developing a clinical eye

[orangepink, NP]

Hi! I'm a new grad nurse. After a 3 month orientation/training, I've been on my own for 2 months now and I just want to ask the older/more experienced nurses in this forum on how to develop one's assessment skills / clinical eye. For example, I had a pt who had difficulty breathing and my manager pointed out to me "don't u see that he's already using his accessory muscles?". This may sound dumb but honestly, I didn't notice that because I just thought it was just part of him being skinny. Plus, the CNA told me that his O2 sat was above 95%.

Then, there was another pt who was foaming in the mouth. I just thought that it was just saliva. Like, some people who fall asleep and saliva pools at the side of their mouth.

I know I sound really stupid but I am eager to learn. Would appreciate any helpful tips.

[diane227, LPN, RN]

Critical thinking, the critical eye just comes from experience, from just seeing sick over and over and from learning from mistakes. I really learned sick when I worked in a large county emergency level one trauma center where we saw over 300 patients per day. You saw the end stages of many diseases and since you never had enough monitoring equipment to go around you learned to assess patients by looking at them and doing nothing more than touching their skin and taking a pulse and listening to their chest. You can read about it but until you see it it will not make an impact on you. I can tell you that after 31 years there is nothing that surprises me any more that nothing that I have not seen.

If you really want to learn how to assess sick quickly, get to an ED, the bigger the better and you will learn it there. Get about two years of experience under your belt first. I don't think any new grad should start in the ED.