We recently set up a new inpatient unit and this involved making various decisions about our philosophy and approach to nursing practice (Shaw et al, 2007). One of the clinical issues we had to deal with was how to manage syringe drivers. Syringe drivers had been used within the community for many years, and local guidelines about their use along with various policies and procedures existed. We considered all of this information and asked some critical questions about it. One of the most practical issues we explored was the volume (or length) of infusions. This single issue and our response to it caused a significant amount of reaction among colleagues. We have written this article in an attempt to explain some of the issues relating to nursing practice and culture as we perceive them and to raise questions about why and how professionals sometimes respond to changes in practice.