Is my nursing license in jeopardy?

[Pretzlgl]

Hi all. Any input would be appreciated. I work for a facility with no policy and procedure manual. I have repeatedly asked for a policy pertaining to, for example, how to flush a central line - only to be told "we don't have a policy on that". It is a hospice - not JCAHO accredited - so they technically don't have to have policies set. BUT - I feel that my license is on the line every time I do something but it isn't according to any policy or procedure set by the facility. I'm told just do it by MD order. Well the MD order say, Central line flush per protocol. I really feel that this is done purposefully - it will be the individual nurse hung out to dry and not the facility if something goes wrong. What do you all think?????

[mushberry]

it seems scary. Probably your best bet is to follow...well, I don't know if you use this down there, but Perry and Potter's clinical skills and nursing techniques, the latest editions. That's what all the policies and procedures are kind of based off of in all the hospitals I went through in nursing school. then, you know you are doing it right, and if you did get called under question, then they'd analyze your technique and determine whether what you did was what a wise and prudent nurse would do, and you wouldn't be in trouble, you know? But I can see why you'd worry...guess the only thing you can do is a) find another job, or b) follow what the procedure books say, and do the best you can to follow proper procedure.

[canoehead, BSN, RN]

If you get policies from the IV Nurses Association and follow their recommendations you would be covered.

[jemb]

Unless the doctor is the owner/operator of the facility, I doubt if the doctor has a clue that the facility has no policy. So it probably is not a conspiracy to hang the nurse out to dry.

There are nursing standard protocols for such things even if your facility does not have it in a policy manual. I'm not familiar with Perry and Potters (mentioned by mushberry), but there are numerous references regarding nursing standards and procedure protocols.

Oncology Nursing Society (http://www.ons.org) has tons of reference materials that would be useful for hospice, including specific info on care of VADs.

[leslie :-D]

we would go by our pharmacy's iv dept.

[barefootlady, ADN, RN]

Talk to the boss. This is dangerous. Maybe a Lippencott Manual would cover some of your issues. Good luck.

[purplemania, BSN, RN]

If the MD writes an order to follow protocol when there is no protocol, then you do not have a legitimate order (IMHO) If you tell the MD's they might see the liability for THEM, and that could create pressure to get something done. How do people get evaluated? What standards are they using to determine if staff is functioning according to "standard"? I agree with you. Sounds like a lazy way to do business. If nothing else, there could be a statement in the Vision statement or some such that says "nursing skills are evaluated using the xyz book on nursing standards".

[Pretzlgl]

Thanks for the responses. Let me clarify - I don't mean that the doctor would hang the nurse out to dry - I mean the facility. A little background is that 2 nurses have been fired recently - and one has had disciplinary action placed on their license for not performing according to the facilities' "standard policy". One of the nurses is suing because how can you follow standard policy if no such thing exists. (Wrongful termination). Anyway, I myself am getting out of there - too much liability IMHO.

[night owl]

Exactly, how can you follow "standard policy" if one doesn't exist? I would get out too and fast. Sounds like you're doing the right thing.

[moia]

Get out now...no right now..call and quit as you are reading this.

The nurse who is sueing is going to bring down a rain of you know what....The facility is going to be investigated...worse the facility is probably being investigated right now...

Get all policy and procedures for all procedures you can remember doing...This lawsuit is all about policy...I can almost guarantee all nurses working at the same time she was are going to be questioned by her lawyer and the facility lawyer and they are going to have to demonstrate some understanding of procedures..you are going to be asked what policy are YOU following when you do a procedure...you need to have an answer.

I know you may want to say well the facility has no policy..that is absolutely fine..don't hesitate to say it but be absolutely sure you follow that up with I base my practice on "................" policy and procedure...which I read or was trained in.

The nurse who is sueing is an idiot who will lose and may lose her licence because any fool knows that a nurse must act like a prudent nurse...meaning if no policy exists it is the NURSES obligation to find one...it is what a PRUDENT nurse would do.If she was fired for not following PRUDENT policy..meaning her care completely deviated from any published resource she is sunk...if she can prove she followed the policy of a published source she may be fine...but she cannot just say the facility had no policy so I just winged it hoping for the best and you can't fault me for that...well she is toast..and so are you if you don't have a policy you are actively following.

If you go back (and you absoulutely should not) go straight to management with a witness or two or three and in writing and in person tell them that you will be following the policys of whatever book or organization you have chosen and you will be sending the letter on to all doctors working in the facility....tell administration that all doctors who have order priveledges must either agree or disagree and those that disagree MUST write out a complete order and can no longer use according to protocal.

If you must stay there for a few weeks don't stay unless you confront the problem...By making it public that you are following a written published policy and that the doctors are aware of your policy and agree to it you are safe from any censure.

Just winging it hoping for the best is a sure route to disaster.

[lovinghands]

In the words of Frank Romano, "Holy Crap!"

My eyes nearly fell out of my head when I read your post, particularly about the RN who was fired for not following standard policy. Follow your instincts.

Best of luck to you. :)

[Pretzlgl]

Get out now...no right now..call and quit as you are reading this.

The nurse who is sueing is going to bring down a rain of you know what....The facility is going to be investigated...worse the facility is probably being investigated right now...

Get all policy and procedures for all procedures you can remember doing...This lawsuit is all about policy...I can almost guarantee all nurses working at the same time she was are going to be questioned by her lawyer and the facility lawyer and they are going to have to demonstrate some understanding of procedures..you are going to be asked what policy are YOU following when you do a procedure...you need to have an answer.

I know you may want to say well the facility has no policy..that is absolutely fine..don't hesitate to say it but be absolutely sure you follow that up with I base my practice on "................" policy and procedure...which I read or was trained in.

The nurse who is sueing is an idiot who will lose and may lose her licence because any fool knows that a nurse must act like a prudent nurse...meaning if no policy exists it is the NURSES obligation to find one...it is what a PRUDENT nurse would do.If she was fired for not following PRUDENT policy..meaning her care completely deviated from any published resource she is sunk...if she can prove she followed the policy of a published source she may be fine...but she cannot just say the facility had no policy so I just winged it hoping for the best and you can't fault me for that...well she is toast..and so are you if you don't have a policy you are actively following.

If you go back (and you absoulutely should not) go straight to management with a witness or two or three and in writing and in person tell them that you will be following the policys of whatever book or organization you have chosen and you will be sending the letter on to all doctors working in the facility....tell administration that all doctors who have order priveledges must either agree or disagree and those that disagree MUST write out a complete order and can no longer use according to protocal.

If you must stay there for a few weeks don't stay unless you confront the problem...By making it public that you are following a written published policy and that the doctors are aware of your policy and agree to it you are safe from any censure.

Just winging it hoping for the best is a sure route to disaster.

Wow! Thanks for the great reply and advice. I am turning in my 2 week notice - but am going to do just what you said with witnessess. Thanks again!