Going Against Hospital Policy...

weetziebat · Mar 18, 2006

It's easier when you work in a tiny, rural hospital on graveyard shift, with only one other staff member, but YES, I've gone against hospital policy for the sake of a patient and would definately do it again under similar circumstances.

I let the grandkids in to visit a dying woman - entire family begged, patient in tears, administrator saying 'Oh no, not allowed. Against regulations' But he didn't have to work with this woman daily, watching her anquish cause the children weren't allowed in her room. Not for any 'good' reason, simply because the policy said so.

I've let pets visit when the patient was doing poorly, in a private room, and his dogs/cats were his whole family. Nobody got fleas from them, and he died peacefully.

I allowed a patient to go out from a LTC Center when his entire family was having a barbeque and the SNF didn't want to let him go, cause there was no one to drive him. I drove him over on my lunch hour. He had a fantastic time, spent all day visiting with a brother he hadn't seen in years, and arrived 'home' at the facility at the time agreed upon. The next day his brother died of a massive MI. Boy, was I ever glad I didn't stick with faciltiy regs!

I've allowed dying patients to have family favorite foods brought in when they were craving them, rather than put them through the unnecessary torture of eating facility food. They were on a general diet, so what is the big fuss?

I personally feel a big part of a nurse's job is advocating for your patients - if you don't look out for them, likely no one else will either. Dang, as long as its not going to hurt them or cause adverse reactions, why not?

You know its not a good idea to have an entire mariachi band come in to play music in a patient's room while his roommate is fresh post op and needs rest. Just think perhaps the nurses should be given a bit more leeway to make judgment calls.

The funny part is I've never gotten written up or even questioned. I explained the situation, my take on it and explained why I did what I did. Having been a patient myself, the nurses I want are the ones who aren't going to cave into the egotistic rantings of a Dr. who thinks s/he is a god.

I find if you stand up to them, and have solid reasons why you did what you did, they generally come around to seeing it from a different aspect.

vamedic4, EMT-P · Mar 18, 2006

Thank God for nurses like you Weetzie...one can only hope that caring people are still around when WE need them.

Tweety, BSN, RN · Mar 18, 2006

Depends on what you're talking about.

I've gone against visiting hours and other things like that for the sake of the patient many times.

However, if your talking about a procedure or protocol, if there is a bad outcome then you don't have a leg to stand on and the hospital is going to let you fry on your own. As their employee, receiving a paycheck from them, I'm obligated to follow established care plans and protocols.

I would never go against my gut feelings, or follow a procedure I felt would cause harm. Fortunately, I haven't been in that position. So probably my answer to your question is no.

Many times in uncomfortable situations I've used the chain of command. Just the other day I called risk management before I would follow an MD's order about getting consent from a patient for surgery. The Risk Manager told me the policy and what to do and I was comfortable with that, because if on the small chance something came back to me, there was documentation of my conversations with the Risk Manager. In this case I followed hospital protocol. My hospital has been around a long time, they aren't perfect and sometimes things need to change, but for the most part they know what they are doing.

UM Review RN, ASN, RN · Mar 18, 2006

I can think of one reason I'd go against the accepted protocol on a pretty regular basis. This would be if the State BON requires something more stringent than hospital/facility policy.

So what the BON says, goes.

suzanne4, RN · Mar 18, 2006

I can think of one reason I'd go against the accepted protocol on a pretty regular basis. This would be if the State BON requires something more stringent than hospital/facility policy.
So what the BON says, goes.

Actually the facility would then be violating the rulings of the BON for that state. Facilities can set their own Policies and Procedured but they must be within what is stated by the BON. To do otherwise can get them in serious trouble with the state. Because it then places the "Scope of Practice" outside what is considered legal in that state.

su_z1010 · Mar 18, 2006

That was wonderful and insightful. Sounds like you have great judgement. I respect that a lot.