How many times have I heard nurses say, "Oh, sure, we do THAT because we've always done it that way." Or how about, "That nurse did it one time, so it's ok for me to do it" And another, "We did that at the last hospital so it must be ok to do it here." And my favorite, "It's easier and I've always done it like that".
Dear nurses,
If you want to get into some trouble one day, do what everyone is always doing...without question. It's nursing PRACTICE. It is professional and is backed by NURSING RESEARCH. To draw blood from a foot, to not monitor a patient, to give treatments, with your only excuse as "That's what we always do" or "I did this at another hospital" is stupid. And if that is the only logic you can apply to your tasks then you are not practicing wisely or safely. Do not depend on what others are doing. You have policy and procedures and even they should be able to stand the test of questioning.
I am going to play a little "Devil's advocate" here. Of course, I support nursing research and evidence-based practice. I teach it and try to keep up with the latest developments.
But ... there is something to be said for experience and the "test of time." A lot of nursing research is not "practice ready" and too many inexperienced nurses (and experienced ones with just a beginner level knowledge of research) jump to conclusions based on research that is not yet fully developed. Expert evidence-based practice requires the integration of research-based evidence with practice experience and an evaluation of the practice context. Don't totally ignore or denigrate those nurses and their past experiences who raise questions. Some of them might be basing their hesitance to try something new on valid concerns.
A good example can be found in the introduction of new medications. New drugs can't be brought to market without extensive testing -- and yet, we often discover harmful side effects AFTER the product has been on the market for a while. The same is true of many nursing intervention studies: the first research may look very positive, but with mass implementation, problems emerge that require adjustments in the treatment, etc.
Make peace (and friends) with those nurses who are hesitant to try new things. Listen seriously to their concerns and their rationale for clinging to their old ways. Use their experience to tailor the research-based recommendation to best suit your practice setting -- based on their input -- addressing their concerns -- and building their trust. Improvement/change projects go much smoother that way.
Take it from this "Crusty Old Bat" who has worked with this for 35 years.
I think sometimes the "bosses" do not want to make the effort to try the more modern way of doing things. It is a hassle for them to write a new policy etc. So," lets just keep doing it the way we always have", seems to suffice.
as an Educator I can tell you this phrase has been said so many times that my ears ring. I now respond with, well, we aren't doing it that way from now on! Sometimes I ask what evidence they are using to back up that practice. Almost no one can give an answer.
Specializes in NICU, PICU, Transport, L&D, Hospice.
I think sometimes the "bosses" do not want to make the effort to try the more modern way of doing things. It is a hassle for them to write a new policy etc. So," lets just keep doing it the way we always have", seems to suffice.
The professional who has developed an improved process or procedure gets to write the new policy in my neck o' the woods (once it is agreed that said new practice is appropriate).
The worst saying is "We are doing this before you came here and we will continue after you leave. Do not change it if it is not broken"
So why are we even going to nursing school?
We should just learn to practice by doing what nurses do during Florence Nightingale era. Lets wear caps, bow down and get coffee for the doctors, change dressings without gloves, instead of IV bags we should use IV glasses, we should spank babies after deliveries, help drill holes in the heads of psychiatric patients to release demons that cause mental illness...
I can keep going on but I a getting bored!
Hmmm, made me think of a couple of procedures from the "dark ages" that are still in use:
1. Trepanation:
I think all neurosurgeons would readily agree that a hole is the starting point for all neurosurgical procedures.
2. Bloodletting:
Think about it: used for hemochromatosis.
Uh, also could we possibly throw in leech therapy for wound healing?
Hey, if these things were good enough for Hippocrates...just saying.
Specializes in NICU, PICU, PCVICU and peds oncology.
I've heard that phrase far too often too. I find those who speak it are those who have never worked anywhere else and have no idea that what they're espousing is poor practice, detrimental to the patient or based on poor science. It's like that joke about the newlywed who cooks a roast for her new husband. She takes the roast out of the package and slices a chunk off one end before putting it in the oven. When her hubby asks why she did that, she said, "That's how my mother cooks her roasts and they're always delicious." Then one Sunday the couple has dinner with her family only this time there was no slice taken off one end. When the woman asked her mother about it her mother explained, "When all you kids were still at home I had to buy a really big roast. The only way it would fit in the roaster was to cut a piece off..."
It also reminds me of a practice on my unit that I questioned from day 1 and still question when I precept new staff. And that is the practice of recalibrating their pressure lines every time they reposition their patient. Why are you doing that? "Because that's what the educator said to do." Really. What exactly are you doing when you calibrate your pressure lines? "Well, I close the line to the patient..." No, I mean what happens when you calibrate your lines? Why do we calibrate them? And then the really blank looks start popping up. It's comical when I explain the theory behind line zeroing and the fact that the only one who can change atmospheric pressure is our Maker.
