Little is Definite, 100% of the Time

jadelpn, LPN, EMT-B

Policies and procedures vary widely. By state, by facility, by unit. What is "common" for one facility, is not always common in another. Acute vs. LTC is apples to oranges. So as part of orientation, or as part of precepting a new employee, it is important to talk about and become familiar with policies and procedures that affect nursing practice.

There has been a few threads popping up regarding "questionable" practices. Generally speaking, as nurses, we know what a "general rule of thumb" is. We have comfort zones, levels of ethics that we adhere to, safe practices. We are prudent. Everyone's intent is safe patient care, with the best patient outcome as possible. Even nurses who are burnt out or overwhelmed, we go to work everyday with an intent to cause no harm. Sometimes, some of us are confused as to how to deliver care to patients in a way that may be different than what we are taught, generally know to be true, or how we have practiced in the past.

One of the ways that we can look to how a facility and/or unit wants us to practice is by asking where one can access policies and procedures. It is important to know where this information is, and that you have access to it. Not saying for a moment it needs to be read like a novel, however, it should be referred to with any practice questions that a nurse may have.

Another way one can find out information is to ask in a staff meeting forum. If people deviate from set policy (and you may find that policies are really outdated) then the question to ask is why. A thought would be to update policy. A reminder would be that if in fact the unit is audited, what policies are still in play, and which have been deviated from?

Sometimes it takes fresh eyes and new insight. To protect yourself, you should always carry malpractice insurance. This is a good protection. Obviously, if there's a huge disconnect over patient care and how nurses are practicing in outright opposition to safe care, this is a complete other story. In that instance, know where to go or not go with that information--your employee handbook is a good reference, as is your union contract if you are a union facility.

If you are uncomfortable with what someone is asking you to do, then ask why it is that it is done that way. Think about how you are comfortable completing the task at hand, and talk about if you are able to do it that way. There is not just one means to an end. If you are able to talk about alternate orders that support what it is everyone is trying to accomplish with far less time wasting steps, then by all means ask.

We can not go in and change the world. We can not go in and make sweeping assumptions on how things can be done our way, the better way, this way stinks. However, fresh eyes are interesting. And gives pause to how things can be done more efficiently, in a patient's best interest, and a lot less nerve wracking.

Little is Definite, 100% of the Time

About jadelpn, LPN, EMT-B

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