April 9, 2020

Morning Vitals: Going Rogue as a Moral Choice in Nursing

Last week, I wrote about “going rogue” as an ethical response to normalized but questionable behaviors in the profession of nursing–and by extension in health care as a whole. Ultimately, all of us stand to benefit from this sort of rogue behavior, this aspect of what some call positive deviance. What’s really going on behind the term going rogue?

[T]he beneficially rogue … nurse can only be such because of a moral choice to act … to elicit benefit at the risk of losing some aspect of personal security.

The phrases going rogue and positive deviance both imply departure from typical and/or standard behavior. Practically by definition, the rogue or deviant steps into the minority and must bear the consequences of separation from the majority.

Like any other field, nursing offers its share of consequences, both positive and negative, for those who go rogue. I’ve written about some of them elsewhere on Morning Vitals. For most rogues or deviants, the negative consequences come to mind more readily. However, the positives are not so rare as to be doubted.

Now, I used the words typical and standard as if they’re distinct. Is there a difference? I think so. The difference is really between that which is typical and that which is normal. These two words are frequently used interchangeably, but they’re actually quite different. To say that something is typical acknowledges that it’s consistent with the general trend of the group in question, that it characterizes the group. In this way typical serves as shorthand for the behavioral identity of the group. On the other hand, to say that something is normal expresses the thought that it conforms to a norm or standard that transcends any specific member of the group. In other words, typical refers to the group as a whole, whereas normal refers to something beyond the group.

Some might object to the notion that we should identify a standard beyond any group. After all, they might say, one group’s norm may not correspond to that of another group. I don’t deny that such differences exist. Think of all the unit-specific policies that exist throughout your health care organization. The point here is not that there must be a common standard for all groups at all levels of organization but that each group, in order to be cohesive and recognizable as a group, must view itself in terms of the degree of conformity between its individual members and some norm, some ideal or correct reality.

Remember, last week I stated that “the ethical practice of any profession, including nursing, requires a life ordered by objective truth and moral principles.” When we think about whether a certain behavior is typical or normal, or both or neither, we’re approaching truth and morality. A group that’s identifiable by its typical behaviors is likely to have members functioning on the basis of one or more norms or moral principles.

Our behavior isn’t ultimately arbitrary, and truth and morality are necessary underpinnings of human nature. This is true for nurses as much as people from any other walk of life. In light of this, the beneficially rogue or positively deviant nurse can only be such because of a moral choice to act in such a way as to elicit benefit at the risk of losing some aspect of personal security within the organization.

Again, such a choice is moral in nature, directed toward a moral goal. None of us acts simply because there in no reason not to. Rather, we act for reasons, whether those reasons are self-serving or altruistic.

Now that we’ve arrived at the moral nature of behavior, perhaps we’re a step closer to viewing going rogue as a more worthy standard for our behavior. What do you think?

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