Current and former sacred cows in nursing

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Hi everyone,

The oldie but goodie thread got me thinking.

What are some former and current sacred cows in nursing?

By sacred cows, I mean facts, protocols, standards of practice etc. that were once bedrock but have been debunked over time through overwhelming evidence. This could either be stuff in the past that now seem so ridiculous, or stuff you still see nowadays that really should be stopped. Things like diethylstilbestrol for pregnant women, lidocaine and liberal doses of bicarb "just because" in codes, relying on auscultation only to check NG tube placement etc.

One of my big research articles for school was about the routine use of normal saline during endotracheal suctioning. Turns out its bunk. I, for one, was scared by my nursing school teachers into using it all the time. Otherwise, I will always scrape the trachea or leave the patient drowning in his own secretions. Really? Now, I have had chronic trach/vent-dependent patients who ask for NS for their own comfort and preference. I happily oblige but I no longer feel obligated to lavage every intubated and trached patient I have.

So, folks, share your nursing sacred cows!

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Specializes in Nurse Scientist-Research.

Off the top of my head;

1. Trendelenberg for hypotension. Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture

2. Not aspirating with injections. http://ovidsp.tx.ovid.com.ezproxy.lib.utexas.edu/sp-3.12.0b/ovidweb.cgi?QS2=434f4e1a73d37e8ccc0b611cd6b5b34d8a344aff80779f6963ee0164d2a4a45335980bb10678a2076e67ad00fd0083618168ebad229665dda1f3bf4653d6c6e754eb43c008dcced220feeef123cf7841bed19e64d3dcc93e9758c95c3962113bc7e42674d022f907a5f2692b9c9527649e5701655134e4407b3895e18c8685e55937378ba412dff393c8d5e6a921350db4a158f0b15083791a60e9f4523592f5ebb8bf4bb8551903b31a6e1ec30caa7697feb7a22bd8aa8a2e27baf4198b4c7c89f56e5ea4d139de2c56109c7783f48ca609ba3cc29cddb4

I can think of some others given some time.

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I JUST found out about Trendelenburg today. Oh boy, now THAT is a sacred cow. Heck, I am skeptical myself. If I did not turn my patient on his head, I think a lot of my superiors would be writing me up.

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Specializes in Nurse Scientist-Research.

Can't get to my computer right now to pull sources but I seem to remember vigorous debate (maybe on the CRNA boards) about how the theory of COPDers and hypoxic respiratory drive is merely theoretical and never been proven in a lab.

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Can't get to my computer right now to pull sources but I seem to remember vigorous debate (maybe on the CRNA boards) about how the theory of COPDers and hypoxic respiratory drive is merely theoretical and never been proven in a lab.

The hypoxic drive to breathe has been scared into me during nursing school as well. Then I come to the hospital setting seeing COPDers on high levels of oxygen. Why? Well, because they are ill, ABGs truly suck and they need it (along with the careful monitoring that comes with inpatient care). And none of them suddenly dropped dead when the O2 regulator dial turned past 2, despite what my former professors and textbooks seemed to tell me. The subject was simply immune from debate when, clearly, there is room for vigorous discussion.

And that is what I mean by sacred cow.

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Specializes in NICU, ICU, PICU, Academia.

That somehow RBCs would lyse if given through anything smaller than a 20g. Of course, we routinely give babies their transfusions through 24g catheters.

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Specializes in Nurse Scientist-Research.
That somehow RBCs would lyse if given through anything smaller than a 20g. Of course, we routinely give babies their transfusions through 24g catheters.

Yea, when I transferred to NICU a baby had to have blood my first day of orientation. I'm all like "how we gonna get a 20g in this kid?" They didn't laugh in my face at least!

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Specializes in ICU.

Would you believe at my current hospital, we have to obtain a doctor's order to infuse PRBC's thru a 22 g catheter. I have tried to educate nurses here about red cells being 4 microns, and the current trend on the use of Trendelenburg, but they prefer to do things the sacred-cow way!

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Specializes in Nurse Scientist-Research.

To be fair about the blood, infusion rates in the neonate are so much slower one can justify smaller gauges. When your transfusion is 15mls over 2 hrs, it's all right to use a 24g.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I remember not allowing new MI patients couldn't have anything too hot or too cold. They felt it caused coronary spasm

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Specializes in critical care, ER,ICU, CVSURG, CCU.

immmobility and confined bed rest after lumbar disectomy or fussion (70's) :cyclops:

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