Morning Vitals: Going Rogue Redefined as Positive Deviance in Search of Human Fulfillment in Nursing

Horror stories have been told for years about the danger of rogue nurses. Nurses whose practice or behavior is inappropriate, even illegal or simply evil, should concern us all. But is there only one way to think about rogue nurses or “going rogue” in nursing? By a certain definition, wouldn’t going rogue in nursing be a good thing at least some of the time?

Examples of so-called rogue nurses abound. Just ask your state board of nursing. On any given weekday, there are probably a number of nurses appearing before their respective boards of nursing to defend their licenses or seek reinstatement of suspended or revoked licenses. A 1997 article in Nursing Management mentions several varieties of rogue nursing, including drug diversion, presenting oneself as a nurse in the absence of a current license, sexual predatory behavior, and murdering patients.

All of these examples of rogue nurse behavior are deplorable. There are also many that have not been mentioned thus far. There is broad consensus on many aspects of what qualifies as rogue nursing behavior. So, why would I even bring up this topic? Is there anything that can be added to the discussion of rogue nursing that would change our perception of the term and allow it to be applied to something positive?

While considering potential domain names for this blog, I searched the keywords “rogue nurse” and found multiple instances of the phrase. One of them was the article I mentioned previously. Of course, there were also news stories about various unethical and immoral actions by nurses. Some of them were simply horrifying.

On the other hand, there were also multiple instances of what I would consider positive uses of the phrase. One nurse wrote about going rogue in her career path, escaping burnout by leaving bedside nursing to become a per diem nurse. Another has established a business providing publishing assistance to nurses who want to “tell their stories.” Ironically, there are also nursing programs or health systems associated with the name Rogue as a geographic location. These alternative uses of the phrase rogue nurse are better aligned with my views on nursing and its future. They are also better aligned with my vision for myself as a nurse.

Although the etymology of the word is unknown, the word rogue generally refers to dishonesty, worthlessness, mischief, sloth, vice, or destructiveness. However, in an abstract sense, it can also be used to refer to deviation from that which is typical. Therein lies the basis of many positive uses of the idea of going rogue in nursing.

It can be a positive or beneficial thing for nurses to go rogue, to deviate from typical behaviors to the benefit of themselves, their patients, and the health care organizations for which they work. Many leaders in nursing and other health care professions are recognizing this reality. Some have called such atypical but beneficial behaviors positive deviance. However, the key distinction remains: “Deviation from what?”

For me personally, positive deviance relates to rejection of “standard” practices of unethical or nominally ethical behavior in the nursing workplace. I do my best to resist the temptation to cut corners, denigrate patients and coworkers behind their backs, and offer half my best. I refuse to watch the clock, avoiding nursing tasks after 6 o’clock when my shift ends at 7:30. While working as a bedside nurse, I ran to bed or chair alarms. I wouldn’t want my loved one to hit the floor just before her nurse came sauntering in with an annoyed look on her face. Would you?

Some standard behaviors pertain to the internal function of health care organizations. Contemporary health care is well known by health care professionals to be, in many cases, abrasive and abusive to the individuals who work for those organizations. The same is true of other professional domains and organizations. We should anticipate nothing different when people are involved. We are sabotaged by human nature.

Deviance from such questionable behaviors can only be beneficial. In my own life, I find going rogue in this sense to be a path toward human fulfillment. Nursing as a caring or helping profession can only be so to the extent nurses are willing and able to live humanely within their profession. Further, the ethical practice of any profession, including nursing, requires a life ordered by objective truth and moral principles.

There is a deep connection between going rogue, as an ethical response to normalized but unethical behaviors, and the notion of a theology of nursing. That connection is clearly in focus for me as I contemplate the way forward for Morning Vitals. As I seek a way forward in my career, I hope to develop the thoughts introduced here. I hope you’ll join me on a career-defining journey.