Unlearning Our Sacred Cows

By Rose O. Sherman, EdD, RN, FAAN

How many sacred cows do you have?  These may be ideas, rituals or processes that you adhere to because you so strongly believe in them.  But what happens when the context of a situation changes and your sacred cow is no longer relevant.  I was reminded this week of how difficult it can be to challenge our “sacred cows” in nursing.  These are ideas or practice that we have held or done for so long that they often go unquestioned.  We have seen with evidence-based practice that we have challenged some of our clinical sacred cows such as instilling normal saline into endotracheal tubes before suctioning.  But sacred cows go beyond our clinical practice and often extend to our thinking about our own professional careers.

I was talking with a group of seasoned CNOs last week and they all agreed that they had to rethink many of their sacred cows in era of recruitment and retention challenges.  A good example we discussed was whether a new graduate should be required to spend one year on the unit where they accepted their initial employment.  This has long been a practice in many medical centers.  The goal has been to reduce churn on units by making sure that the skill mix includes both experienced and inexperienced nurses.

While there are very practical reasons why such rules are believed to be important, the reality of what these CNOs are seeing in their practice settings is quite different.  They are learning (sometimes the hard way) that their millennial nurses want to move ahead in their careers and this may involve moving specialty areas during the first year.  With our national RN turnover at 16% a year, we know that most of this turnover are nurses in their first year of practice.  What these CNOs have found is that if they do try to hold their millennial nurses to a one year commitment on a unit, they will often seek employment at another facility in their desired professional area.  And usually – they are the best nurses on unit.

So these CNOs are rethinking this long held practice.  They don’t want to lose their best nurses.  They also recognize a reality that young millennial nurses can and will seek other employment if they feel they are not “getting ahead” in their careers.  Marshall Goldsmith in his wonderful book What Got You Here May Not Get You There, makes the astute observation that situations change and our internal GPS and beliefs need to shift in response to changes in reality or we will become ineffective leaders.  Some policies and practices outlive their usefulness and need to be reconsidered.  As leaders, we often need to kill our own sacred cows.