I recently started work for a nursing agency, and was given a copy of their policies and procedures. Do these trump the policies and procedures of any client I work for (such as hospitals and long-term-care facilities)? -V. N., R.I.

Agency nurses must abide by the policies and procedures of the hospital or long-term-care facility where they're currently working. Policies and procedures are internal, self-set standards, designed to create an environment of safe patient care. It's truly a challenge for an agency nurse to know the policies and procedures of numerous facilities, but her hiring agency should help her-for example by giving her access to this important information before her assignment begins.

Patients in a hospital or other facility expect that the nurses caring for them are all practicing in compliance with the facility's policies and procedures. Many patients select a facility based on its patient- safety standards. Agency nurses must comply with those in-house standards.

If as an agency nurse you're caring for a patient in his home and your agency has contracted to provide the patient care, the agency's policies and procedures apply. If a home health care company has hired you to provide care, then that company's policies and procedures apply.