lemon butter cuticle cream has made my hands worth looking at for the first time in about 20 years. (Oh, and Paxil CR did wonders for the nail biting.)

  • MinnieJ

    March 4, 2007 at 4:02 pm

    I am a rehab nurse.
    My director of nurses has acrylics.

    I have acrylics and so does a lot of other nurses.

    OH well, I wear gloves and wash my hands before and after every patient.

    I think the evidence is not true.

    What about stethascopes don’t you think they have infection on them. ee-hmm.

  • reneeb

    June 5, 2007 at 5:48 pm

    If you coat a nail with a product that is completely sealed and does not have a free edge, why should nails not be allowed? We have developed a product that gives everyone an option. Go to our website at: http://www.vipsalonandspa.com. Don’t hesitate to write comments!

  • jenny

    July 2, 2007 at 9:03 pm

    I don’t believe fake nails cause infections. I think poor observance of univesal precautions causes infections. As an RN with nails’ mine are short. washed between patients
    , and I wear gloves as I am suppose to. If every health care provider followed the guidelines for infection control, acrylic nails -properly cared for would not be an issue.

  • Dorie

    July 6, 2007 at 11:48 pm

    I think that “evidence” behind that study needs revisited. If the nurses WEAR GLOVES like they are supposed to and WASH THEIR HANDS before and after every patient contact, acrylics would not transmit an infection. I am an RN and have been for almost 20 years. I am tired of working in a “profession” (they call it that when it is convenient for the administration, but they don’t treat you like a professional) where we are expected to look like a frump. Dorothea Dix died a long time ago! Come on!

  • Leanne

    November 14, 2009 at 3:25 am

    I am a theatre nurse, and have had acrylics for 15 years. Between washing hands before and after patient contact and closed gloving, I find it hard to believe acrylic nails are breeding grounds for germs. I’ve seen nurses with parynicia’s, chewed nails down to the beds, and cracks in the skin that are just as potential (if not more) breeding grounds for bacteria. When I googled research on the subject, the last article I could find was from 1991. Like everything, acrylic nails have evolved with technology and perhaps not allowing them in nursing is just another sacred cow.

  • Michele Lunow

    May 11, 2010 at 9:27 am

    I work for a medical transport company and when i brought up the subject of acrylic nails and how they can harbor bacteria…on of the medics that works for the company said i didn’t know what I was talking about and that it only pertains to hospital workers in other words only nurses not medics. If any one out there knows of any studies which includes ems in their studies, please pass on the info. In the mean time I will continue my research. Thank you

  • Mo

    June 27, 2010 at 11:09 am

    I have been working on a research project for the last few weeks that has provided me with substantial empirical evidence to support the ban on acrylics, wraps, any evidence of chipped polish and any nail longer than the tip of the finger.Bacterial loads flourish under acrylics before and after a 5 minute antimicrobial scrub according to CDC, AORN, WHO standards. Why remain in healthcare if you are not commited to best practice. New moms are risking the health of their newborns. Your food service providers are risking your health, nail salons pose many risks. This is all supported with well substantiated data. How can you scrub under your nail bed with the nail in palm method as used in standard handwashing technique if your lengthy nails do not pemit the tips of your fingers close to the palm. The CDC issued their strongest recommendation to ban acrylic nails for ALL healthcare workers after completing a number of conclusive epidemiological studies. JCAHO then ruled that fingernails be short, natural, and healthy for anyone in contact with patients.I ask you, at what price vanity? Immunosupressed, elderly, neonates? We did not enter healthcare to spread disease, let’s not lose sight of our original mission. If it’s any consulation to you, RN’s came out with the highest hand hygiene compliance rate.

  • Mo

    June 27, 2010 at 11:11 am

    I misspelled consolation while on my pulpit, sorry…my passion overtook me before a thorough proofreading.

  • Noel

    October 11, 2010 at 11:07 am

    As a former nail technician/manicurist I so understand wanting to have beautiful nails and hands. Having to remove the acrylic nails makes sense but women still deserve to feel good about their appearance no matter what profession they’re in! There are ways to be able to grow your own healthy nails, it just takes a little effort. I’ve started a blog with some info. that might help Nailfitness.wordpress.com . I remember when I took my acrylics off years ago….it wasn’t a pretty sight. But eventually they did grow out and now they look great!

  • Joshysgramm

    January 14, 2011 at 2:17 pm

    Having been a Nail Tech in Indiana for 10 yrs., I have to agree with Noel…you can have pretty nails but it takes time. What I don’t agree with is the ignorance that ALL nail salons are the same…do some research! Most of your “discount” salons use products with MMA (which is illegal in Indiana)…this product can cause cancer, but hey, you get nails $10 cheaper! LOL It also makes a huge difference how the nail is prepped (the nail “bed” is never prepped…it’s under the nail plate) There’s also the misconception that all natural nails are clean and healthy…ever do a petre dish swab of what is under your nails…I have and it’s disgusting!!
    Bottom line…if you go to a good, reliable Nail Tech (not your local cosmetologist) they can help you all you need…that’s what we are trained in!

  • Joshysgramm

    January 14, 2011 at 2:18 pm

    P.S. You can NEVER scrub under your “nail bed”!!!

  • Vicky Blaise

    January 16, 2011 at 10:32 am

    To all on this blog I have been a RN in many nursing ares for 18 years wearing acrylic nails the whole time and NEVER have I had a patient develope an infection of any kind while in my care. So I find it hard to believe the EBP presented in this blog and normally I am a HUGE proponent of EBP. I believe these studies may not have taken in to account the hygeine habits of the participants. I use frequent hand washing, alcohol foams and gloves. I clean my nails with a toothbrush and soap and water daily and as needed. And yes you can clean the underside of nails with acrylic the same as nails without acrylic. The acrylic does not cover the under tip of the nail. I have also been a participant if a local hospital study where a surgeon blamed the infections of his patients on the nurses so we volunteered to have our nails cultured. Nothing but mixed flora was found however some ugly things were found in the beard of the surgeon in question. If the RN that mentioned several studies stating the infection caused by acrylic nails would share links to those articles, I would love to read them.

  • Jane Moss

    July 21, 2011 at 6:00 pm

    I’m a cma doing a paper on babies who have died from acrylic nails in neo some one said they get a infection, can any one tell me about that please and thanks.

  • Sharon

    April 1, 2013 at 1:19 pm

    Ok. So. I have work induced eczema. I’ve been a nurse for over 30 years. The only way I can have decent looking nails is to have acrylics done. I don’t want them long I just want them natural looking. I wear gloves whenever I touch a patient. So, WTF is the big deal exactly?!

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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