Nurses are once again the most trusted profession, according to a Gallup poll. Every year (except for 2001, when firefighters edged us out because of 9/11) this happens, and every year I wonder how exactly this result occurs. The people answering the questions are not the same people I see on a daily basis.
The people I see say things like, “oh, you’re just a nurse.” Therefore, I am left to wonder what being perceived as honest and ethical actually does for the profession. Would it be better to be dishonest and unethical, yet be perceived as highly technically competent and knowledgeable about disease processes and medications? What exactly does it take to prevent the “just a nurse” reaction?
The American Journal of Nursing published a fantastic article on “positive deviance” (2013;113:26–34) last summer, and nurses went nuts on social media about how it was about time someone not only brought the concept to light but also advocated it. Positive deviance is basically doing something you are not really supposed to do, for the good of the patient, and then covering your tracks.
This is clearly not honest. Is it ethical? I say absolutely, but that point is arguable.
All nurses do this. I am not talking about major things; I mean things like your patient has a terrible headache from his nitroglycerin drip, so you give him a gram of Tylenol without an order and then get an order 8 hours later when a physician appears. Everyone wins. The patient feels better, the physician is happy you didn’t call and wake her up for a Tylenol order, and you are happy because you didn’t get yelled at for calling and waking up a physician for a Tylenol order.
This is still not honest.
Nurses push boundaries and pull strings and think way outside the box every single day for the good of our patients. Often we do such things so often that they are accepted as standard even though they are technically not within our prescribed scope (giving even Tylenol without an order is practicing outside an RN’s scope).
I would think that such things would not bother Patient Q. Average, whereas on the contrary being told that he can’t even have Tylenol for a headache even though he could at home would bother him very much. Patients know we do things like this, so they know we are not scrupulously honest. Are people giving us a pass because we are dishonest for their benefit? If so, this poll has some very machiavellian results, because the ends are justifying the means.
I also wonder if these polled subjects answered on the basis of a platonic idea of nurse-ness and not on actual nurses. For some reason, many people believe strongly that nurses are sweet bundles of goodness and light who are pure as the driven snow. I assume this because if they did not hold this belief, they would not be stunned and outraged when they find out that nurses are also regular people, get angry, have off days, swear, and make decisions that might have been better off made another way. So is it only the the ideal nurse who is so honest and ethical?
Don’t get me wrong. I’m thrilled that the public has a positive opinion of any kind about nurses. I am simply intrigued by it and wonder where this comes from, because I wouldn’t say that honesty is a quality I see all that consistently in this field. Positive deviance is, and I am just fine with that.