I've been caught with my scrubs down a few times in my younger years. Now I can tell a doc how many hairs my patient has on his head (ok....exaggerating a little...).
It pays to know what is going on with your patient. Understand what they're in the hospital for. Know what the physician plan of care is. Know which doc is handling which body part/function. Do you need to call the pulmonologist or the intensivist? What are their labs? If they're "Not Right", then be able to describe how they "were right" and what changed to make them "Not right".
Just a tad off subject, but........ Once upon a time, I had a post heart cath patient on whom I did a textbook sheath pull. At 11pm, the family said "good night" and went home. At 1am, the patient requested that I bring his family in. "I'm going to die." He said assuredly. I checked EVERYTHING. Nothing to do differently.
I dialed the phone to bring the family in, and sure enough, three hours later, he coded and died. He blew out the entire back side of his heart.
(I had been a nurse for over 13 years at that time...and I still took a bathroom break to have a cry by myself
NEVER...NEVER....NEVER let a second thought get in the way of following the patient's wishes when the patient tells you something to the effect of "I aint gonna make it"