It's OK to Break the Rules, Sometimes

Alexandra Wilson Pecci, September 10, 2013

A nurse leader advocates for "positive deviance" in nursing—bending or tweaking rules or guidelines in the interest of positively affecting patient care, even though there is no outcomes data to support the practice.

When Jodie Gary was working nights as a critical care nurse, she was written up by her supervisor for breaking hospital policy and letting a man spend the night holding his hospitalized wife's hand.

The two had never spent a night away from each other in their 50-year marriage. When the man left his wife's side for the evening, per hospital rules, the woman got anxious, her blood pressure rose, and she required higher doses of pain medication.

So Gary acted in what she believed was in the patient's best interest, and sure enough, when her husband returned, the woman's blood pressure lowered, she calmed down, and she didn't need as much pain medication.

"I broke visitation policy and let him stay at the bedside all night," Gary remembers. It's something that she still feels was the right decision, regardless of whether she was written up, regardless of whether she broke the rules.

Alexandra Wilson Pecci

Alexandra Wilson Pecci is an editor for HealthLeaders Media.

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