October 31, 2020

Morning Vitals: Going Rogue as a Positive Standard of Behavior for Nursing

Last week, I wrote about the moral implications of going rogue or positive deviance in nursing. I ended with the thought that going rogue in a positive sense may, in fact, be a worthy standard of behavior in itself. This week, I’d like to think about this a bit more.

Nursing involves a wide variety of people. Among all of those people, there are behavioral trends involving specific circumstances. Under certain circumstances, the vast majority of people will act similarly.

Examples of this are all around. The vast majority of nurses would administer a statin to a patient when one is ordered to be given. Most nurses would either perform incontinence care for a patient or delegate that care to be performed when needed. Most nurses would contact a physician with a critical lab result, if for no other reason than that hospital policy requires it.

Those are easy examples, of course, because they all involve at least some presumed benefit to a patient. One of the major reasons people enter the field of nursing is a desire to help people in need. Ensuring that these benefits reach patients is part and parcel of nursing.

When a nurse decides to endure the risks associated with positive deviance in nursing, there must be an aim beyond the “safety in numbers” he might otherwise enjoy.

Are there examples of behavioral trends in nursing that have detrimental effects? I think there are, although it may be difficult to identify them with the same confidence with which we identify the easier helpful behaviors. Ironically, this difficulty may be a kind of confirmation of the risks involved in positive deviance in nursing. After all, who among us will enthusiastically point out the failures and foibles of the majority without fear of backlash?

I can think of a few examples of positive deviance in nursing even now. A general example involves the honorable effort of many nurses to resist the temptation to cut corners in nursing care, which many nurses do to clock out on time. Some nurses are committed to fighting “alarm fatigue” by making it a personal habit to answer call lights promptly, even for rooms not assigned to them, and to hustle to bed and chair alarms to promote patient safety. Another example involves speaking up and correcting colleagues when they perform contrary to institutional policy, even when such policy noncompliance is ingrained in the culture of the organization and is in some cases intentional.

When a nurse decides to endure the risks associated with positive deviance in nursing, there must be an aim beyond the “safety in numbers” he might otherwise enjoy. It is generally safe to hide among the majority of nurses who indulge in particular behaviors. This may even be true when the general trend of nursing practice in an organization runs counter to institutional policy. Sadly, it is all too often true in nursing education as well. Some research demonstrates that cheating is widespread among nursing students and that this trend may correlate well with policy noncompliance post-licensure.

Only by acknowledging and pursuing a transcendent ground for human behavior can nurses be freed from fear.

Most nurses realize that health care in general is dysfunctional in many ways and that nursing is not immune to deeply rooted problems. The task at hand for nurses willing to venture personally into uncharted territory is to identify and embrace the risk of nonconformity for moral reasons that uphold truths and principles that transcend their desire for personal safety.

Risk aversion is the companion of fear–of being different, of sticking out like a sore thumb, of being identified as a problem, of being subject to unwarranted discipline. All of these and more are obstacles to nursing, especially when they interfere with one’s ability to personally live up to one’s principles. Only by acknowledging and pursuing a transcendent ground for human behavior can nurses be freed from fear.

I’m not perfectly fearless myself, but none of us is. What I do know is that I’m seeing more clearly than ever that nursing and Christian ministry must walk hand in hand.

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