CHRO.nl
January 15, 2024
Sometimes, you must break the rules to achieve better results or… to save a life. That’s precisely what nurse Gayle Kasparian learned when she put two premature twin sisters together in an incubator against protocol. The healthcare sector needs to give such rebel nurses more space, argues innovation expert Simone van Neerven. ‘There’s an incredible untapped potential there.’
Saving a life
On October 17, 1995, twins Kyrie and Brielle were born twelve weeks before their due date. At that time, premature twins were always placed in separate incubators to reduce the risk of infection. Kyrie was doing fine, but Brielle struggled and was expected not to make it. She could barely breathe and turned cold and blue.
Hospital nurse Gayle Kasparian had tried everything, but nothing worked. As a last resort, she deviated from protocol and put the twins together in an incubator. Brielle snuggled up to her sister Kyrie, who put her arm around her little sister. Almost immediately, Brielle calmed down, and her condition stabilised. Not long after, the girls were doing so well that they were allowed to go home.
A little bit rebellious
Nurses need to provide high-quality care within the boundaries of rules and protocols. But what if these boundaries clash with their norms and beliefs about good quality care? Then you have to be a little bit rebellious, just like Kasparian. But she did not act thoughtlessly. Years earlier, she had read a study about some hospitals that put premature twins together in an incubator. She also consulted with Kyrie and Brielle’s parents before deciding to act.
A big misconception
One of the biggest misconceptions about rebels is that it is all about defiance; they don’t want to follow the rules, resist everything, and complain all the time. But that image isn’t exactly accurate because most rebels are very committed to their work.
However, they often can’t give their best due to unworkable rules, processes and protocols drawn up by people who do not do the work themselves. So, when they deviate from the rules, it’s not because they want to but because they feel they have no choice.
Over-protocolled
In healthcare, there are countless quality standards, rules, guidelines, protocols, and work instructions to ensure safety. However, there are so many of them that they can conflict and work against each other. Often, they emphasise only one aspect of healthcare, while other matters are also important.
Moreover, these standards are based on an average patient, which in practice never occurs. Especially in complex, long-term healthcare situations, these standards fall short. And so, care providers often have to disobey to provide accurate healthcare to a patient.
Under the radar
According to Eline de Kok, who obtained her PhD in rebellion in healthcare at the beginning of 2025 and is a nurse herself, around 70% of all rebel actions by care providers remain under the radar due to deep-rooted beliefs that sustain the current system.
When nurses colour outside the lines and take a ‘goat path’ to provide the best care to their patients, they keep their actions to themselves to avoid hassle. They implicitly assume that by not adhering to the rules, they will get into trouble with their managers or colleagues. However, these goat paths are often time-consuming and do not solve the problem structurally. At the same time, many managers believe that nurses jeopardise patients by deviating from the protocol.
These assumptions lead to an impasse with hardly any room for structural improvements.
Untapped potential
In the meantime, healthcare is facing ever-increasing challenges. The staff shortage is growing, and due to the high workload, the sector is also struggling with an absenteeism rate of no less than 8%. In addition, more than two-thirds of nurses, care providers and nursing specialists (69%) regularly experience problems with aids, which affects the quality of care and, in addition to the enormous workload, also causes moral stress among healthcare professionals.
A key to breaking this vicious circle lies in the untapped potential of healthcare providers. Every day, they are in the thick of things, know all the problems, and often have figured out smart solutions already. As de Kok states: “Nurses are not just hands at the bedside. They also have a head!”.
Creating space for rebelliousness
If you want to retain nurses and increase their job satisfaction, you must value them. Give them space and involve them. Create an environment where rebellious actions don’t remain under the radar but are put in the spotlight and lead to sustainable improvements in healthcare.
Like the protocol for premature twins. Nowadays, it is standard procedure in almost all hospitals worldwide to place newborn twins together in an incubator. That has reduced the risk factors, and the number of hospital days has decreased significantly.
Infectious positive energy
Tackling unworkable practices together is infectious and leads to an upward spiral of energy. If care providers are more involved, they will question and solve impractical rules and unnecessary bureaucracy. The quality of the work gets better and more fun. That gives a lot of positive energy, and patients receive the best care.
And thus, the solution for the issues in healthcare is fairly simple, yet not easy.
This article was originally published in Dutch on MT/Sprout, the most popular business and management platform in the Netherlands.
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