Promoting Clinical Inquiry with a Sacred Cow Contest
JoAnn Mick, PhD, RN, AOCN, NEA-BC
Harris County Hospital District, Houston TX
Problem:
As nurses examine practices and actions in the work setting, they begin to identify many traditional practices
that have no supporting rationale. These traditional practices, or Sacred Cows, can be costly and often
consume nursing time without providing good outcomes.
Evidence:
Development of nurses’ skills to identify and ask appropriate clinical questions is one of several essential
requirements to ensure an evidence-based profession.
Strategy:
Brown’s Sacred Cow Contest (1993) provides a creative strategy to promote clinical inquiry and generate
interest in EBP.
Practice Change:
Submission guidelines and an entry form were developed for a Sacred Cow Contest. Entries were accepted
for seven prize categories: Cash Cow, Mad Cow, Holy Cow, I never saw a purple cow, ‘til the cow comes
home, Don’t have a cow, and Put the cow out to pasture.
Evaluation:
The Sacred Cow Contest inspired a review of current nursing practices to determine if they were
evidence-based or required changes to optimize patient outcomes.
Results:
One hundred eighteen entries were submitted by nurses from both inpatient (n= 97, 82%) and outpatient
settings [n= 21, 18%). Both individual nurse (n= 90, 76%) and nursing team (n= 28, 24%) entries were
received. Nurses questioned practices that were categorized according to seven identified themes: Nursing
practice (n= 38, 32%); Policy and procedure (n= 24, 20%); Administrative, i.e. schedule, staffing, and evaluation
processes (n= 13, 11%); Physician order-related (n= 13, 11%); Supplies (n= 13, 11%); Documentation and use
of paper (n= 10, 9%); and Customer service, i.e. wait time, appointments and scheduling (n= 7, 6%).
Recommendations:
Best practices in patient care occur when providers continually ask questions about treatments and
interventions, search for and evaluate the evidence to support or refute traditional practices, implement best
evidence, and evaluate outcomes.
Lessons Learned:
As individuals and/or groups of nurses question current nursing practice, they can begin to recognize
relationships between scientific evidence, best practice recommendations, clinical decision-making, and
patient outcomes.
Bibliography:
Melnyk BM, Fineout-Overholt E, Stillwell SB, Williamson KM. Evidence-based practice: step by step: igniting a
spirit of inquiry: an essential foundation for evidence-based practice. Am J Nurs. 2009; 109(11):49-52.
Brown, G. H. The sacred cow contest. Canadian Nurse. 1993; 89(1),31-33.
Fineout-Overholt E, Levin RF, Melnyk BM. Strategies for advancing evidence-based practice in clinical settings.
J N Y State Nurses Assoc. 2004; 35(2):28-32.
Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based practice, step by step: asking the
clinical question: a key step in evidence-based practice. Am J Nurs. 2010; 110(3):58-61.