no policy or protocols

[COLD IN ALASKA]

i work in an icu in a small hospital with a great group of nurses, but we work by the seat of our pants we really don't have a lot of policies to cover our butts. i have worked in bigger hospitals that had too many policies. there are so many different ideas about what drips shpuld be icu and what drip can be imcu. with management it changes due to staffing needs. for example a nitro drip is usually icu except when there is an admit in the er then the director says it can be imcu which of course means you will take this admit no matter what. integrilin is treated the same. what have ya'll seen? i have asked the director for a list of drips that make a pt icu and a list that can be imcu or even the floor like other hospitals i have worked in and was told we don't have one.this leaves a lot of us frustrated.

[lindarn]

I would take it up with the Risk Management Department. They can set the hospital straight. JMHO and my NY $0.02.

Lindarn, RN ,BSN, CCRN

Spokane, Washington

[lifetimern]

I think this a great opportunity for you and you colleagues! If policy and procedures are lacking, you should offer to create a committee to develop them. You should offer to chair the committee yourself. This is your chance to make a real impact on how your hospital is run -- now and in the future.

You may think that larger hospitals have too many policies, but they are there to protect the patients and the staff. They insure uniformity and increase quality of care. They also "cover your butt," as you put it.

Really, I'm surprised that JCAHO hasn't had some objections to your hospital's lack of substantive policy, but, if they haven't yet, let me assure you JCAHO will in the future.

I urge you to be proactive in this matter. Who better to write policy and define nursing's role at you hospital than you and your co-workers!

[Zookeeper3]

honestly you've been given great advise, talk to your manager and ask for a committee with the ICU and step down of two to three people each to come up with a list of meds that are appropriate for use in each area as well as a firm line where you will transfer up or down to the level of care.

this cannot be done with out both units involved to succeed, you may consider conversing with key staff in the step down first, getting a list of goals and guidelines before talking with the manager.

In my facility, changing policy takes six to nine months. To get around this meanwhile, we do trials, collect data and change our goals based on staff survey and feedback. Sound like a clinical practice committee in the making which is a step towards magnet status.

[tgb3rn]

I am guessing due to your title--Cold in Alaska, that you are in a small critical access hospital, small anyway. I would guess you are not JCAHO certified. The hospital I work at is not. In the situation you are in, it will be a problem. Small will often mean the very few set the rules for the rest of us. It is almost impossible if you are not already one of the special few. If you step on toes then you may get the whole foot in your backside. Try to make changes in small steps. After everyone gets used to the first step, take another.

Good luck,

Tom