When Policy, Physician Orders, and the Standard of Care Don’t Line Up
Policies are one of those things in healthcare that we all know we need—and almost everyone has been frustrated by.
For nurses, a good policy can be incredibly useful. It gives us a shared framework for practice, establishes expectations, and gives us somewhere to turn when we encounter a situation we don’t manage every day.
I’ve also spent a lot of time with policies over the years: as a staff nurse trying to use them, an educator trying to teach to them, a consultant helping write them, and an expert witness reviewing whether they reflected the standard of care—or contributed to an unfortunate outcome.
And one thing I’ve come to appreciate is how difficult it actually is to write a good one.
A policy needs to provide enough direction to support safe, consistent care without trying to practice nursing for the nurse.
That’s a harder balance than it sounds.
When something goes wrong, the natural response is often to add another rule. Clarify the policy. Add another step. Make sure this particular thing can never happen again.
It makes sense.
But eventually, if we’re not careful, we can create systems that ask nurses to rely more on rules and less on the clinical judgment those rules were supposed to support in the first place.
And that’s where good nurses can get stuck.
What happens when the policy says one thing, the physician’s order seems to say another, and your assessment of the patient is telling you something else?
