Subversion

[healthcare2015]

Has anyone dealt with responsible subversion. This is something I am struggling with currently. Some of the subversion is against my ethics and moral code as to how some cut corners and cover for one another and management is blind or simply chooses not to see the reality. Im currently a CNA in a hospital. Im starting RN program next fall but if this really is common practice I may choose another major. Any advice?

[TriciaJ, RN]

So it's bending rigid rules a bit for the benefit of the patient. Like leaving all four rails up to prevent a fall. I've done stuff like this. I once had a patient who was dying of cancer and spending much time hospitalized. Her husband brought their dog to visit. I informed him that it was against the rules since it wasn't a service animal and that if I saw him bring in their dog, I would have to ask him to remove it. Then I winked, because of course, the dog was right there. He was careful to keep it out of sight, and the very sick lady got some pet therapy from her own pet. (It was a cared-for animal and no one was neutropenic).

But cutting corners to make our own lives easier is generally a no-no. If the workload is so unsafe that corner-cutting is the only way to survive, then time to go. I once got sent to a nursing home as an agency nurse where this was the case. After 5 shifts of trying to stay above water, I finally told the agency I wouldn't go there any more. Hated to turn down work, but couldn't work there, ethically.

It often comes down to judgement calls, which is why they discuss it in nursing school.

[MunoRN, RN]

Crazin01 understands what I mean. There is a judgement call balance constantly and unrealistic expectations set by upper management. Many break the rules and have to to get things done but then some of these nurses may turn in another for doing the exact same thing forcing disciplinary action or termination.

Legally Speaking: The trouble with bending the rules | Modern medicine

Is your issue with the fact that responsible subversion exists in nursing, or that it can be used to allow one nurse throw another nurse under the bus?

What you referenced, responsible subversion, most definitely exists in nursing, in fact I'd argue it's our biggest asset. In trying to manage or control anything patient care related, there is a natural preference to move towards a level of inflexibility that isn't compatible with the highly variable needs of patients. Nurses ensure that patients aren't harmed or that their care isn't compromised by these inflexible systems, that's how nurses establish their value to the system (by knowing when patients need to be protected from the system).

[crazin01]

Healthcare 2015, please don't change your major because of internet responses. You are currently a CNA, you obviously LOVE what you do and any profession (especially healthcare) so needs folks that feel so passionately about their "job". It's clearly not just a job or paycheck to you (you asked the question in the first place, demonstrating your passion and calling).

Muno said it well, that "Nurses ensure that patients aren't harmed or that their care isn't compromised" that our number one goal is to be our patients' best friend & advocate in their time of need. And TriciaJ, letting that animal in to love on their owner (and the owner back on them) , I think was absolutely priceless, and I'm a HUGE animal lover. Because it benefited the PATIENT/CLIENT/person in need, during their time of need. And, if we can do that.... well, isn't that why we love our job in the first place? corney yes, "to help", but absolutely true.