Policies and procedures: Friend or foe? Part 2

Policies and procedures: Friend or foe? Part 2

Austin, Sally

Abstract: Review a case where policy and procedure breaches resulted in disaster. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com. [Nurs Manage 2001:32(2):25]

Last month, we reviewed several principles of policies and procedures:

* When a health care facility establishes policies and procedures, it creates duty.

* Deviation from established policies and procedures creates liability for your facility if someone is injured as a result of the deviation.

* Four elements must be present for someone to prevail in a negligence action. They include:

1. duty, which is created when there’s a patient-health care provider relationship

2. deviation from the duty, for example, breaching an adopted policy/procedure that’s a standard of care

3. damage to the person

4. a direct relationship between this damage and the standard of care breach.

The following actual case* demonstrates how breaches in policy and procedure could’ve been avoided and how these breaches resulted in liability for the hospital and a negligence action.

Austin vs. Hospital X

All facilities must establish a policy and procedure that addresses fire emergencies. As with many hospitals, Hospital X employed the acronym RACE in case of a fire. Hospital X also established a policy that prohibited smoking in patient rooms.

* What does the RACE acronym stand for?

Hospital X admitted Abner Austin. When his brother, Asher, arrived for a visit, Abner was smoking in his room. Asher was unaware that smoking was against hospital policy. Unable to find an ashtray, Asher used a juice glass for the cigarette ashes.

Because Abner’s balance was off and he wasn’t to move about unattended, a nurse restrained Abner in his chair. Soon afterward, Asher decided to leave. He lit another cigarette and held it up to Abner, then extinguished it and threw it in the wastebasket on his way out. Within a few minutes, a fire broke out in the room. Nurse Short entered and noticed the fire.

* What should the nursing staff have told Abner about smoking in his room?

* According to this hospital’s policy and procedure for steps to follow during a fire, what should nurse Short have done?

Nurse Short failed to detect any real danger for Abner’s roommate, Mugsy. Rather than evacuate him, she unsuccessfully attempted to untie Abner’s restraints. She then tried to put the fire out by smothering it with a sheet. Her attempts failed, so she ran to the door and called for help. She then resumed her attempts to smother the flames. Nurses Cannon and White entered the room but quickly returned to the nurses’ station, passing a fire extinguisher on the way, to sound the fire alarm and call security.

* Before going to the nurses’ station to sound the fire alarm, what should nurses Cannon and White have done?

When nurses Cannon and White returned to the room, they assisted nurse Short in grabbing the legs on Abner’s chair and dragging him into the hallway. By that time, Abner suffered severe burns over much of his body.

Nurse Short then attempted to remove Mugsy but the heat, smoke, and flames prevented her from entering the room. Mugsy died in the room from smoke inhalation. Abner also died from infections secondary to his burns. Both families filed wrongful death actions.

* What should be the outcome of these wrongful death actions?

Information appearing in Legal checkpoints is general and not meant to give precise legal advice. Always refer specific situations to your facility’s legal representation.

2001: A page odyssey Let reading feed your soul.

Get inspiration from great lives…

* No Greater Love, by Teresa, Becky Benenate (editor), Joseph Durepos (editor), Mother Teresa, and Thomas Moore, New World Library.

* Out of My Life and Thought: An Autobiography (Albert Schweitzer Library), by Albert Schweitzer, et al., Johns Hopkins Univ. Press.

* Florence Nightingale: Mystic, Visionary, Healer, by Barbara Montgomery Dossey, Springhouse Corporation.

Or, reach deeper into your profession…

* The Gift of Pain, by Paul W. Brand and Philip Yancey, Zondervan Publishing House.

* Tending Lives: Nurses on the Medical Front, by Echo Heron, Ivy Books.

* The Wheel of Life: A Memoir of Living and Dying, by Elisabeth Kubler-Ross, MD, Scribner.

Call it quits?

