Is anything at your work that puzzles you

MOSTLYHAPPYRN · May 14, 2015

I'm puzzled why patient family members don't understand why it's not acceptable to raid the linen cart or nutrition room, and why some staff tells them it's okay.

Once we had a family member take a trash bag into the nutrition room and started filling it up with cans of coke and sprite!!!!

nrsang97, BSN, RN · May 14, 2015

Why when we have a new policy regarding lab draws that lab is not on board even though they were part of the policy writing process?

Why do some MD's not want to follow a recommendation especially when it comes from a nurse?

Why is it so cumbersome to look up policies on the intra net? You can't find the policy unless you use the exact key word. So frustrating.

Why does one unit have the reputation as being difficult with every other department? Why can't they just play nice?

2011RN · May 14, 2015

Verbal policies that are followed yet cannot ever be located in writing and written policies that no one follows.

kiszi, RN · May 14, 2015

Also, I'm puzzled by how little blood is actually coming out ( of wherever) when a patient calls you to come to them right away because they BLEEEEEEEEEDING!

Or, on the flip side, a family member waits quietly while you finish a conversation then sheepishly says "Sorry to bother you, but I think something's wrong with my mom's IV" and you walk into a BLOOD bath!

ixchel · May 14, 2015

Or, on the flip side, a family member waits quietly while you finish a conversation then sheepishly says "Sorry to bother you, but I think something's wrong with my mom's IV" and you walk into a BLOOD bath!

I had a phlebotomist tell me, "I think something is wrong with his IV". While my patient was delirious and receiving blood, he disconnected the hub from the IV catheter, which was firmly secured by tape and tegaderm. Not only had the pump pumped blood all over the place, but the guy had back flowed blood just pouring out of his IV catheter. Talk about downplaying it.....

blondy2061h, MSN, RN · May 14, 2015

Why are policies written so vaguely that there's no purpose in even having one at all?

amoLucia · May 14, 2015

Why do I need a key to get into the area that has the emergency eyewash station? I mean, what if I'm the key-carrier and it's ME who needs the eyewash station???

Duh ....

Asystole RN · May 14, 2015

Why are policies written so vaguely that there's no purpose in even having one at all?

I have written a lot of policies and consult facilities on policy writing.

There is a misconception that policies are instruction manuals. Yes, many policies will have instructions included but they are not there to be step-by-step instructions on how to perform a particular task.

They are there to set a basic minimum level of care and/or guide care but not to micromanage the care itself.

The problem with writing a very specific policy with detailed instructions is that it sets the facility up for failure in litigation, accreditation, and basic practice. If the policy is too specific it is very easy for any given nurse to violate that policy by slightly deviating from the written script. That deviation can get them dinged by accreditors and cause the facility to lose in the courtroom, not to mention potentially reduce the quality of patient care.

There are few things in nursing that have a single way to accomplish it, if everything had a single way of doing it then registered nurses would not need to critically think or asses but need only to simply vomit out policy.

The art to writing policy is to identify the key objectives you are attempting to accomplish but allow enough vagueness to provide variation in practice so that the objective can be accomplished in a variety of settings and circumstances.

blondy2061h, MSN, RN · May 14, 2015

I have written a lot of policies and consult facilities on policy writing.
There is a misconception that policies are instruction manuals. Yes, many policies will have instructions included but they are not there to be step-by-step instructions on how to perform a particular task.
They are there to set a basic minimum level of care and/or guide care but not to micromanage the care itself.
The problem with writing a very specific policy with detailed instructions is that it sets the facility up for failure in litigation, accreditation, and basic practice. If the policy is too specific it is very easy for any given nurse to violate that policy by slightly deviating from the written script. That deviation can get them dinged by accreditors and cause the facility to lose in the courtroom, not to mention potentially reduce the quality of patient care.
There are few things in nursing that have a single way to accomplish it, if everything had a single way of doing it then registered nurses would not need to critically think or asses but need only to simply vomit out policy.
The art to writing policy is to identify the key objectives you are attempting to accomplish but allow enough vagueness to provide variation in practice so that the objective can be accomplished in a variety of settings and circumstances.

I'm not talking about step by step guides. I'm talking about obvious things not covered that need to be standardized. How often peripheral IV's get changed. Who can suction a trach? I had an aid who had been suctioning trachs on one unit. The policy did not say anywhere who could or couldn't do it. His theory was that if patients self suction, since he had learned how to do it, why couldn't he help them? We have certain devices, like subq ports, with no policy written at all- everyone doing their own thing.

I complained too much, and now I, too, am involved in policy writing.

CamillusRN, BSN · May 15, 2015

Having meetings about having meetings that were, themselves, about having meetings. The point?

wilma30RN · May 15, 2015

I can give a patient drugs that will paralyze and sedate them- no cosigner required. One unit of insulin- cosigned required.

nurseprnRN, BSN, RN · May 15, 2015

On a related note: you have to get subq insulin cosigned, even though if you OD somebody on it, it reverses easily with common D50. But you can give somebody IV digoxin without anybody seeing that you've given enough to kill them outright.