Protect Yourself, Protect Your License, and Most of All Protect Your Patient

[madwife2002]

Did you know that the only way to protect yourself in a court of law is to follow your company's policies and procedures, to the letter!

If it is in the Policy and Procedure (P & P) manual, then it is written in stone for your workplace. If you chose to not follow the P & P and something goes wrong then you are not covered by the facility where you work.

P & P are available to support, guide, and protect your practice. They are also there to protect the hospital or facility you work at from being sued. If you do not follow the P & P then they can fire you immediately and if a patient is harmed or dies then the buck stops at you!

Reading the P & P is up to you. I strongly suggest you find out where it is located and familiarize yourself with the contents.

If you had poor nursing training, mentors, and or preceptors then you can bet your bottom dollar half of them don't follow the policy and procedures provided by your facility.

I suggest that you familiarize yourself with your company's current P & P. Most health care facilities have a committee who update these on a regular basis and often they will change. You will be informed of the changes either by email or in a staff meeting.

Some Managers will review changes with you - making sure you understand them. Even if they send you these changes via email, read them because when these policies are sent out they have a 'read' receipt which confirms it was delivered and you read it. This will indicate that you have accepted the email and confirmed that you know about the policy changes.

If you are anything like me, it is all dry boring stuff and you haven't got the time to read it. You have to make the time - trust me

You have to respect these P & P because they are important and they do matter. I force myself to read them to check if I need to change my practice.

P & P are normally in place because something went wrong in the past somewhere and there was a need to formalize practice; and, to make sure we are all doing the same thing.

Often we worked and trained at different schools, hospitals. Not one of us practices the same, yet we all believe what what we are doing is safe and hat we are safe.

What you need to keep in mind is that we need to make sure we are practicing safely according to our company's policies. Under normal circumstances, it is a small change in our daily routines to comply to policy changes.

Can you imagine a defense in the court room of "Well I heard about it on a web site, so it must be true?" Or, "Well she does it that way so I did it."

It's not a good defense, trust me!

You have to follow your P & P and do it the way it is outlined in your P & P! Your internet friends could be correct in their practice but it is only correct if they are following their companies guidelines (ther own P & P).

I do not know about you but I have worked with a lot of healthcare professionals who practice is less than desirable. How do you know that the advice you are receiving via the internet is not from one of those less than desirable professionals?

You don't!

If you are concerned about your practice and you want to practice safely then you know what to do!

Protect yourself, protect your license, and most of all protect your patient.

Go find that manual!

Oh, and by the way, when you signed all that paperwork when you started your job, you probably signed to say you would follow the P & P of that facility.

Remember your company will be protecting themselves, now you need to protect yourself.

[Susie2310]

Thank you for a very important article. I believe it is very important to know what one's own nursing Liability Insurance policy does and does not cover, and what the exclusions are.

[brownbook]

Great topic, you protect yourself by having your own personal nursing Liability Insurance.

I would suggest newbies, or any nurse, think through what are the 10 top issues I deal with frequently that I am a little unsure of, and make a copy of those. No one can read or remember every P&P.

However I hate to be to rigid. I have knowingly NOT followed P&P's.....yes I know "my license was on the line"...... but P&P's can get in the way of common sense. I could easily give 10 examples without breaking a sweat. I am not advocating any nurse not follow P&P's, but personally I am OKAY with doing it in certain situations.

Not a hospital or nursing example but last summer a mentally ill man was standing up to his neck in a near-by bay for over an hour. The police and fire officers stood by on the beach, due to budget cuts they had not been re-certified in water rescue. They would not go into the water and get him per their P&P's.....he died.

I don't know exactly every detail....but the broad outline is honest to God true.

[Pets to People]

Just to clarify, you must understand, know and follow the laws of your state before that of your facilities policies. If your facilities policies tell you not to do something, but the law states you should, then you have to follow your states law.

[CrufflerJJ, BSN, RN, EMT-P]

In my unit there is a young, "click" of about 5 nurses. My unit director is a member of this click. ...snip... One young nurse is involved with a surgeon from our floor.She makes it no secret. The guy is married with children of his own. When he comes to the floor, this nurse and he go to the nurse's lounge area and close the door. (That's our hint to not go in there) These young nurses donot care about the patient at all. I have seen them ignore call lights ...snip... I don't know anymore as to what to do with the stuff I hear and say....any advice?

Ummm...and your post addresses the original article in what way?

[amygarside]

This is informative and helpful. I would surely go back and brush up on the P&P of the hospital I work in.

[Conqueror+, BSN, RN]

In my area there are a dozen or so for profit RN schools and 4 legit ones. If a nurse did as this article suggests they would simply be replaced by one of the many new grads available every month. Please understand that the written policy is there to cover THE FACILITY in the event of a lawsuit. They will systematically bully, pressure, and direct you to do things that are against written policy because it is more profitable and then give the BON and lawyers a blank stare if something goes wrong and you're involved. "that's not policy" and "I never told you that". This is why I came to the difficult decision to leave direct pt care. I didn't put in 19 years to lose my license for any one patient or facility. I got into nursing to help not fight and worry. I have a family and at least another 20 years of employment to consider. It was a hard and sad transition but I won't look back. Evolve or die off.

