If I hear this one more time, I'm going to lose it!!

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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.

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Well, expert opinion is the lowest-rated evidence for EBP...and then only if it is an expert consensus.

Right, but expert opinion isn't what I was talking about. As I said I was talking about evidence. Evidence obtained by preforming an action, or therapy, then closely and objectively observing the results. Something nurses do every day.

Just brining up to possibility that the response may very well not mean what the person asking it thinks it means. Consider the possibility that you might be receiving a response designed to humor you, or be condescending, or maybe even a polite response to a question deemed to be silly.

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Specializes in Oncology.
I am not sure if I have EVER heard a nurse say that. Maybe but if so I don't remember it. Glad I don't work where you work if you are hearing that all the time.

I have often done things a certain way becuase that is the way the hospital policy states it must be done, despite evidence to the contrary. One small example. My current hospital, typicaly big on EBP, is STILL using stand alone PCAs rather than the correct PCA slaved to ETCO2 monitors.

Policy is policy, even if you know better. I am lucky that in my hospital policy USUALLY is only a couple steps behind the best evidence, but some things slip through.

This sounds like my hospital. Big on EBP. If you say, "Because it's always been that way" get prepared to be slapped upside the head. We also don't have PCA's linked to etCO2. Wish we did. I'm sure it's a cost thing. Usually if you can provide published evidence why something is better we can get it changed.

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This sounds like my hospital. Big on EBP. If you say, "Because it's always been that way" get prepared to be slapped upside the head. We also don't have PCA's linked to etCO2. Wish we did. I'm sure it's a cost thing. Usually if you can provide published evidence why something is better we can get it changed.

EtCO2 is a good example of good EBP that ends up not working so well in practice because the cannulas are so positional - among other issues.

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Specializes in Oncology.
EtCO2 is a good example of good EBP that ends up not working so well in practice because the cannulas are so positional - among other issues.

Our non-critical care units implemented bedside monitors that can do O2 sat, etCO2, HR (from the O2 sat) and RR (from the etCO2). My unit is considered critical care so we just have our cardiac monitors. Kinda sad I have never gotten to play with the new ones.

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Specializes in pediatrics, occupational health.

Interesting topic! One time I was giving a nurse report and she got all upset about something I did. She said, "WHY DID YOU DO THAT? WE DON'T DO THAT HERE!" I said, "because this is the way you are SUPPOSED to do it CORRECTLY".

I wish I could remember what it was, but it was just mind blowing. I know I thought other thoughts, but sometimes I just want to say, "I am NOT your teacher, you should KNOW this stuff".... this is why we do CONTINUING EDUCATION!!!!!

haha!

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Specializes in Trauma Surgical ICU.
EtCO2 is a good example of good EBP that ends up not working so well in practice because the cannulas are so positional - among other issues.

Oh yes. So many issues. Pts complained so much about the nonstop beeping physicians all but stopped using PCAs. We went from seeing 50 or so PCAs a day to less than 5 in a 500 bed facility.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Oh yes. So many issues. Pts complained so much about the nonstop beeping physicians all but stopped using PCAs. We went from seeing 50 or so PCAs a day to less than 5 in a 500 bed facility.

Interesting. At my other job the PCA / ETCO2 has worked very well and has resulted in many more PCAs. Previously nurses never advocated for a PCA simply becuase the huge work load it meant for them. There had been a sentinal event in the hospital resulting in a patien't death. Administration over reacted and made having a PCA such a huge charting buden on the nurses that nurses simply stopped advocating for PCAs. They far prefered to just do their pain assessements and provide pain meds IV push.

Since they have gone to PCA with ETCO2 (back in 2005 or 2006) the charting burden for the nurses has been lifted and the nurses now often advocate for PCAs. I wonder if we are talking about different equipment being the issues? We use the Alaris PCA & ETCO2 units. The both just snap onto the Alaris IV pump brain.

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Specializes in Trauma Surgical ICU.

Most likely. Pts complained non stop. They ate it beeped. They talked it beeped. They got oob it beeps because the HR went above norm. It was outrageous. If it beeped for any reason it would start beeping a different sound because now the pump was locked. Our charting was not bad but the pt complaints went through the roof so the docs stopped ordering them. I have left that facility so I'm not sure if they have fixed that problem or not.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Most likely. Pts complained non stop. They ate it beeped. They talked it beeped. They got oob it beeps because the HR went above norm. It was outrageous. If it beeped for any reason it would start beeping a different sound because now the pump was locked. Our charting was not bad but the pt complaints went through the roof so the docs stopped ordering them. I have left that facility so I'm not sure if they have fixed that problem or not.

Beeped? Ours never beeped. The pumps are slaved to the EMR and the RN gets an alert when ETCO2 drops. The PCA is automatically shut off as well and much be restarted by the RN. We could do it either at the pump or from our tablet.

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Specializes in Trauma Surgical ICU.

Sounds nice. Nothing like what I've dealt with.

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Actually, that is the type of place I am working at right now and that is why I am considering leaving. I work with some inexperienced nurses with limited skills. I am a 35 year CCRN, CVRN, BSN with extensive experience working in a teaching hospital (a Magnet Hospital) so I have been trained to consider evidenced based practice as a necessity to practice. Where I am now, there are many questionable nursing practices that are not addressed via policy and procedure. Nurses are just doing things based on very limited experience and knowledge. They become frustrated and flustered when they are questioned regarding a nursing task they are doing, if it is appropriate, such as not checking for an order or a consent for a blood transfusion BEFORE starting the infusion. To them, it's just unnecessary. Why? Because their experience with the procedure of giving blood is very limited. So they just do what they think is best. This is only one example.....

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Actually, that is the type of place I am working at right now and that is why I am considering leaving. I work with some inexperienced nurses with limited skills. I am a 35 year CCRN, CVRN, BSN with extensive experience working in a teaching hospital (a Magnet Hospital) so I have been trained to consider evidenced based practice as a necessity to practice. Where I am now, there are many questionable nursing practices that are not addressed via policy and procedure. Nurses are just doing things based on very limited experience and knowledge. They become frustrated and flustered when they are questioned regarding a nursing task they are doing, if it is appropriate, such as not checking for an order or a consent for a blood transfusion BEFORE starting the infusion. To them, it's just unnecessary. Why? Because their experience with the procedure of giving blood is very limited. So they just do what they think is best. This is only one example.....

The place you work NOW and want to leave sounds exactly like my experience with every Magnet hospital I have ever worked in.

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