Policies and Procedures

[Laceyrochelle26]

Hello everyone

I am not sure if it is best to post this here or in the specialty of nurse staff development (this normally doesn't fall under education responsibilities in some of the bigger hospitals so I didn't know if it really fit in that group). I am a clinical education coordinator at a small rural hospital. I have always worked in a large metro hospital until just a few months ago when I took this position to be closer to home. Wow.. culture shock!!!

We are currently going to change from using written policies and procedures for nurses to using lippincott (an evidence based online program that we buy a subscription too... they have the procedures, check lists, videos, etc)... but I am curious of HOW we do this. At the previous hospital I worked for there was a commitee that worked on policies and procedures and kept them updated.. no one does that here. It used to be one person but they left a couple years ago and now no one really does it so everything is very outdated.

Does anyone work for a small hospital and have any experience in this being done or have any suggestions for me about how we go about doing this? I was thinking about having shared governance take it on and work through comparing and helping us c hange over to the new system or starting a committee specific to this?

Thank you! :-)

[nurseprnRN, BSN, RN]

I was in exactly your position once upon a time. I had previously heard one humorous, yet oddly perfect, suggestion that the entire P&P manual in a big University teaching hospital be replaced by three pages, the first two covering schedules, vacation time, paychecks, etc., and the third saying, "For all clinical practice questions, refer to the Lippincott Manual of Nursing Practice, most current edition." I did see that every nursing unit had a copy of that great book early on.

Seriously, it's a great book and generally well up-to-date on all matters of evidence-based nursing practice.

If you really want to take on a multiyear project, because that's how long it takes, get a copy of the P&P book and go through it for outdated or no-longer-applicable ones. Bring them to the next nursing management meeting (which you should always attend), and make your case for puling those out of the books on the floors. Then when they OK that, make a great show of doing that in the middle of the nursing station with staff watching. That's your start.

Then you block out a few hours per week for a few weeks to sit down in the library or your office and go through the remaining ones one by one to see how they compare to the LMNP. Flag the ones that are seriously bad, and bring those to nursing management meeting the next month. If any nurse manager's unit specializes in one of those, ask for a reference to an experienced and respected staff nurse to look at it and help rewrite it to be congruent c the LMNP. When done, another big show of appreciation on the floor, recognition in the house newsletter or bulletin board outside the cafeteria. Lather, rinse, repeat, getting input prn from physicians/nursing specialists/pharmacy/therapists/whoever is also involved in a given policy, e.g., conscious sedation, cardiac monitoring, newborn evals, wound VAC, infection control, hospice referrals .... whatever. Be sure to type the date of the revision on the bottom of the pages.

When you have a few nurses who have helped c this, dub them a Nursing P&P Committee on paid time (yes, get approval for that) and ask them to meet for no more than an hour quarterly (and bring good snacks, and rotate hours if any of your experts are on non-day shifts) to review what's left. Let them decide how to divide up the book for periodic review at your quarterly meetings.

[Laceyrochelle26]

Thank you for your suggestions!! :-) We aren't using the book we are using their online program... you get log ins and it is automatically updated by lippincott which is nice.. granted they've probably been paying for it for multiple years and never use the darn thing!

I should be going to nurse management meetings? HA! I wondered since they seem to talk about some things that would pertain to education.. not always but sometimes. I think it is just the directors and our CNO right now that attend.

Everything is like that here though.. their orientation process is absolutely horrible.. no preceptors nothing really. I have to make one from scratch and really don't have any idea how ha. I know there are quite a few good programs out there you can buy that help you along but I don't think they have the money for it. Education has no budget.. what I do is try and sweet talk all the different departments into buying something that Ic an use... if we want some assessment testing or bring someone in to do a discussion and get CEUs.. I have to get another dept to buy it so I can offer it

[nurseprnRN, BSN, RN]

Nobody will give you power. You have to take it. Make up a budget for what you reasonably need-- CPR dummies, IV arms, paper, demo stuff, whatever (don't forget to meet your new best friends in the purchasing department-- they know all the vendor reps and can get you samples and freebies) --- and ask to be put on the agenda for the next mgmt meeting to discuss this and the P&P issue. Say you will report back to the next meeting. Then before the next mgmt meeting, remind the secretary who types up the agenda (another new best friend) to be put on the agenda because you're coming to update everyone.

Like Scheherazade, your goal is to keep them hanging in expectation for the updates and the next installments, and soon they will assume you'll be there regularly. You may also find the occasion to ask if there's an issue you can help with-- you're right almost everything has an education component. :)