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Positively Deviant Nurses – Why Not?


Pretty sure my mom would say my 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 my work as ‘Communications Director’ for the HR department 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 use only those responses to create the stories. 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?

The result? He was mad. REALLY mad. Red-Face-Cigar-Smoke-Blowing-Mad.

Remember, folks, 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 experience was when I first learned that questioning the status quo can create career opportunities and add value to an organization.

Over the course of my career, I have 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’s subsequent coaching, I also learned how to be “Positively Deviant,” without getting fired.

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

Positive deviance is bending or tweaking rules or guidelines in the interest of improving patient care. I found a great article 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 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 just might 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 moving forward.

That’s 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! “

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?


Carol Bush
Carol Bush

I am a Coach & Mentor to High Performing Health Writers. I co-host The Savvy Scribe Podcast and champion #PlainLanguageWriting.

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  1. Hi Carol,
    Your post really hit home for me! I am an advocate for nurses and nursing students with disabilities.
    Through my work, I have come to know some phenomenal nurses who practice nursing with a wide range of disabilities.
    When, I hear from a person with a disability who asks… “Can I become a nurse?”. I routinely say…”Why not?”
    Or, when I hear from a nursing instructor or disability services office staffer…who asks “can a nurse with “x” do “y”…I say “Why not?”

    Great post!
    Thanks, Donna

    • The Social Nurse The Social Nurse

      Thanks for stopping by to share, Donna! You make a great point that our ability to practice as nurses is limitless. I’ve always felt the boundaries were only limited by our imagination.

  2. Cheryl Cheryl

    I’ve been a positive deviant all my working life and didn’t know there was a “name” for it – in our “business” of nursing it’s absolutely imperative not to be an unquestioning drone as our patient’s outcomes depend on our clinical competency&expertise, advocacy, and proactiveness.

    • The Social Nurse The Social Nurse

      I so agree with you about the power of assertiveness in nursing practice! I freely admit that when I learned of the term ‘Positive Deviance’…and that there was some marrvy nursing research on the topic…I was ecstatic!

    • Phyllis Everett Phyllis Everett


  3. What an interesting post! I believe I fall into this category all of the time. I avoid flowing with the crowd. I do things based on what I value. What feels good and right for me. I hope to inspire others to live from within. Great to hear of another nurse who went with the traditionally ‘male’ choices. LOL. It’s nice to hear of another ‘tom boy’. I loved this post and will share. Thank you for offering these tips and techniques with us all!

    • The Social Nurse The Social Nurse

      Elizabeth- I am glad to hear you enjoyed the post….and thank you so much for sharing! The stories you share have been a big inspiration to me…and I am very happy to meet a fellow ‘tom boy’!!

  4. Kim Allen Kim Allen

    Thank you for opening the discussion on how nurses can effect change by moving outside the box. Our strength in numbers combined with the public’s view of nursing as the “most trusted professionals” aligns us perfectly to create a positive change within our health care system.

    My goal as a soon to be FNP is to incorporate an Outward Bound style of healthcare into my profession whereby patients are encouraged to participate with greater accountability in in their health with the support of an integrative team of health professionals. The health of the individual is key to a healthy community and a healthy planet.

    • The Social Nurse The Social Nurse

      Kim- Thanks so much for taking the time to share such a thoughtful response! Best wishes to you in the completion of your FNP work…and hat tip to you for tapping into your creativity & focusing on ways to be an innovative partner with patients in their health care!

  5. Diane (Greco) Allen Diane (Greco) Allen

    What a great post Carol. I needed this today. I have many naysayers !!

    • So glad you liked it, @Diane! Surround yourself with powerful, positive people and believe in your dream! #Persist!

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