Has Anybody Experienced Working at a Facility That Doesn't Have Policies & Procedures?

[mayapapaya3]

I have been working at an enhanced care facility ( similar to and ALF but for patients with persistent mental health issues) since October. I have repeatedly asked for a P&P manual to guide me in my role and be able to direct unlicensed staff appropriately to no avail. I finally confirmed with the administrator that they do not have official P&P's. What is used are in office typed 'instructions.' I have worked in several ALF's over the past couple of years and am familiar with the role as defined by the states administrative rules and have not experienced this before. There are so many areas that I feel that I am failing in but Im afraid to 'take control' and start doing things like weight audits, psychotropic med reviews, pain med use assessments ect because I feel that this could lead to more issues if something were to go wrong ( it appears this facility has not historically addressed these areas prior to my employment although they are required per state regs. Example- they weigh Residents monthly but have no policy on how to proceed if weights are up or down. I was just told to monitor the weights) Should I just 'wing it' and do what I think is right without any guidance from the facility? Am I making too much out of this issue and I should just start managing based on my roles at other facilities. I feel it would be more detrimental to me and my license to just make up my own 'policies' based on my past experiences. I am getting increasingly worried due to the fact that I am currently fighting charges against me by APS ( very very very long story short-found guilty of abuse and neglect D/T a med tech that had not administered a narc correctly. Investigation took place after I resigned from the facility and I didnt even know about it until I failed my background check a year later after getting the job I am talking about above.) I feel that any mistake now will be career ending for me, especially since APS has been into the building several times in the past 2 months for other non medical complaints & issues. Where does my responsibility begin and end in terms of my role when I dont have P&Ps to work off of? Any positive responses or advice welcome. Thank you

[KrysyRN, BSN]

Yes...I have worked in a place like this. It was in an occupational health clinic that employed 2 RN's (one being the manager), 2 LPNs, and 2 MAs. It did not serve that clinic well not to have a policy manual. They didn't know what they didn't know, so to speak.

I don't think you're making too much out of this. I do think you should do what is right. Would you be able to get copies of policies from other facilities that can be adapted to your facility? I realize that info is proprietary, but you never know. Or if you have time, start writing some protocols that your administrator can sign off on.

[VivaLasViejas, ASN, RN]

I worked in an ALF that was relatively new and really didn't have much in the way of policies and procedures, so I wrote them myself. It was ridiculous---there was no guidance on what to do when the resident care coordinator/lead med aide was caught diverting narcotics, or when norovirus was spreading through the building faster than a rumor, or when the whole swing shift staff quit. I must have written over 50 P&Ps and given them to the administrator for his signature. He pretty much rubber-stamped everything I did; not to toot my own horn, but it was a good thing I was honest and straightforward and had a modicum of talent, or that facility would have been in a world of hurt.