top of page

Strategy Submission

Staff work-arounds assignment


Lisa Day



Assistant Clinical Professor


Elaine L. Smith RN, MSN, MBA, CNAA, Clinical Assistant Professor, University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, North Carolina


UCSF, School of Nursing, Dept. of Physiological Nursing


Competency Categories:

Evidence-Based Practice, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s):

New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN

Learner Setting(s):

Clinical Setting

Strategy Type:

General Strategy

Learning Objectives:

Students will:
  1. demonstrate skills in identifying gaps between practice on the unit and what has been identified as best practice
  2. demonstrate skills at finding professional practice standards and research literature related to a specific nursing intervention
  3. demonstrate skills in accounting for patient preferences within the boundaries of safe and therapeutic practice
  4. demonstrate attitudes and behaviors that show that they value teamwork and want to contribute to maintaining standards of safe and effective care

Strategy Overview:

This assignment is meant to familiarize the student with standardized nursing policies, procedures, standards of care, and other evidence based nursing practice guidelines, and to encourage students to observe actual nursing practice on the units to note compliance with, deviations from, or “work arounds” by RN’s when implementing nursing procedures. The following aspects of the assignment can guide students in preparation for clinical conference discussion, in writing a paper or in putting together a poster presentation.

  1. Choose a nursing policy or procedure that is commonly used on your nursing unit.

    Examples : Central line dressing change, Hand washing, Insertion of a peripheral IV catheter, Obtaining lab specimens, Pain management

  2. Find the current written nursing policy or procedure in place for your institution/unit and answer these questions:

    *How easy/difficult was it to find the policy/procedure?

    *Did the RN’s know where to find the written policy/procedure?

    *How was the policy/procedure originally disseminated to the staff?

    *Is the policy/procedure evidence-based?

    Review the current practice standards from professional organizations and/or oversight and accreditation groups (eg: JCAHO, CDC) and/or the research literature

  3. Observe RN’s on the unit performing the identified procedure and describe:

    *what steps the RN took

    *in what ways the RN deviated from the written policy/procedure

    *what prompted the RN to make the deviations she/he did

    *as many details as you can recollect

  4. Discuss why RN’s may or may not follow the institution’s written policies and procedures. Reflect on the opportunities and challenges of evidence based practice and the implementation into actual bedside nursing practice.
  5. Discuss what the proper response should be when you as an RN discover unsafe practice that deviates from standards, policies or procedures.

Submitted Materials:

Additional Materials:

Evaluation Description:

Students are evaluated on how thoroughly they address each of the five categories listed in the strategy overview. A grading rubric based on these categories can be used to score each student’s presentation, paper or poster.

In my experience students do a good job with this assignment. They take their work as investigators seriously and are able to find literature and national standards on the internet with faculty guidance. The most difficult step is knowing what to do with the information when students uncover unsafe practices. A discussion of the best action is always fruitful and some students are willing to bring their findings to the attention of the manager or educator on the unit. Others prefer to have the faculty talk with the managers without identifying students by name.

bottom of page