Evidenced-based practice. Guidelines. Cochrane Review. For the last two years, these buzzwords have driven every clinical thought and paper required of me for nurse practitioner school.

It’s understandable, I guess — if you want to be the best nurse practitioner right out of the chute, then you have to be up to speed on the latest and greatest to provide the most good for your patients. Right?

Nearly every week during rotations I ask myself, “with these signs and symptoms…” or “according to some guideline I’ve been exposed to, I recommend such and such…” This is when reality will set in.

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After I present the latest and greatest evidence-based practice guideline, a patient will inevitable say, “that’s not what I’m used to,” or, “the other doctor always gives me this other thing.”

Or, my preceptor will say, “well, I know that’s what the guidelines say, but I like to go with my gut and prescribe antibiotics anyway. The curmudgeon emergency department doctor will say, “I don’t have time for evidence-based practice, this is what I’ve always done.”

Okay, I get it; I’ve been around for a while. Trust me, I am not that guy who says, “well, at school I learned this,” or my favorite, “at my other job…” I understand there is a difference between real-life and school. I have enough experience to know that school requires one set of expectations and real life may require another.