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Justifiable situations when to break policy?

Specializes in LAD.

Is it ever justifiable to break hospital policy?

  1. 1. Is it ever justifiable to break hospital policy?

    • Yes, there are justifiable reasons.
    • NEVER!!!

19 members have participated

Can you describe a situation in which you thought it was justifiable to break hospital policy?

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown.

Say if you have a low blood sugar and the patient is symptomatic/unresponsive and hospital protocol is to get an MD order for D50W. I would break protocol and get/give the D50W and try my best to either call the code or the MD in the meantime but you bet your tail end that I'm giving that D50W regardless of how it says to follow protocol. If the Pt's just low and maintaining then protocol will be followed to a T by me. :yes:

KelRN215, BSN, RN

Specializes in Pedi.

When a patient (child) is dying and parents don't want to leave the room out of fear that he will pass when they are not present. Neither has eaten in days. I'd order food for them from the hospital cafeteria under the patient's name and be glad to do it. We've snuck pets in for patients in the same situation before. There are very few rules that I believe should never be broken.

Be mindful of the fact that if discovered, one can lose their job over breaking facility policy.

No matter how justifiable it may seem.

The political correctness, what you as a nurse believes should happen, what a thought process is for patients.....this can be well meaning, but bottom line is that if you are caught, you can pay with your job.

And in the above 2 examples, there may be policy that one can be not learned in--meaning standing orders for critically low blood sugars, and parent meals when they are with their children. And a good way to think about policy change if this is occurring and immediate and/or comfort measures need to come into play.

AJJKRN

Specializes in Medical-Surgical/Float Pool/Stepdown.

Touché touché. I however would not want to work in a hospital where I was not supported by my physicians if the circumstances presented itself that I had to choose between following policy or knowing that my actions could be life saving if I chose not to hesitate. I pride myself on being painfully accountable and I do not "cowboy nurse" as I call it. But...if someone's life was hanging in the balance I would probably choose to tip the scales in their favor and let the chips fall where they may afterwards.

A former coworker of got into nursing because of some nurses who broke protocol.

Her mother was dying of cancer and she was a 10 year old girl at the time.

In those days there was strict rules refusing children under 12 to visit. My coworker was tall for her age, and she suspected that the nurses knew she wasn't 12, but they let her come visit anyway. My coworker said that she was grateful that she could spend that final time with her mother rather than wave goodbye at window over the parking lot.

Pink Magnolia, BSN, RN

Specializes in LAD.

Being new and all to nursing, I have never had to handle this type of situation. I am preparing for an interview coming up and this question really stood out to me. Thanks everyone! If you have tips on how to answer this during an interview, I'd really appreciate your thoughts!

KelRN215, BSN, RN

Specializes in Pedi.

Be mindful of the fact that if discovered, one can lose their job over breaking facility policy.

No matter how justifiable it may seem.

The political correctness, what you as a nurse believes should happen, what a thought process is for patients.....this can be well meaning, but bottom line is that if you are caught, you can pay with your job.

And in the above 2 examples, there may be policy that one can be not learned in--meaning standing orders for critically low blood sugars, and parent meals when they are with their children. And a good way to think about policy change if this is occurring and immediate and/or comfort measures need to come into play.

The policy was that they were allowed one meal/day from the cafeteria in that situation. Most parents (other than breast feeding Moms) were not allowed to order from the patient menu at all. How many people do you know can stay awake 24 hrs/day for days on end to be with their dying children on 1 meal/day, weak coffee and rice krispies from the kitchen on the floor? I ordered food for them every time I took care of their child and was glad to do it. I hardly think what was maybe $10 worth of food/day is going to bankrupt the hospital with the highest charges in the state.

Policy changes in this particular institution took YEARS to go into effect. There was so much red tape and committee BS that anything had to go through first. And this was a "we do things this way because that's the way we've always done them" kind of place.

Be mindful of the fact that if discovered, one can lose their job over breaking facility policy.

No matter how justifiable it may seem.

The political correctness, what you as a nurse believes should happen, what a thought process is for patients.....this can be well meaning, but bottom line is that if you are caught, you can pay with your job.

And in the above 2 examples, there may be policy that one can be not learned in--meaning standing orders for critically low blood sugars, and parent meals when they are with their children. And a good way to think about policy change if this is occurring and immediate and/or comfort measures need to come into play.

If you are putting your job on the line, then never break policy. If you do break policy and something goes wrong you are possibly risking your license.

A hypoglycemic patient should have standing orders. Be proactive-request them from the physician before you find yourself in that situation. That goes for any patient who you recognize as having the potential to go south--if it's predictable, request orders ahead of a catastrophe. As for those parents, go buy then a sandwich on your break rather than risk your job.

We worked hard to be where we are today and in my opinion there is never a situation that is worth putting your job or license at risk.

Pink Magnolia, BSN, RN

Specializes in LAD.

If you are putting your job on the line, then never break policy. If you do break policy and something goes wrong you are possibly risking your license.

A hypoglycemic patient should have standing orders. Be proactive-request them from the physician before you find yourself in that situation. That goes for any patient who you recognize as having the potential to go south--if it's predictable, request orders ahead of a catastrophe. As for those parents, go buy then a sandwich on your break rather than risk your job.

We worked hard to be where we are today and in my opinion there is never a situation that is worth putting your job or license at risk.

Great answer! Thank you :)

If anyone else has suggestions or ideas please share!

Pink Magnolia, BSN, RN

Specializes in LAD.

After thinking about this question A LOT, I think I would agree most with scaredsilly. At first I voted yes to the question I posted, but not anymore. There is no reason to jeopardize your license or job. It's important to follow the organization's rules because breaking them can actually be harmful to patients .... then it's your fault. There are things you can do prior to a problem arising and scaredsilly's response about being proactive caught my attention. The nurse MUST adhere to HER/HIS scope of practice.

psu_213, BSN, RN

Specializes in Emergency, Telemetry, Transplant.

I'd order food for them from the hospital cafeteria under the patient's name and be glad to do it.

I guess I was thinking something more "clinically" related when I answered no. I too would get food for a dying patient's family even if policy does not allow it.

However, when it does come to a clinical matter (for instance, our hypoglycemia protocol), I'm going to follow it unless specifically given other orders by a physician, NP, PA, etc. If I didn't follow policy/protocol and something goes wrong, I would be in some deep doo-doo if it is found that I didn't follow policy.

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU.

In 1991 some nit wit decided to make it a policy to identify HIV positive patients by requiring a red dot sticker on the spine of the chart.

I took the stickers off the charts and I stole all the sheets of red dot stickers. I never told anyone except my medical director who put a stop to that foolishness.

Edited by icuRNmaggie

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education.

IMO, there are no policies that should supersede the expert judgement of an expert clinician.

For instance - every organization in the US has an ironclad policy about handwashing. But - what if you saw a patient falling out of bed and rushed in to prevent this without stopping to wash your hands first. Should this action be punished? Of course not.

The 'justifiable' breach of policy is one of the precepts of a Just Culture behavioral analysis. There are definitely instances when this is justified. If you are being asked this question on an interview, you may want to brush up on the principles of Just Culture ahead of time.

One of my instructors used to work at a Children's Hospital and had a child with end-stage cancer who wanted to go outside but was forbidden. On an overnight shift she, an RT and a few others took him outside. She said she almost lost her job but would do it again.

I want to be brave enough to do something like that if it ever came down to it.

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