Tuesday, April 24, 2007

what's the point of policies?

I left work feeling quite discouraged the other day, just wondering what's the point of it all. Why do I even bother encouraging graduates to demonstrate excellence in their practice? Nobody else cares. Why should I? (Broad brush strokes, broad brush strokes!)

In two short weeks I will no longer be a graduate support nurse. Instead I'm moving back to shift work on a general surgical ward. Before I make this transition (can I have a support nurse for myself please?!) I'm trying to work a day with every graduate RN in order to write a comprehensive assessment of their practice for the clinical educators who will take on my role. It's been quite an eye opener!

As usual, there's a broad range of competence. Some are the most amazing graduates I've come across. Thorough, well informed, good skills. A few practice in a way that is altogether too risky for my liking. They consistently select patients outside of their scope of practice and make mistakes because they're not quite sure what they should be doing. One or two are just plain careless. They drift through their day without paying a great deal of attention to anything and they certainly aren't interested in doing anything properly.

It was a slap dash, careless graduate who sparked my outburst at the beginning of this post. For once I mastered the art of standing back and letting them do the work while I observed. How very revealing! By the end of the shift any pressure area care was only performed at my desperate suggestion; those requiring assistance with hygiene were simply not washed; and huge slabs of time were spent defending why this or that policy was not being followed in their practice.

Come knock off time, I was infuriated. What a cheek, swanning into nursing and refusing to follow policies and protocols because after two months of practice they deem them an unnecessary hindrance?! The arrogance.

I was so angry I couldn't stay around and give the graduate any feedback. I needed time to calm down, gather my thoughts and form a measured response.

As I debriefed with a colleague I realised the graduate is not the only one at fault here. One of their stated reasons for not following policy is that 'nobody else does'. Here I am running around highlighting policies, reviewing protocols, urging professional practice while at the same time a host of other nurses are running around breaking policies, ignorant of protocols and role modeling unprofessional practice. What hope does this or any other graduate have of developing professional work habits? Why should they follow the policies when no one else does?

And here I come to my question - what's the point of policies? Why have them? We can all get along fine without them!
"See, I just moved the patient up the bed without that simple lifting device, and did I hurt my back? No!

"And what about giving an injection without gloves? I didn't sustain a needle stick injury!

"Did I give the medication to the wrong patient when I didn't check their hospital number? Of course not!

"Where's the wound infection in the patient who I failed to maintain asepsis with?

"I didn't splash myself in the eye when I didn't wear protective goggles to remove that drain!

"Get over yourself Muse! Stop pushing policies onto me that I just don't need."
Stated like that they do seem like silly, insignificant things. Maybe I should just get over myself and stop obsessing over every broken policy. Maybe it doesn't matter. We're all doing fine without them.

But it does matter! Policies are there for a reason. (I'm such a rule follower) Somewhere, sometime, something terrible happened enough times that a policy was drawn up to protect patients, and to protect nurses.

We can't just ignore policies and protocols because they are inconvenient or slow us down. We can't rebel against the machine because we don't like somebody telling us how to practice. And we certainly can't let our standards slip because everybody else has.

Take a stand, make a difference. For yourself and for the patient!

I don't have much longer to teach graduates the importance of policies, but soon I'll be on the ward working beside them as one of the staff. My goal? To be a role model who does practice professionally, and who does follow policies. We're sunk if we don't!

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At Friday, May 04, 2007 4:21:00 am, Blogger Labor Nurse said...

It matters. I'm on your side on this one!

I am sure that your hospital policies are backed up by research, and not made up to make their lives more difficult. Unfortunately it might take one really bad error for them to wish they followed policy.

At Saturday, May 05, 2007 2:41:00 am, Anonymous Anonymous said...

HAHAHAHA backed up by research!?!?? Oh come on, you know that MOST policy is because "thats the way we have always done it!!"
Now, granted, there are common sense things like gloves and goggles and such; but come on!!! When did you do anything because "evidence based practice" supported the practice.
Nursing has to get out of the Templars era and into the 21st century. Nursing has to promote evidence based practice. Nursing has to STOP apologizing for our existence and start living like nursing is a legitimate profession.


At Saturday, May 05, 2007 8:20:00 pm, Anonymous muse said...

Good thing our policies actually are based on research... they're all referenced at the end. In a token kind of way! ;)

At Monday, May 07, 2007 12:11:00 pm, Anonymous Happy said...

Good to see someone is trying to make sure new graduates have basic skills. A return to work based training rather than university only would fix that. With university based training the wrong people are entering who are not intersted in caring for patients.

At Wednesday, August 01, 2007 12:41:00 am, Blogger Peter said...

Hi! Great Site.

I could not get your email address right so sorry for adding this here in your comments section. But anyway here goes...

I wish to add a link on my blog to your site. My site is about nursing at St Vincent's Hospital Darlinghurst Sydney.

My site: http://stvincentsdarlinghurstmalenurses.blogspot.com/

Why: I am trying to find as many australian nursing blogs as I can to add to my list.

Do I have your permission please? If not no worries!

I can not find many Australian nursing blogs, so if you know of any could you let me know, if possible please.

Regards Peter McCartney

At Tuesday, October 02, 2007 12:05:00 am, Anonymous Onehealthpro said...

Thank you for this post. You are correct and the graduates and other professionals who are not following policies are wrong. In many hospitals today, there are signs on the wall telling patients to advise their health care professionals when they aren't following proper protocol, for instance hand washing technique. What a pitiful way to address this issue. Here sick patients, if you get a minute, figure out what we're not doing right and tell us. How many people think it would be appropriate for an airline to post such a notice in the airport advising passengers to let the pilot know if he fails to follow proper protocol. In my opinion, these posters are an acknowledgement by health care organizations that techniques are not being followed correctly, and they have no idea what to do about it so they thought they'd ask patients to help. Absurd! That said, I do want patients and families to be informed, but to be responsible for holding health care professionals accountable for their own standards. No! That is wrong, wrong, wrong.

At Monday, November 05, 2007 5:04:00 pm, Anonymous Anonymous said...

Kudos! Very informative article, keep up the good work!
This blog will be one of the many that I visit everyday.

Best of luck,


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