Positively Deviant Nurses: The Power of . . . Why Not?

CAROL BUSH, BS, RN
Wednesday, February 05, 2014
Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
Pretty sure my mom would say questioning the status quo started at a very young age . . ."If I said the moon was white, you would say it was black...just to be different." I recall feeling frustrated when my kindergarten teacher did not want me to ‘color outside the lines.’ Why not?

In high school, when all the girls in my class took Home Ec, I signed up for the guy stuff:  agriculture, drafting, and woodworking.  Pretty sure the fact I was the only girl in a class full of guys had something to do with it, also. Why not?

My first “big girl” job out of college - part of the work as Communications Director was to write and edit the monthly HR magazine.  Big title. No autonomy.

One section was dedicated to employees celebrating milestone anniversaries.  The mag design was from the 50s and the “stories” were BORING.  My boss did not want me to discover and report the cool facts which made these folks awesome and unique. He demanded I send them a boring questionnaire and “write”only off those answers.  It was completely embarrassing and the joke of the company. It made me cringe.

I followed his paradigm for 6 months and repeatedly made my case for bringing the little magazine into the New Age. His response? “We have done it this way for 30 years.  We are not going to change.” Sound familiar?

Then one day, I decided to change it anyway.  I figured what was the worst thing that could happen?  I would get fired.  In my 22-year-old mind . . . that was no big deal, I could always find another job. Why not?

I’ve never regretted it and would do it again in a heartbeat.  The result?  He was mad.  REALLY mad.  Red-Face-Cigar-Smoke-Blowing-Mad. (This was the 80s…every smoker lit up at work). Thankfully, the company president and my fellow employees loved it. I did not get fired. In fact, as a result, my position was moved under the marketing and publications department, and I became a member of the communications team, where I had a super awesome mentor.

Looking back to the HR job in 1984 . . . THAT was when I first learned how questioning the status quo can create career opportunities and add value to an organization. I learned that not a lot of people question the status quo.  I learned I am not afraid to question and am able to bring value to any organization or project I am a part of, as a result.  Thankfully, because of that early mentor, I also learned how to be “Positively Deviant,” without getting fired.

What is positive deviance and how does it apply to nursing? 

It is bending or tweaking rules or guidelines in the interest of improving patient care.  I found a great article about it by Jodie Gary, PhD, RN in the American Journal of Nursing.  Through her work, Gary developed a nice operational definition:

“Positive deviance is intentional and honorable behavior that departs or differs from an established norm; contains elements of innovation, creativity, adaptability, or a combination thereof; and involves risk for the nurse.”

According to Gary, the concept can offer nurses a basis for decision-making when the normal, expected actions collide with a nurse's view of the right thing to do.

I am constantly on a quest to connect with other positively deviant nurses. Recently, one internet search uncovered a couple innovative nurses who are breaking the mold to create new models of patient care: Nancy Bergstrom, PhD, RN, FAAN, whose research has called into question 50 years of standard pressure ulcer prevention, and Sharon Schindler Rising, CNM, MSN, whose innovative ideas include the Centering Model of group healthcare

I believe all nurses are innovators and scientists. By the very foundation of the nursing process, we are trained in quality improvement. We are the original “Real time gap analysis” people.  Our industry is in the midst of disruption. Your idea might just be the solution. Why Not?

When you hear others tell you why you can’t do something, remember that other people have no idea what you are capable of. They are basing your ideas on their experiences, capabilities, and viewpoints of the world.

They have no idea how you think, what you can do, and what you believe.

If you listen to these naysayers, cracks will appear and begin to shatter your dreams away. My solution for negating this crazy thinking? State my dreams and desires, then follow it up with a simple . . . Why not?

Sometimes my “why not” has fallen into a massive failure. But, this is life. No one is perfect. Everyone fails somewhere. My focus then becomes turning the failures into lessons and move forward.

That is why when someone tells me they have an idea to change a process, or reinvent themselves in their career, my response is always:
“Sounds great! Why not?”

It’s not my place to tell them they can’t. It’s my place to help them believe that anything is possible. Why Not?


Talk about this article with nurses and others in the oncology community in the General Discussions Oncology Nursing News discussion group.
Carol Bush, BS, RN
Blog Info
The Disruptive Nurse: An oncology nurse navigator with a passion for helping medical teams embrace innovation.
Author Bio
Carol Bush, BS, RN, is an oncology nurse navigator with the Midwest Cancer Alliance and a nurse consultant for Remedy Heathcare Consulting.  She has a passion for helping medical teams learn to embrace innovation and thrive in a patient-focused environment.  An ardent advocate of social media in healthcare, she especially enjoys working with care managers, health coaches, and nurse navigators.  Connect with Carol Bush via Twitter @remedyhc_RN.
External Resources

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