Different policies on different units within same hospital?

JKL33 · Apr 18, 2018

The other day an ICU nurse, who is also brand new (we started in the same residency group) transferred a patient to me and was telling me about how the pt was having difficulty urinating so she straight-cathed the pt. I asked if there were orders to do that if I run into the same problem later and need to do it. She then stated "oh no, I just do it" and gave me a kind of smirk. I even mentioned how the ICU draws blood from lines with no orders and she said "oh yeah we just do it". It irked me a little to hear that. Like, okay I don't know how it works on your unit but I can just do things whenever I please without orders.

She is very likely doing these things according to established protocols (otherwise known as standing orders/protocolized orders)...maybe she didn't quite get that bulletin during the orientation process?

I agree it is concerning that she thinks she is doing these things because she is just special enough to be able to - - but that has nothing to do with you.

Yes, protocols may be different on different units.

nurse_kitkat1014 · Apr 18, 2018

Hmm okay I didn't even think about standing orders, that makes more sense. I'm glad you picked up on the fact that the way she says she just "does it", like she's special enough to. Yeah that's what kind of annoyed me.

bugya90, ASN, BSN, LVN, RN · Apr 18, 2018

In the hospital I work at there are different protocols for each specialty. ICU/ER follows critical care protocols and perform certain tasks that med-surg nurses don't. The cardiac med-surg unit have their own protocols for post-procedure care and interventions for cardiac procedures, renal unit has protocols to hold certain meds prior to dialysis, pedi has protocols for Weight based drugs, etc. It has to do with competencies also. For each unit's nurses to use those protocols they have to demonstrate competence in their specialty through training.

Sour Lemon · Apr 18, 2018

Hi guys, just want to get an opinion on something I've been wondering about lately. I'm a new nurse,
So anyways, that kind of became a rant but still have have to wonder. Do the policies for general med/surg floors tend to differ for more critical units like ICU? Is this ICU nurse I'm referring to crossing a line by doing things without orders? Love to hear y'all's opinions on this.

I've also seen units that operate that way and it's not always protocol. Sometimes, it's nurses trusting the relationships they have with the MDs managing the patients ...and knowing the MDs will give them orders (or sign the orders nursing has written) when they eventually round.

I've been invited to use my own discretion by a few doctors, but I'm not quite that trusting. If something goes wrong, I'm pretty sure they wouldn't fall on the sword for me. I'd rather keep things "official".

klone, MSN, RN · Apr 18, 2018

I've also seen units that operate that way and it's not always protocol. Sometimes, it's nurses trusting the relationships they have with the MDs managing the patients ...and knowing the MDs will give them orders (or sign the orders nursing has written) when they eventually round.
I've been invited to use my own discretion by a few doctors, but I'm not quite that trusting. If something goes wrong, I'm pretty sure they wouldn't fall on the sword for me. I'd rather keep things "official".

While this is a common practice at many places, it is NOT okay. It goes against CMS and TJC rules/regulations. Nurses can't just do whatever they want without an order, and I guarantee it will come back to bite the hospital (and the individual nurse) in the butt someday.

If ever you (general you) see this, please be an advocate for change! Either to insist that physicians place written orders to cover these actions, or that you get a specific protocol in place that addresses it (and if it is covered under a protocol, the protocol needs to be reviewed annually for it to be valid).

As to your statement that I bolded - BINGO. If **** hits the fan, it's every man/woman for him/herself, I promise. PROTECT YOUR ASS.