A nurse I was orienting asked a question that stopped me.

“Why do we have to wait for a current type and screen before ordering red blood cells, but not platelets?”

It was the kind of question that should have a clear answer. She wasn’t new to nursing, just new to our unit, which made it land differently. This wasn’t inexperience. It was a fresh perspective on a practice I had stopped questioning.

I had a general understanding. I knew that red blood cells carry the antigens most likely to trigger clinically significant antibody formation, and that ensuring compatibility before transfusion is critical. Platelets, by comparison, are less likely to require the same level of matching in routine situations. But when I tried to explain it clearly and completely, I hesitated.

My first instinct was to simplify the answer: “That’s just how we do it.” I paused before saying it out loud. Although the practice made sense to me, I had never examined it in a way that I could confidently teach, explain, or connect back to policy.

The question exposed a gap between practice, policy, and understanding. It also raised something larger: how often do we follow practices we can’t fully explain, document, or defend?

This experience highlighted a broader […]