The Definition of Insanity (In Nursing)

During my spelunking around the Internet for things to check on for this post, I learned that the definition of insanity (doing the same thing over and over and expecting different results) was not coined by Albert Einstein, as I had always thought and as Pinterest will tell you. Instead, if you’re curious, it seems to have first appeared in a Narcotics Anonymous book.

One might conclude that looking anything up on Pinterest and expecting accuracy is therefore a form of insanity, but that is neither here nor there.

I read an intriguing post called “Why Nursing Feels Like Groundhog Day and What to Do About It” and immediately thought of the quote’s ideas, whoever originally said it. From the first day of nursing school through the umpteenth committee meeting designed to unearth why problems are occurring, we nurses are all afflicted with a version of insanity. We individually and as a profession do exactly the same things, year after year, decade after decade, and seriously wonder why the field is fairly solidly stuck.

If our actions and those of the institutions we work for stay the same, the outcomes pretty much have to be the same as well. It is like Groundhog Day. To produce a different outcome, someone has to intervene at some point in the process. For example, if you’re in health care, how many times have you heard it trotted out that your institution is promoting an error-free, blame-free culture and will not punish those who self-report errors? Same audience: how many of you know someone who’s been punished for doing it? Again, same audience: how many of you therefore hesitate before reporting or simply do not report errors?

I have seen committees and focus groups about this issue everywhere I have ever worked, and I am always puzzled. If you want a blame-free culture, you probably are going to have to stop blaming people. No focus group needed. Yet we collectively scratch our heads and wonder why it is so difficult to improve patient safety by getting accurate error data. Insane? I think so.

Another example is the ongoing “why do we have staffing issues?” question. Any nurse can answer this question, instantly and thoroughly. All facilities have to do is ask them and listen to what they say. The answers are mostly the same (“you’re mean to nurses, you don’t keep your promises, you pay badly, you fire experienced people to hire cheaper labor, you don’t care about our safety…”). What happens, though? They keep creating committees and drafting action plans that address none of those answers; therefore, the problem cannot possibly be resolved.

Maybe this is one reason why it is exhausting to be a nurse. One can enter the field excited to make a difference and very quickly have that impulse extinguished by this insanity. In health care, motion and action are very often mistaken for one another, and those taking actual action will be overruled by those in useless motion. I think the only way to reliably avoid this is to avoid motion. Choose action!

About Megen Duffy

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Megen Duffy, RN, BA, BSN, CEN, is a practicing nurse, blogger, and contributing editor for the American Journal of Nursing. Megen has practiced in a variety of settings from emergency rooms to prisons.