How much do you follow Policy and Procedure?

TazziRN, RN · Jun 3, 2006

in the er our policy is one visitor per pt, but if it's not crowded i will allow 2-3 as long as they are family and not friends. also, if the pt is a child, i will allow both parents.

as for c/s, dads should be sent back with the babies. sewing up of mom is not something they need to stay for, especially since the moms are usually sedated for that part.

epiphany · Jun 3, 2006

in the er our policy is one visitor per pt, but if it's not crowded i will allow 2-3 as long as they are family and not friends. also, if the pt is a child, i will allow both parents.
as for c/s, dads should be sent back with the babies. sewing up of mom is not something they need to stay for, especially since the moms are usually sedated for that part.

Thanks for your response. The problem I am facing is the inconsistency of protocol with what is actually happening and my difficulty in following the standard of care, because the nurses literally demand that I can't. As a new nurse, I simply can't fight the unanimous resistance.

From what you are saying, you seem to be able to exercise your own judgement, which is not happening with me. Ugh.

burn out · Jun 3, 2006

I had a similar instance the other day in ICU. My patient sedated on the vent had just had an incontinent bowel movement and needed cleaned up. Visiting times were over 30 minutes earlier and one of the other nurses was allowing family members at bedside to fed a patient so she wouldn't have too (they had been feeding her for over an hour). I do not like to bath a patient with visitors because someone is always opeining the curtain or the curtain does not protect the patient enough. I discreetly pointed to my watch to the other nurse to signal visiting times were over and she went bullistic...she was not having her family member leave because everyone else gets to have visitors back anytime they want blah blah blah. I reminded her that I always stick to visiting policy unless my patient is dying

and if the policy wasn't ment to be infoced why were the times still posted outside the ICU doors. She asked the family to leave but was not happy about it and is still mad at me but so what. Policy and procedure are like our rights is we don't use them we lose them. Also, you can not be fired or disciplined by following the rules set forth by the institution.

buildingmyfaith57 · Jun 3, 2006

but isn't the policy and procedure aren't they supposely be updated every two years ?

CseMgr1, ASN, RN · Jun 3, 2006

Our HHA has several hundred policies and procedures, but trying to get people to follow them is another matter. Our Administrator, in an effort to keep more nurses from leaving our already critically short-staffed agency has basically let the ones who have been there for years do as they please during the six years she's been there. As a result, I have NO authority as Clinical Manager. Why write anyone up for not following P&P's when she's not going to do anything about it to begin with?

In the meantime, I'm just going through the motions of my job and drawing a paycheck. I know this sounds apathetic, because I do care. Maybe things will get straightened out when the State comes in or another company steps in and takes us over.

epiphany · Jun 3, 2006

Our Administrator, in an effort to keep more nurses from leaving our already critically short-staffed agency has basically let the ones who have been there for years do as they please during the six years she's been there. As a result, I have NO authority as Clinical Manager. Why write anyone up for not following P&P's when she's not going to do anything about it to begin with?
In the meantime, I'm just going through the motions of my job and drawing a paycheck. I know this sounds apathetic, because I do care. Maybe things will get straightened out when the State comes in or another company steps in and takes us over.

I am beyond caring what the other nurses do with their patients because if I do, I'd never concentrate on my own job. I just want to be allowed to care about my patients professionally - and following the P&P is one way. If I think a policy needs to be revisited, I'd be the one proposing a change. It is a guideline, and common sense should take over.

However, the nurses who have been there for years and not following the P&P's seem to react very violently when I am simply following P&P. What makes it more frustrating is that it affects my autonomy. No one has been following the P&P's in this place, except where it's convenient for them. Can you imagine trying to let an extra family member in because it's the compassionate thing to do, and having ALL the nursing staff harass you, including the clerk?

bonesrn · Jun 3, 2006

csemgr1....I know what you mean...our DON is a nice lady but is lacking a backbone. She hold nobody accountable..when I try to she always wants to give then ANOTHER verbal warning! How many times do people have to be told???? I am made out to be the bad person when I try to hold people accountable but they just run to her anyway and cry until they get their way! I have only been the ADON since Jan and have gone to her with multiple concerns and action plans but she really just wants to look the other way...nurses come and complain to me about things not getting done..bullying that is going on etc and her standard answer is "Well you were not there to witness anything and the truth is somewhere in the middle so what can we really do??? HUH???? Anyway, my only hope is that the new DON will have a backbone and hold people accountable. The current DON announced that she is leaving the position..I wish her luck but really hope that we get someone younger with fresh ideas and a spine!...sorry for the rant

TazziRN, RN · Jun 3, 2006

there have been times when my coworkers have been more lax about p&p, and when it's mentioned i reply "I am following our p&p, i can't answer about the others."