[anotherone, BSN, RN]

In my unit there is a young, "click" of about 5 nurses. My unit director is a member of this click. These women could care less about the ppl they care floor. I have seen alot of stuff and heard them talk excessively (laugh, make fun of) the patient, right there in the front of the nurses station where they all gather. They all sit behind a computer and you can hear them laughing very loudly. Patients fam members (and the patient) have overheard many conversations. One young nurse is involved with a surgeon from our floor.She makes it no secret. The guy is married with children of his own. When he comes to the floor, this nurse and he go to the nurse's lounge area and close the door. (That's our hint to not go in there) These young nurses donot care about the patient at all. I have seen them ignore call lights and they take thier time getting pain meds to the patient on time. One patient waited an hr (after repeated calls to the nurse) for his pain meds. When I reminded her again, she was with another nurse headed for the staff elevator to go get her breakfast from downstairs. She told me she would give him (the patient) his pain meds after she was done eating. I have been in a tight spot to where I needed the assistance of a nurse and been refused help. Had one nurse tell me once,"I have done my CNA work in the past and I don't do that anymore." I have seen them refusing to go into a terminally ill patients room, telling me "they are DNR anyway, we don't need to go in there." (Do not recusitate) Stuff like this I put up with on a daily basis. My dir has been made known of this and she gets mad and says to just do my job and stay out of her nurses business. I don't know anymore as to what to do with the stuff I hear and say....any advice?

Could you have given that pt pain meds? You don't want to do their work too, but that is what I would do. If she was on break who was watching her patients? This is a management issue more than anything else. Most people need to be managed as they have a poor work ethic. My advice is if managment doesn't care than don't bring it up over and over. You will be disliked by management . It isn't ideal but it is reality. You can try going hire up if you want. Maybe look for a job somewhere else.

[cienurse]

Hospitals who get paid by Medicare and Medicaid services, and who are also JCAHO accredited, MUST have policies and procedures in place or no payment or certification will occur. Unless you are in a very rural area where your hospital accepts private pay patients only, somewhere tucked away is a set of policies, procedures, and protocols that haven't been shared. It is not prudent to provide ANY care without a policy and/or procedure to back it up. I'd double check that if I were you.

[Conqueror+, BSN, RN]

Cienurse's comment reminded me that making the P & P's hard to find/read/understand is another way that facilities trick nurses into doing what they are told. You better believe that when you end up on the stand they will have that page placed right in front of you. Saying " I've never seen that" will get you sarcastic stares even if it's the truth.

[n'ville]

Then you are practicing medicine without a license and putting yourself at risk for a malpractice suit and loss of your license because if any of those patients experience adverse effects from the care you provided without a physician's order or protocol, neither the physician nor your hospital will stand behind you.

Have you and your fellow ER nurses approached your hospital and physicians about developing basic protocols of care for frequent symptoms and complaints that present at your ER. This would not only be some protection for your, but would also protect the hospital and the physician's would have some input into what basic emergency care should be initiated until the physician can be in attendance.

I am not unrealistic enough to think that there will not be unusual situations that must be dealt with, but it should not be common practice. I also am well aware of what happens in the ER. I am an RN of greater than 35 years and I, too, have worked in the emergency department.

I wish you well and thank you and all of us nurses for the hard work we do.

[bnmekiki]

Thank you for mentioning that. Hospitals and nursing homes (I've worked at both) are constantly putting you in unsafe situation where your license and the patient is at risk. They give you no help and you better not complain or you're scrutinized and labeled. Those policies only protect themselves they could care less about the nurse. You'll be out the door just as another one will be coming in. It's a vicious cycle we need to get in contact with unions and our state legislatures about this. Needlessly to say things aren't going to change especially with the medicare/medicaid cuts and all the facilities trying to cut cost by adding on more responsibility to one nurse. It's totally nerve wrecking but what can we do.

[Over-the-hill-Nurse]

I agree with the OP. You should know what the P/P are in your facility. Just to give you an example on what could happen: (and it did happen to me) I had a client that insisted on getting out of bed and was going to do it on her own if myself and a CNA didn't help her. She was not my patient and I was not familiar with her chart. After asking the necessary questions about what are you in the hospital for, are you able to support yourself standing, how long can you stand, etc... well needless to say, she was getting up whether we helped or not. Once her feet hit the floor, her legs started going out on her. My partner and I gently slid her to the floor and took the sheet off the bed and placed a sturdy life under her, went and obtained more staff to assist with lifting her back into bed, things went really smooth and everything was documented and step by step was noted as we placed her back on her bed. That same evening she was telling her husband that we were forcing her to move to the chair and she insisted that the nursing staff had let her fall on the floor and that we did not asist her properly Needless to say, she sued. I was named in the suit as well as the CNA helping me. Knowing my policy and procedures helped me to avert a disaster! If in wasnt for the fact that I had read them and knew how to deal with this incident, not to mention being sued for damage and a fracture of her ribs. Both the P/P really helped me to maintain my practice, to be able to prove that there were no injuries with this patient. (Lady claimed that she was dropped and she suffered a fracture in you back.)

The moral of this_ don't think that you can't be sued individual by client that you are caring for. It can and does happen! In this case, the women claimed that she was hurt while this transport was being handled. She did indeed have a fracture but because of xray's that had been done just the day before while in ER and the current new ixray that was ordered, found that she had that fracture prior to being moved to our floor. My Point is this: You need to know at least the basics of what your facility requires for you to do! Policiy and Procedure can either break you are make you! Oh and by the way, this client dropped the suit. Knowing your facility's P&P are there to protect you. If you don't know them and something like this ocurrs, you will need it to prove that you did no harm.

Take time to read them! Most of them are reviewed, rewritten, or removed, every year. I worked as a floor nurse at that time. Protect your self and you patient. KNOW YOUR P&P OF YOUR FACILITY. WHEN YOU LEAST EXPECT IT, YOu MIGHT NEED TO HANDLE THINGS SUCH AS THIS!