Despite its prevalence though, positive deviance in nursing isn't often documented, for several reasons. First, nurses might not think to document such actions, especially when they're taken for granted as the kind of quick-thinking that's simply all in a day's work.
They also might not want to document rule-breaking for fear of being reprimanded. And electronic charting doesn't really allow for nuance: Users simply tick a box when a task is completed; they don't explain how it was completed.
Gary told me that she conducted a (still-to-be-published) study in which she surveyed 106 critical care nurses via the American Association of Critical-Care Nurses and asked them to describe "a time when a policy procedure or guideline didn't fit the needs of the patients and what they did about it." She found a lot of "responsible subversion," rule-bending and breaking in the interest of patients, often in emergent situations and end-of-life care.
"They're kind of doing these creative workarounds," Gary says. And, "I was surprised to hear about how many people were sneaking pets in, or children."
Of course, there are risks involved for nurses who choose to break rules in this way, sometimes more serious ones than getting written up.