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Sacred cow round-up


One of the best ways to support innovation is to model and facilitate evidence-based practice. This approach deemphasizes the “we’ve always done it this way” rituals and traditions that have dictated nursing practice—and deterred innovation—for years.
In the past year, I’ve talked about evidence-based practice, adapting to change, and empowerment. These topics converge when we embrace innovation. Resisting change and innovation, on the other hand, protects sacred cows. It’s my hope (or fantasy) that we can unleash the talent on our front lines and innovate from within. To accomplish this, we need to round up our sacred cows and clear a path.
“Challenging nursing’s sacred cows” (April 2008 issue, page 23) compels us to reexamine how we make decisions about care. When research gives us the evidence to effect better outcomes, our job is to ensure the dissemination and implementation of these findings so a ripple effect bridges the gap from theory and research to practice.

Sacred cows create inertia
Many years ago, when driving in the canyons of southern Utah, I rounded a curve and came face to face with a herd of cows. They were in no hurry to let me pass; their sheer mass created an enormous barrier for my compact car. My choices were to wait (take no action and accept the current state of affairs indefinitely) or move cautiously forward to create movement (change) in the herd. With trepidation, I moved forward slowly and was able to coax the beasts out of my way.
To keep up with the results of research and other technological advances, we need to move our sacred cows out of the road. Some of the most fundamental changes in nursing practice have taken more than 10 years to bridge the theory-to-practice gap. With evidence in hand, our goal should be to shorten this adoption time.
But letting go of sacred cows can be scary. Getting others to want to change is the hard part. Most people resist alternatives because change threatens the status quo. The very act of changing the status quo is the underpinning of innovation.

How else can we round up the sacred cows?
Disruptive innovation leads the way. In nursing, a disruptive innovation is a new approach or technology that allows us to simplify or improve care by enhancing safety, efficiency, or outcomes.
We experienced disruptive innovation in our educational system with the advent of nurse practitioner programs in the 1960s and more recently, with clinical nurse leader and nursing practice doctorate programs. Technology has revolutionized nursing practice. I.V. pumps no longer require manual-drip counting and calculation, and can warn us of potential hazards. Automatic capture of vital signs via a monitor-computer interface spares us from having to record frequent values. Patients monitor their own blood glucose and practice health maintenance at home. Devices deliver chemotherapy at home. Less invasive treatments lead to shorter hospitalizations and a different nurse-patient relationship. Families care for ventilators and dialysis machines.
The strategic plan of the National Institute of Nursing Research (NINR) includes the goal of “adopting, adapting, and generating new technologies” for better health care. NINR encourages the development and application of genetic and genomic science that may lead to understanding new interventions, as well as the design and testing of information and communication technologies. We need to make sure sacred cows don’t block the path to these new discoveries.
Nurses are responsible for creating or embracing disruptive technologies that will change nursing. Helping others embrace such change requires willingness to adopt an innovation. Adoption hurdles may pop up based on individual beliefs, sense of cooperation, or lack of trust. Attitude is everything, and it’s not affected by age or position.
Let’s not delay adoption of evidence that will benefit patients or nurses. We know the impact the presence of registered nurses makes on nurse-sensitive outcomes. We know time-saving and enabling technologies can spare us physical strain or harm. Following the advice of Kriegel and Brandt, authors of Sacred Cows Make the Best Burgers, we can examine the value of current activities, assess whether stopping a particular practice will lead to consequences, and identify benefits to adopting new practices. We can’t afford to let sacred cows graze away our innovative thought and creativity.

Pamela F. Cipriano, PhD, RN, FAAN

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