Some nurses are big fans of something called evidence based nursing. According to this school of thought, nurses should not make any patient care decisions without at least having two research references in their hip pocket to backup their plan of care. I, on the other hand, subscribe to “old school” nursing. Sometimes these two schools of thought collide.

Don’t get me wrong, I think evidence based nursing is valid, that is, until it gets in the way of patient care. One of my patients went ballistic one day while I was working as the unit charge nurse. She was yelling and screaming as she scratched her wrist with a paperclip. I walked over to the patient, told her to stop, and escorted her to her room. The patient and I had a brief discussion about what constitutes appropriate behavior on the unit, and how she could ask for help the next time she had the urge to act out. As far as I was concerned, the incident was over.

When I returned to the nurse’s station, my boss and one of my colleagues were busy developing a patient treatment plan based on evidence based nursing. They were talking about what to do next, and they were blaspheming my approach with the patient. My boss said that, according to research data, the patient needed to be watched 1 on 1 by a nurse due to her impulsive behavior, and he questioned what research theories I used when I took my patient to her room. Say, what? I giggled to myself, paused, and then started sniffing the air like a hound dog tracking his prey. My boss peered at me from over his glasses and asked me what I was doing. I told him I was doing research. I said that I theorized that I could smell an out-of-control borderline personality that needed limits set on her behavior, and that I had concluded that watching the patient 1 on 1 would give the patient positive reinforcement for negative behavior. I told him that I wasn’t rewarding the patient’s bad behavior by providing her with a private audience. End of discussion.

An anonymous reader responding to my post about Clara Barton observed that you can’t be a good nurse without caring, but neither can you be one without knowing a lot, and that new knowledge is derived from research. The reader went on to say that theory is supposed to lead to better nursing practice, but that falling in love with theories isn’t anymore helpful than falling in love with our patients. I couldn’t agree more.

Sometimes common sense trumps a hypothesis.