Illustration by Janet Hamlin.

Illustration by Janet Hamlin.

By Sylvia Foley, AJN senior editor

The word deviant tends to have a negative connotation, suggesting something aberrant or harmful. But deviance simply means a departure from the expected or usual way of doing things—and there are times when being able and willing to do so is crucial. Indeed, some have called this trailblazing.

In “Exploring the Concept and Use of Positive Deviance in Nursing,” an August CE, author Jodie Gary points out that “the clinical setting contains an infinite assortment of situations” in which applicable pro­fessional standards might be unavailable or unrealistic; at such times, “nurses might have to react creatively” in order to provide optimal patient care. This article provides an in-depth, evidence-based look at positive deviance in nursing.

Overview: Positive deviance involves an intentional act of breaking the rules in order to serve the greater good. For nurses, the rightness or wrongness of such actions will be judged by other people who are in charge of rules enforcement; but the decision to engage in positive deviance lies solely with the nurse. There is no uniform or consistent definition of positive deviance. This article uses the Walker and Avant method of concept analysis to explore and identify the essence of the term positive deviance in the nursing practice environment, provide a better understanding of the concept, and clarify its meaning for the nursing pro­fession. In turn this led to an 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. The concept of positive deviance is useful, offer­ing nurses a basis for decision making when the normal, expected actions collide with the nurse’s view of the right thing to do.

Gary further argues for the importance of accurate documentation. “Nurses who are positive deviants may be generating new knowledge on the fly,” she writes. “We need to be able to access that knowledge. It’s essential, then, that nurses have a way to safely report the deviations they make for the sake of pa­tients. The true cause-and-effect relationships between care and outcomes cannot be known otherwise.”

To learn more, read the article, which is free online, and listen to our podcast with the author. If you’ve used positive deviance in your practice or know nurses who have, we’d love to hear your stories and thoughts in the comments.