It's Our Policy & It Won't Help You!

Routine night-shift staffing on my L&D unit was four nurses and a tech. Some nights were slower than others and as happens in the world of birth’n those babies, some nights were insanely busy. I remember a night when we did 12 deliveries with 4 of them being C-sections, maybe it was actually 13?? A “normal” night would have been 4 deliveries max, and a busy night would have been 8 – 9 deliveries. Those numbers only account for the deliveries and do not include the number of turnovers to rooms, the patients still in labor, or the patients arriving in the AM to be delivered. To say we didn’t have time to eat or pee or even drink water would be accurate. Forget that we had done the work of 8 nurses, or that we had given it our all for 12-hours.

The day-shift arrived and that’s when the policies began to be enforced…

• “We can’t take report because you didn’t give the meds that were ordered one hour ago and that’s our policy!”

• “You have to finish the AM induction before I can take report because that’s our policy!”

• “I’m not taking report because I want my same patient back, and that’s our policy!”

None of these were actual, approved, real policies. These were the made-up policies that were were used as tools to be uncivil and did not do anything to promote teamwork. I wish that my unit was “special” and that these types of made-up rules were one offs in the harmonious world of nursing. Unfortunately, these same type of made-up rules continue to invade our departments and our hospitals and they do nothing more than provide a format for our members of our teams to promote incivility and create disruption and angst for others.

These made-up policies are not written, but they are memorized, enforced, and can be spouted off verbatim more accurately than any written policy ever has. If only we could get our teams to enforce the real policies, the ones that promote patient safety or meet regulatory requirements, with the same passion and energy that they apply these made-up policies.

As a leader, allowing these types of policies to permeate in your department is in essence promoting incivility. These made-up policies are self-serving at their best, harmful to morale and patient safety at their worst. These rules negatively impact you as the leader in terms of your metrics (i.e., OT, delays in care, patient complaints), which means they are costing your organization money and reflecting negatively on your leadership abilities.

These polices often times cross over to impacting patients and the impact can be so much worse. …One missed step off the platform and instead of sliding down the playground fireman pole, my sweet child plunged to the ground with a broken radial and ulna to show for it, along with a weirdly bent wrist. Luckily we live close by and we were in the emergency room in less than 30 minutes.

What seemed to be a quick admission was really just a quick triage and two hours later, we were still waiting to be seen. Waiting to be seen meant, we were also waiting for an x-ray, and more importantly waiting for pain medication. I’m a nurse, I get busy ER situations, and I get that some events take priority over two broken bones. What I didn’t get then and still don’t get today, are the enforcement of made-up policies. In this instance, two made up policies that did nothing to help my child.

Made-Up Policy #1: We don’t start IVs or give pain medication in the waiting room. Can guarantee without having worked for this organization that that was not a true policy. She was admitted and I know this because she had an arm band and even if she wasn’t assigned to a room, all medication machines have an override and there is no way the policy said – Must be in an assigned bed to get IV started and/or pain medication.

Made-Up Policy #2: We can’t move her to a room right now because we are in report. Can again guarantee without having worked for this organization that that was not a true policy. That was a policy made-up, memorized, and repeated multiple times daily – and one that is not exclusive to just this team, but by nursing teams everywhere. Hands down, the “we are in report” is one of the most memorized and repeated policies that exists in healthcare.

If you are wondering if these made-up rules are really uncivil, I guess that depends on which side you are on. For a patient in severe pain, or weak and incapable of sitting, or suffering with the effects of chemo, I can assure you that they feel these policies are uncivil. A complete lack of empathy, of compassion, of just doing the right thing. If you are the nurse or tech or colleague that has just lived through a day of hell and unending patient care, reminding you of a missed med or a delayed admission is the equivalent of kicking you when you are down.

Has anything changed in the past twenty years in the world of made-up policies? Not really. Over the past five years, and in working interim, I have had the opportunity to work for a few organizations. I have faced made-up policies at every organization. Some of the polices are the “usual suspects, and some are beyond anything I would expect to see.

A few that I’ve heard quoted…

“We are too busy to take report and we have a 15-minute window so call back – that’s our policy!!” – That translates to your ER or PACU or other inpatient unit back-logging, delaying transfers, increasing the work load of the sending unit, as they watch the clock, call back, get put on hold, wait some more, get frustrated, and on and on.

“We can’t take report because we are at shift change and that’s our policy!” – This one has a life of its own! I think it’s been viral for about 100 years!

The worst I have seen… I actually worked for a hospital that banned a wife from sitting at the bedside of her dying husband because they had a policy! Not a policy that said you couldn’t sit at the bedside of your dying spouse – that would just be too rude. Their policy was, “For patient safety, you can’t sleep in the patient room.” (I will just point out that it was a private room, had a sleeper chair, and in no way could this woman in anyway impact patient safety by sitting there). This poor woman sat by her husband of 53 years for most of the day and unfortunately early in the evening she dozed off. She was awoken by the nurse and told she needed “to take a walk and to try to drink some caffeine because she wasn’t allowed to sleep in his room." Remember – it's about patient safety! The end of that story… This sweet woman was so upset, she went home to sleep, and yep.. he died alone, and she missed his last moments on earth.

Spend some time this week talking with your staff about ALL of the policies being enforced on your unit. You’ll probably be surprised by how many exist. Then spend some time with your team figuring out who these “policies” benefit, how they promote a healthy work environment, and how they are patient centered. And then, put an end to the ones that do nothing more than create negativity and toxic outcomes. #EndIT, #YourEmployeesDeserveBetter #YourPatientsDeserveBetter