ZASHAGALKA, RN · Jun 3, 2006

I just want to be allowed to care about my patients professionally - and following the P&P is one way.

Every institution has its rules: it's written ones, and its UNWRITTEN ones.

You are violating the rules of your unit. It's just that, you are violating the UNWRITTEN rules for that unit. It's all good and all to say 'but the P&P says. . .', but that doesn't change that the real rules of the unit are different.

IN most cases, a willful and unit wide slide away from the P&P is a dangerous thing that would need to be corrected because it is the P&P which establishes the duty that can provide for successful litigation against you if breached. In this case, however, you are talking about P&P that affects the culture of the unit more than P&P that 'establishes a duty'.

Your unit has decided that its culture lies differently. For whatever purpose, it isn't appropriate to amend the P&P to say as much (we live in a 'customer service' culture and many in upper management would balk at any policy change that would appear to constrain any such service). Nevertheless, everyone from the manager to the unit clerks recognize the unwritten changes to this P&P.

You can make waves, for certain. And you are an advocate; when your decisions affect advocacy enough to make a stand (and that's not always the case), then you should stand up for your pts.

But, it's not exactly accurate to say that your co-workers aren't obeying the unit rules, and they get mad at you for doing so. The reverse is true, regardless what the P&P says.

~faith,

Timothy.

buildingmyfaith57 · Jun 3, 2006

i feel this that all staff members should all follow the policy and procedure. including managers,owners etc etc. and stop the favoristm.

epiphany · Jun 3, 2006

Every institution has its rules: it's written ones, and its UNWRITTEN ones.
You are violating the rules of your unit. It's just that, you are violating the UNWRITTEN rules for that unit. It's all good and all to say 'but the P&P says. . .', but that doesn't change that the real rules of the unit are different.
IN most cases, a willful and unit wide slide away from the P&P is a dangerous thing that would need to be corrected because it is the P&P which establishes the duty that can provide for successful litigation against you if breached. In this case, however, you are talking about P&P that affects the culture of the unit more than P&P that 'establishes a duty'.
Your unit has decided that its culture lies differently. For whatever purpose, it isn't appropriate to amend the P&P to say as much (we live in a 'customer service' culture and many in upper management would balk at any policy change that would appear to constrain any such service). Nevertheless, everyone from the manager to the unit clerks recognize the unwritten changes to this P&P.
You can make waves, for certain. And you are an advocate; when your decisions affect advocacy enough to make a stand (and that's not always the case), then you should stand up for your pts.
But, it's not exactly accurate to say that your co-workers aren't obeying the unit rules, and they get mad at you for doing so. The reverse is true, regardless what the P&P says.
~faith,
Timothy.

I have no idea why you are misquoting me. I am very aware of unwritten rules - it's in my face. Follow the pack, regardless of the pt's benefit.

Are you saying that every new nurse should try to learn the pack rules blindly and abandon what you believe is the right thing to do? First of all, allowing extra visitors where it's compassionate should be the intuitive thing to do, and if it's in the P&P, then it's there for a reason. This is not about me stupidly doing something by the book, if you bothered to read my posts - it's about pt care, and how P&P's role in it.

You don't have the authority or knowledge to correct me on the accuracy of my experience. But if you are implying that there's a culture which we all should follow when we go into a new floor regardless of what one feels is the right thing to do, and regardless of how each individual needs to be happy in their work place knowing that they are doing the right thing, and you are implying in your door-slamming statement that there should be no dialogue about this, then I accept your prerogative to be narrow minded, which is much more than you did for me.