Policy and Procedures

[TexasLVN91]

I recently left a job, for various reasons, but mainly because each preceptor I was with had a 'different way' of doing things, in all aspects. It was pretty confusing, and when I mentioned that I was having difficulty with policies and protocols, they said to just ask them.

They did have a Policy and Procedures manual but it was very brief. When I mentioned it to my preceptor she said she had never even seen it. To me this sounds sketchy and if anything were to go wrong, the nurses would be thrown under the bus.

I'm wondering how other people dealt with this or if it is common? It seems extreme to leave a job over this but I felt so uncomfortable following policies that were just by word of mouth.

[Sour Lemon]

It's extremely common for people to do things different ways. The policies and procedures where I work are also a vague and lacking.

I tend to not be too bothered unless it's something big. In those cases, I'll try to get something in writing ...even an email from a supervisor. Worst case scenario, I act in the most conservative manner possible.

[Davey Do]

if anything were to go wrong, the nurses would be thrown under the bus.

I'm wondering how other people dealt with this or if it is common? ...I felt so uncomfortable following policies that were just by word of mouth.

This is Modus Operandi at Wrongway Regional Medical Center. Administrators will put procedures in place at the drop of a hat without any supporting documentation. This sort of situation just occurred last weekend.

When a procedure change is passed to me verbally, I asked if it's documented anywhere. No? If a policy change is not documented, it doesn't exist.

I perform my responsibilities based on my education, knowledge, and past history.

I understand your discomfort, TexasLVN, and support your perception.

I often give both coworkers and administrators my philosophy based on Harry S. Truman's: "The feces stops rolling downhill here".

Good luck to you, TexasLVN!

[Pepper The Cat, BSN, RN]

I have often said, ask 5 people how to hard boil an egg and you will get 5 ways to hard boil an egg. The process may be different, but the end result is the same. A hard boiled egg.

so yes, different nurses will do things different ways. Policies and procedures are find and dandy, but don't always work in the real world.

[Susie2310]

I remember in the days of paper charting when huge binders full of detailed policies/procedures existed for many nursing procedures. When facilities moved to computerized charting I assumed this information was transferred to the electronic database for health care personnel to access as needed.

[TexasLVN91]

Thank you all your for input!

Just to clarify, I do know that nurses all do things differently, I was referring more to policy regarding protocol, for example, after a fall, all the paperwork and proper documentation, or in the situation that someone needed to be sent to the hospital. I got different explanations each time and even then they seemed half-***. Too many red flags for me.

[Guest219794]

This is Modus Operandi at Wrongway Regional Medical Center. Administrators will put procedures in place at the drop of a hat without any supporting documentation. This sort of situation just occurred last weekend.

When a procedure change is passed to me verbally, I asked if it's documented anywhere. No? If a policy change is not documented, it doesn't exist.

I perform my responsibilities based on my education, knowledge, and past history.

I understand your discomfort, TexasLVN, and support your perception.

I often give both coworkers and administrators my philosophy based on Harry S. Truman's: "The feces stops rolling downhill here".

Good luck to you, TexasLVN!

I am in the same boat.

Nobody seems to know how to find most policies. When you really want a policy to guide practice, there is none. But, there are multiple beliefs, passed by word of mouth, that people refer to as policies.

Can't give blood through a 22, that sort of stuff.

[Susie2310]

I am in the same boat.

Nobody seems to know how to find most policies. When you really want a policy to guide practice, there is none. But, there are multiple beliefs, passed by word of mouth, that people refer to as policies.

Can't give blood through a 22, that sort of stuff.

Do the policies exist on your facility's computer system, somewhere?

[Kallie3006, ADN]

When I switched hospitals some of the nurses would laugh at me for looking up different policies and procedures. I almost felt that I was at a bigger disadvantage having experience than if I would have started at this facility. I had a hard time with the adjustment and lack of procedural backing to support the way various tasks were carried out. I completely understand where you are coming from. Someone said there are policies and procedures that have no credibility behind the reasoning or policy set in place. Its frustrating to say the least. If you are taking care of your patients safely and following your nurse practice act, you will find your own niche to do things. I would address any concerns to your manager or educational department if it is something that needs to be completed a specific way (incident reports etc).

[klone, MSN, RN]

Everywhere I've ever worked, I live and die by the official policies, as do most nurses I've worked with. Whenever I start at a new facility, reading through the policies is one of the first things I do.

[Buckeye.nurse]

I agree with Klone. The place you worked doesn't sound typical (or safe) TexasLVN. My employer has a policy/procedure database with a clear link on our intranet. You can view the policies from the default settings, or log in and save your most used/favorite policies to a separate tab. I love this feature for frequently used policies that I want to show to my preceptees.

For many aspects of nursing care (PEG care, trach care, central line care, etc.) our policy is to use Mosby's nursing skills. We have a link to that as well and can search for titles or look up subjects by alphabetical letter.

Finally, we have clinical practice guidelines with algorithms to guide us in situations such as suspected sepsis, neutropenic fever, acute chest pain, suspected stroke, etc. The guidelines have tools that include printable ACLS pocket cards, ISBAR guides for calling providers, and time sensitive best practice advice (ie. medication timelines for ACS, antibiotic grid/timeline for neutropenic fever).

[cleback]

I tend to agree with you. Not having a policy seems like inviting blaming the nurses for a bad outcome. It's probably not intentional... maybe a smaller facility never really invested the time to develop them... but it would make me nervous as well. I think before leaving I'd think long and hard about their culture of safety and how they've dealt with incidents in the past.