It's OK to Break the Rules, Sometimes
It's this kind of "positive deviance" in nursing—bending or tweaking rules or guidelines in the interest of positively affecting patient care—that Gary, Ph.D., RN, assistant professor of nursing at the Texas A&M University Health Science Center College of Nursing, discusses in her American Journal of Nursing concept analysis, "Exploring the Concept and Use of Positive Deviance in Nursing."
Positive deviance is a somewhat ambiguous-sounding term; after all, the word "deviance" carries with it negative connotations. But it's not negative in this context; quite the opposite.
"It's departing from any sport of policy, procedure, [or] routine… intentionally but honorably, using some sort of creativity," Gary tells me, and it's doing so with the intention providing patient-centered care.
"People are very gray. Not everybody fits into this black-and-white policy, so a nurse might slightly tweak something to make it better."
For instance, maybe a nurse breaks visitation rules, like Gary did. Maybe he or she administers an extra dose of pain medication without physician orders at 2:00 am or uses a bigger central line dressing—or two of them—than guidelines dictate because a patient weighs 500 pounds and the line is in his groin.
Gary believes that nurses do these sorts of thing all the time, every day in their work, but "we don't really have outcomes data on this," she says. "I think that everyone who's been a nurse can relate to it on some level."
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