Policy & Practice – Never the Twain Shall Meet?

The focus of the 2012 RCNA National Conference in Cairns was clinical governance, quality and safety.  After listening to the many speakers and having great discussions with highly experienced nurses, I began to question some assumptions I had made during my time as an undergraduate.  Had I been wrong in my criticisms of nurses who deviate from policy?

When discussing clinical placement experiences, numerous students describe being told by an RN “this isn’t the way we’re meant to do it”, but with an assurance it was actually better.  The reasoning as to why it was better than the written policy is often not provided.  As a result, these RNs are labelled as poor clinicians, willing to jeopardise patient safety for their own benefit.

The ‘perfect’ nurse, in many students’ eyes, is the nurse who follows policy to the letter, often showing where these policies can be found and emphasising the importance of never deviating from the prescribed path.  However, in my limited experience, it would seem these nurses are few and far between and I was curious as to why.

Certainly when viewed through a clinical governance lens, any deviation from a set policy is frowned upon.  Yet, more and more I am starting to ask are we judging these RNs too harshly?  Yes, there are nurses in practice who cut corners and deliberately ignore policies, practicing as they have always done, disregarding evidence-based guidelines, often leading to poorer outcomes for their patients.  These are not the nurses I am talking about.  These are not the nurses I aspire to be like when I am a registered nurse.

The nurses I am referring to are the ones willing to look at a policy, are able to understand the critical ‘must-do’ components and then apply their own clinical reasoning as to how the policy is applied.  These nurses understand it is impossible for any single policy to offer individualised, patient-centred care to the immense variety of patients seen in our health system.  They realise the policy may need to be adjusted slightly to accommodate the different sexes, ages, cultures, personalities and attitudes of their patients.  Their destination is still the same, a good outcome for their patient with safety and quality principles maintained.  They just see that sometimes an alternate route may be needed to get there.

These are simply the musings of a NN (nearly nurse), based on observations made during my clinical placements.  I do believe the majority of nurses I have seen deviate from policy have done so with only the best intentions, with patients often reporting to me how kind and compassionate these nurses were.

I would like to see, however, these nurses providing the reasoning behind their decisions to their students, to help our future nurses understand the importance of focusing on the patient, not just the policy.

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