Another inherent belief that goes along with this one is, "If you didn't learn it here, you don't know it." It's like new staff arrive completely clueless, a blank slate, a dry sponge just waiting to absorb all the great wisdom these superior beings might impart to them. Makes me absolutely NUTS!
I am going to play a little "Devil's advocate" here. Of course, I support nursing research and evidence-based practice. I teach it and try to keep up with the latest developments.
But ... there is something to be said for experience and the "test of time." A lot of nursing research is not "practice ready" and too many inexperienced nurses (and experienced ones with just a beginner level knowledge of research) jump to conclusions based on research that is not yet fully developed. Expert evidence-based practice requires the integration of research-based evidence with practice experience and an evaluation of the practice context. Don't totally ignore or denigrate those nurses and their past experiences who raise questions. Some of them might be basing their hesitance to try something new on valid concerns.
A good example can be found in the introduction of new medications. New drugs can't be brought to market without extensive testing -- and yet, we often discover harmful side effects AFTER the product has been on the market for a while. The same is true of many nursing intervention studies: the first research may look very positive, but with mass implementation, problems emerge that require adjustments in the treatment, etc.
Make peace (and friends) with those nurses who are hesitant to try new things. Listen seriously to their concerns and their rationale for clinging to their old ways. Use their experience to tailor the research-based recommendation to best suit your practice setting -- based on their input -- addressing their concerns -- and building their trust. Improvement/change projects go much smoother that way.
Take it from this "Crusty Old Bat" who has worked with this for 35 years.
llg, PhD, RN-BC
Very well said, llg.
And if I can expound a bit further on that theme: while nurses should absolutely be engaged in their own independent learning, reading journals and such ... a reference in literature to Practice X does not make Practice Y invalid. And new nurses, prepare yourself for the inevitability that further down the road, some Practice Ys will be touted as the latest & greatest.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
as an Educator I can tell you this phrase has been said so many times that my ears ring. I now respond with, well, we aren't doing it that way from now on! Sometimes I ask what evidence they are using to back up that practice. Almost no one can give an answer.
First I am wondering if those of you who work with nurses whose only response is "that's the way we have always done it" live and work in the south or north east? I haven't ever worked in either area as a nurse and I am wondering if its a regional thing.
Second it's a two way street. If you are going to insist that we give up a tried and proven effective practice then you better have the evidence to support the practice change.
I work in a teaching hospital where lots of the nurses are going to school for something, so I don't hear that phrase much at all. Still, I understand a bit of hesitation and doubt about change. Eventually, we all change and adapt, but it is not always instant. New is not always better.
If the issue is research driven practice, I am more likely to be accepting.
If the issue is the latest corporate workplace fad or buzzword, wait and see.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
If the issue is research driven practice, I am more likely to be accepting.
If the issue is the latest corporate workplace fad or buzzword, wait and see.
Maybe "because that's the way we have always done it" is a polite way of saying "if you had more experience and had done this thousands of times on a huge variety of patients, then closely monitored the results like I have you would be asking such a silly question".
Maybe "because that's the way we have always done it" is a polite way of saying "if you had more experience and had done this thousands of times on a huge variety of patients, then closely monitored the results like I have you would be asking such a silly question".
Well, expert opinion is the lowest-rated evidence for EBP...and then only if it is an expert consensus.
made me think of a couple of procedures from the "dark ages" that are still in use:
llg, PhD, RN
13,469 Posts
I am going to play a little "Devil's advocate" here. Of course, I support nursing research and evidence-based practice. I teach it and try to keep up with the latest developments.
But ... there is something to be said for experience and the "test of time." A lot of nursing research is not "practice ready" and too many inexperienced nurses (and experienced ones with just a beginner level knowledge of research) jump to conclusions based on research that is not yet fully developed. Expert evidence-based practice requires the integration of research-based evidence with practice experience and an evaluation of the practice context. Don't totally ignore or denigrate those nurses and their past experiences who raise questions. Some of them might be basing their hesitance to try something new on valid concerns.
A good example can be found in the introduction of new medications. New drugs can't be brought to market without extensive testing -- and yet, we often discover harmful side effects AFTER the product has been on the market for a while. The same is true of many nursing intervention studies: the first research may look very positive, but with mass implementation, problems emerge that require adjustments in the treatment, etc.
Make peace (and friends) with those nurses who are hesitant to try new things. Listen seriously to their concerns and their rationale for clinging to their old ways. Use their experience to tailor the research-based recommendation to best suit your practice setting -- based on their input -- addressing their concerns -- and building their trust. Improvement/change projects go much smoother that way.
Take it from this "Crusty Old Bat" who has worked with this for 35 years.
llg, PhD, RN-BC