Unwritten Rules within the Nursing Profession
Courtesy of NurseConnect

Like many professions, don’t you think there are many unwritten rules in nursing? Depending on where you work, you have probably been exposed to many of these tacit expectations. Some of these norms are more obvious than others.
 
For instance, beginning with nursing school, most nurses are told that there is the “ideal way of doing things in our profession,” and then, there is the “real way things are done.” I remember hearing this idiom when I first started out as a nursing assistant. It still sounds cynical to me.
 
Since the early days of nursing, there seem to have been several unwritten rules based on convention. When it comes to health and life-and-death situations, it makes sense to have some hard-and-fast rules. However, at times, inflexible “traditions” may interfere with a nurse’s critical thinking. They can also hamper the potential for promoting positive change within a facility.
 
This brings me to a common, unwritten rule among certain groups of nurses: Don’t ask too many questions. Having precepted students and oriented new nurses, I can definitely identify with this notion. Nurses stay busy, and questions (especially complicated ones) can slow us down. Too many questions can interfere with our already hectic workload.
 
One of my favorite responses to an overly inquisitive student or new nurse is to have them briefly tell me what they think the answer is. This approach empowers them to learn to think through their questions before approaching busy nurses for an easy answer. If practical, I encourage novice nurses to research some answers on their own. Of course, this depends on the type of question. For theoretical questions, I try to give them a quick overview and then encourage them to look at relevant literature. On the other hand, when questions are in regard to ongoing duties or imminent procedures, then quick (and accurate) answers are essential. Sometimes, we must interrupt our own work flow in order to assist new nurses with equipment, clinical skills, or locating vital supplies.
 
Some health care facilities seem to have an unwritten rule that nurses must be fast and efficient. While I believe that nurses should be organized and effective, they must also be tuned into the needs of the patient and family members. Patients don’t like to feel rushed, and rushing can lead to errors. Furthermore, it may not be effective to try to rush all of our tasks into one hurried encounter with our patient. Take, for instance, patients with increased intracranial pressure or the unstable patient who may desaturate with too much stimulation. These patients need to have their bedside care doled out in easily manageable pieces.
 
Another unwritten rule in nursing seems to be that a seated or talking nurse is somehow unproductive. Most of our seated time involves charting, which is very much a part of our expected nursing role. And, talking to patients and family members is not necessarily nonproductive. We may be calming our clients, assessing their mental status, or building their trust. This unwritten rule is closely related to the all-too-often “norm” of expecting nurses to skip meals and interrupting them on their way to the rest room.
 
There is a great deal of physical work involved in the routine bedside care that we provide everyday. Hopefully, your facility doesn’t have an unwritten rule that every nurse should “tough it out on his own.” I prefer sharing the load, whenever possible. Many hands make for a lighter load.
 
Does your facility or floor have any unwritten rules or nonflexible traditions?

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