Protect yourself Protect your license and most of all Protect your patient

Well, I know my fellow nurses are going to dislike me for saying this, but is part of their P & P to constantly put us in unsafe situations putting our license and patients lives at risk? Yes, should we should always follow their P&P, but what do you do when you are simply overwhelmed all the time? I say in addition, get your own liability insurance. You can't always trust what these facilities say. Sorry just my 2 cents.

Thanks for a very true, informative, and alerting dissertation.If only we could say on the stand, "My facility constantly places me in dangerous situations!" I know too well they would say, "And could you tell the jury, loud and audibly, did you accept that assignment?"I totally feel your angst and resentment at unsafe Nursing Practice Environments, and I know refusing a report is difficult- could even lead to firing. But, I would rather explain my resignation for unsafe conditions, than my termination for the medical error that severely injured a patient. The Policy and Procedure is what we will be judged by in nursing practice, documentation, and Admission/Discharging- and if I even have a twinge in my gut- I pull that big monster binder down.

It is so frustrating isn't it, that we cannot protect ourselves against the unsafe working practices we are all put in during our nursing career.I wrote this article because I worry about my fellow nurses, and how easily we can be thrown under the bus!

I work in an ER with very few written protocols.There is nothing written anywhere that allows me to start o2, iv, labs, let alone meds I might give without an order, including glucose, ntg, or ativan.In a perfect world, there would be a set of protocols for most foreseeable situations. I don't work in that perfect world. In the event of an emergency, I would really like for the doc to be there. They know more than me, and have the education, knowledge and authority to make better decisions than me. But- sometimes all the docs are tied up. At night, the one doc could be in the middle of a lumbar puncture, or an intubation. Or taking a poop.Where I work, a nurse who followed the P&P would be considered useless. I have worked in severa ERs, and this is not all that unusual

You can practice anyway you want but you need to be aware that In order to protect yourself , you need to know the policies and procedures of the unit where you work.If your place of work has none, then I would worry that they have them and you just haven't been told where they live.

Quote from hherrnI work in an ER with very few written protocols.There is nothing written anywhere that allows me to start o2, iv, labs, let alone meds I might give without an order, including glucose, ntg, or ativan.In a perfect world, there would be a set of protocols for most foreseeable situations. I don't work in that perfect world. In the event of an emergency, I would really like for the doc to be there. They know more than me, and have the education, knowledge and authority to make better decisions than me. But- sometimes all the docs are tied up. At night, the one doc could be in the middle of a lumbar puncture, or an intubation. Or taking a poop.Where I work, a nurse who followed the P&P would be considered useless. I have worked in severa ERs, and this is not all that unusual

Im glad someone started this thread. Since I am a new grad this is a topic that I have spent a lot of time thinking about. When I started I was told that there would always be another Nurse to ask questions if I needed to. Latley I have noticed that I have not been getting much support on that front. It seems like other Nurses are afraid to give advice or sometimes are not sure what to do themselves. I work second shift and weekends when there is no managment. I had a client fall for the first time on me the other night. One of the other Nurses saw them on the floor in their room and she stood outside the door and asked a CNA to run and get me. I was on my own, no advice offered, nothing. I had to go find the paperwork and try to do it myself hoping that I was doing everything correctly. When I gave change of shift report I asked the oncoming Nurse where to put all the paperwork. I was just waiting to get a call today that I screwed something up. I would love if I could take the policies and procedures home because there is not 1 minute on my shift to go through that book because its all I can do to get all my work done. There was never a day of training where I was instructed on policy and procedure, it was just following another Nurse around and a checklist of things they were supposed to tell me.

OP thank you for writing this. The only thing I would add is that there is a difference between policy and procedure. Where I work they are not used interchangeably. The policy is why I go by, not the procedure. The procedure can be formal or informal and tells you how to implement a policy. However, a policy stands on its' own and following policy is ALWAYS the best way to go. One day I had questioned something and was ready to take on the clinical specialist, after all I had proof: I had a printed of the "procedure". After I handed her the procedure she directed me to the policy which was slightly different. However, it was that small detail in the policy that changed my whole view on the situation. As nurses we have to be proactive about this. [FONT=Arial, Helvetica, sans-serif][COLOR=#004000]DEFINITIONS[FONT=Arial, Helvetica, sans-serif].Policy: The formal guidance needed to coordinate and execute activity throughout the institution. When effectively deployed, policy statements help focus attention and resources on high priority issues - aligning and merging efforts to achieve the institutional vision. Policy provides the operational framework within which the institution functions. [FONT=Arial, Helvetica, sans-serif]Procedures: The operational processes required to implement institutional policy. Operating practices can be formal or informal, specific to a department or applicable across the entire institution. If policy is "what" the institution does operationally, then its procedures are "how" it intends to carry out those operating policy expressions.

What bothers me most is that the P&P's are in 3 huge binders! Not to mention all of the new ones that come out daily. It is very overwhelming and next to impossible to find the time to actually look one up when you need it. I took a one day course over the summer and got some really good advice; look at one policy each day you work and eventually you will get through the books. I've been meaning to start.....

Got a new medical director shortly-I will be trying. The old one was a nice guy, but not great at getting stuff done.

In my unit there is a young, "click" of about 5 nurses. My unit director is a member of this click. These women could care less about the ppl they care floor. I have seen alot of stuff and heard them talk excessively (laugh, make fun of) the patient, right there in the front of the nurses station where they all gather. They all sit behind a computer and you can hear them laughing very loudly. Patients fam members (and the patient) have overheard many conversations. One young nurse is involved with a surgeon from our floor.She makes it no secret. The guy is married with children of his own. When he comes to the floor, this nurse and he go to the nurse's lounge area and close the door. (That's our hint to not go in there) These young nurses donot care about the patient at all. I have seen them ignore call lights and they take thier time getting pain meds to the patient on time. One patient waited an hr (after repeated calls to the nurse) for his pain meds. When I reminded her again, she was with another nurse headed for the staff elevator to go get her breakfast from downstairs. She told me she would give him (the patient) his pain meds after she was done eating. I have been in a tight spot to where I needed the assistance of a nurse and been refused help. Had one nurse tell me once,"I have done my CNA work in the past and I don't do that anymore." I have seen them refusing to go into a terminally ill patients room, telling me "they are DNR anyway, we don't need to go in there." (Do not recusitate) Stuff like this I put up with on a daily basis. My dir has been made known of this and she gets mad and says to just do my job and stay out of her nurses business. I don't know anymore as to what to do with the stuff I hear and say....any advice?

Thank you for a very important article. I believe it is very important to know what one's own nursing liability insurance policy does and does not cover, and what the exclusions are.