If you’re in a rut and can’t get out, find an objective advisor and go through a SWOT analysis (Strengths, Weaknesses, Opportunities, Threats):

* Divide a sheet of paper into quarters, assigning a category to each one. List the strengths, weaknesses, opportunities, and threats to your particular situation.

* Take note: Where’s the greatest number of entries? Do you see a pattern? Anything unexpected?

Remember, not everyone succeeds at every task. Knowing when to cut your losses can be difficult. But if you set boundaries and keep them, you’re honoring yourself.

Source: “Know when to give up,” by Jennifer Lawton. For more information, visit the World Wide Web, http://www.inc.com.

Seven secrets of success

Go above and beyond as a manager by maintaining these positive habits:

1. Increase self-discipline. You’re a role model. You set the standard regarding personal behavior, so keep it high. Remember, one moment of impulsiveness can erase years of hard work.

2. Show consistent kindness. Marquis managers don’t intimidate to get results. Treating others poorly will ultimately affect your self-esteem: How can you feel good about yourself if you’re upsetting or neglecting your staff? And if you don’t feel good about yourself, how effective can you be?

3. Stretch goals. Without clear goals in mind, to which you’re firmly committed, your career plan is tragically flawed. Highimpact managers take goal-setting seriously. Write your aspirations down, and then post them in a visible area so they serve as a reminder. This increases the chances that you’ll meet them.

4. Welcome criticism. Embrace feedback, don’t avoid it. Don’t fool yourself into thinking other opinions don’t matter. Your credibility and reputation play pivotal roles in how far and how quickly you’ll move ahead. Soliciting input from staff provides a clearer view of your blind spots. Growing hostile and defensive in the face of constructive criticism insulates you from the truth and limits your potential.

5. Be a solution-finder, not a problem– identifier. It takes no talent to find fault. Criticizing or blaming your superiors for their decisions shows disloyalty and sets a bad example for your staff. You have a responsibility to stand behind the powers that be, whether or not you totally agree with their decisions. This doesn’t mean that you have to remain silent: Criticize positively by recommending a more perfect solution.

6. Show boundless enthusiasm. Enthusiasm is contagious. Successful managers realize the effect their attitude has on mood and productivity. Employees will absorb your energy if you show a passion for your work.

7. Embrace opportunity. Great opportunities often hide in work clothes. Get busy, show initiative, and take a risk. Organizations change when managers seize opportunities with boldness and confidence-encourage staff to do the same.

Source: “Seven habits of highly effective managers,” by Kathy Simmons,

Available on the World Wide Web, http://content. careers.msn.com/WorkingLife/GettingAhead. Your home office: Put it in its place

Follow these pointers to an efficient home office:

* Develop clear guidelines with others in your household to minimize misunderstandings about the space.

* Set up at a location that you enjoy. But if you run a business, keep it separate from your personal living space.

* Use furniture and lighting that suit your individual preferences. If possible, create an L-shape for your desk area with filing space within reach. Consider ergonomics to protect yourself from fatigue and injury.

* Set up your desk so you can process mail quickly. Use three containers- in, out, and file.

* Keep wastebaskets and recycling containers near your desk, filing cabinet, and fax machine.

* Create a filing system so that you or someone else can locate information quickly and easily.

* Divide your papers into action and reference categories.

* If you’re short on filing space, create archives in a less accessible or off-site location. Keep a list of these files at your desk for easy reference.

* Use wall space for bookshelves or cabinets.

* Continually ask yourself, What’s the worst thing that could happen if I didn’t have this? If it’s an answer you can live with, toss or recycle it. Think of clutter as postponed decisions and apply the FAT system: File, Act, or Toss.

Barbara Hemphill Hemphill Productivity Institute Raleigh, N.C.

*All names have been changed.

About the author

Sally Austin is Senior Vice-President, General Counsel, and Corporate Compliance Officer for Charter Behavioral Health Systems, Alpharetta, Ga., and Past– President of the American Association of Nurse Attorneys, Pensacola, Fla.

Copyright Springhouse Corporation Feb 2001

Provided by ProQuest Information and Learning Company. All rights Reserved