Sacred Cows

Sacred Cows: An Editorial

May 4, 2022

Joy Stepinski, MSN

I first heard of the expression “sacred cow” when I started my nursing career. The phrase happened to be a hot topic at the time. I have to admit, I had never heard of the term. “What does a cow have to do with nursing?” I would wonder. I laughed a little at myself when I finally comprehended why this saying was used. Sacred cows are deeply held traditions that are done without question. Miller and colleagues (2015) describe this well with the following statement: “grounded in tradition rather than science, these ‘sacred cows’ are ineffective, unnecessary, and sometimes dangerous. (p. 46)”

As a new nurse, I was full of questions. I constantly wanted to know why a certain procedure was done. Many times, the answer would be “that’s just the way we do it,” a prime example of a sacred cow. For instance, as a nurse working in a hospital, I would observe that the majority of patients admitted to the inpatient units from the emergency department would have a urinary catheter inserted. If you are not familiar with a urinary catheter, just picture a small tube inserted up through your urethra into your bladder to drain your urine.

Now imagine the following scenario. You visit an emergency room because you have difficulty breathing and the physician decides to admit you. Before you are transferred to your room, the nurse inserts a urinary catheter. For what purpose? What do breathing problems and a urinary catheter have to do with each other? Yes, I would be remiss to say that sometimes this may be appropriate, depending on the patient’s overall health condition. However, this intervention is certainly not the norm. I cared for countless of patients with these devices. I remember that a patient would receive discharge orders, yet the physician did not order the discontinuation of the catheter. Because nurses must follow physician orders, I would approach the doctor and ask about its removal. Frequently he would reply “I had no idea that the patient had a catheter.” This is kind of a problem, wouldn’t you agree?

When we started investigating our practice within all aspects of the hospital, we realized that a high number of patients were in fact diagnosed with a catheter-associated urinary tract infection, a type of UTI specifically related to the catheter. Although that may be a mouthful of a name, the medical world abbreviates the term as CAUTI. Nowadays, a CAUTI is a really big deal because it may be the result of a hospital-acquired infection (HAI). Why are HAIs something to pay attention to? They could signify poor care, but that is a topic for another day. With every day that a patient has a catheter in place, the risk of infection increases by 3 – 7% (Nicolle, 2014)! If we take the middle of that range, consider the first day, the patient has a 5% chance of getting a UTI. The second day, the likelihood rises to 10%. Now picture the patient stays in the hospital for 7 days. By the time the catheter is removed, the patient has between a 21% and a 49% chance of a UTI.

What is the problem? As the Centers for Disease Control and Prevention (CDC, 2010) state on their website, “CAUTIs have been associated with increased morbidity, mortality, healthcare costs and length of stay.” In other words, CAUTIs are associated with increased incidence and frequency of infection, death, cost, and more time required in the hospital. The CDC gives the following percentages. Among all the urinary tract infections acquired in a hospital setting, 75% come from a urinary catheter. As of 2015, 15 – 25% of hospitalized patients receive one (CDC, 2015). The best practice recommended is to only use a catheter appropriately, and remove it as soon as there is no longer a need.

Revisiting the definition of a sacred cow, “grounded in tradition rather than science, these ‘sacred cows’ are ineffective, unnecessary, and sometimes dangerous. (Miller et al., 2015, p. 46)” The catheter was definitely one of those sacred cows. The devices were inserted without question and learned to be something that may be ineffective, unnecessary, and sometimes dangerous. In the worst-case scenario, death could occur. After making a lot of changes with urinary catheter practice, we eventually went through long periods of time without any CAUTIs. This experience unquestionably helped me to learn about the meaning of a sacred cow.

Oddly enough, despite my innocence of not knowing what the expression meant, I worry about sacred cows today and how they affect current patients. I worry that people have so much trust in healthcare that they accept treatment without question or researching what repercussions something may have. Decisions about one’s own body is precious. Take the time you need to thoroughly research a procedure, medication, surgery, and alternatives before you know what is right for you. Ask your healthcare provider to give you published research articles on their recommendation and learn how to read them. Reclaim your health. Let’s ditch the sacred cows!

References:

Centers for Disease Control and Prevention. (2010). Frequently asked questions about catheter-associated urinary tract infections. https://www.cdc.gov/hai/ca_uti/cauti_faqs.html

Centers for Disease Control and Prevention. (2015). Catheter-associated urinary tract infections (CAUTI). https://www.cdc.gov/hai/ca_uti/uti.html

Miller, J., Hayes, D. D., Carey, K. W. (2015). 20 questions: Evidence-based practice or sacred cow? Nursing, 45(8), 46 – 55. https://doi:10.1097/01.NURSE.0000469234.84277.95

Nicolle, L. E. (2014). Catheter associated urinary tract infections. Antimicrobial resistance and infection control, 3(23). https://doi.org/10.1186/2047-2994-3-23