Nursing Best Practice Guidelines: reflecting on the obscene rise of the void

Authors


Dave Holmes
School of Nursing
Faculty of Health Sciences
University of Ottawa
451 Smyth Road
Ottawa K1H 8M5
ON
Canada
E-mail: dholmes@uottawa.ca

Abstract

Aim(s)  Drawing on the work of Jean Baudrillard and Michel Foucault, the purpose of this article is to critique the evidence-based movement [and its derivatives – Nursing Best Practice Guidelines (NBPGs)] in vogue in all spheres of nursing.

Background  NBPGs and their correlate institutions, such as the Registered Nurses’ Association of Ontario (RNAO) and ‘spotlight’ hospitals, impede critical thinking on the part of nurses, and ultimately evacuate the social, political and ethical responsibilities that ought to distinguish the nursing profession.

Evaluation  We contend that the entire NBPG movement is based on the illusion of scientific truth and a promise of ethical care that cannot be delivered in reality. We took as a case study the Registered Nurses’ Association of Ontario (RNAO), in the province of Ontario, Canada.

Key issues  NBPGs, along with the evidence-based movement upon which they are based, are a dangerous technology by which healthcare organizations seek to discipline, govern and regulate nursing work.

Conclusion(s)  Despite the remarkable institutional promotion of ‘ready-made’ and ‘ready-to-use’ guidelines, we demonstrate how the RNAO deploys BPGs as part of an ideological agenda that is scientifically, socially, politically and ethically unsound.

Implications for nursing management  Collaborations between health care organizations and professional organizations can become problematic when the latter dictate nursing conduct in such a way that critical thinking is impeded. We believe that nurse managers need to understand that the evidence-based movement is the target of well-deserved critiques. These critiques should also be considered before implementing so-called ‘Nursing Best Practice Guidelines’ in health care milieux.

Ancillary