I had a moment!

Nurses General Nursing

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All through nursing school, residency/orientation/precepting, everyone tells you, it takes at least a year to feel like you have a clue, 3-5 to feel like you are a competent nurse. Well, I HAD MY MOMENT!

Let me start by saying we are a big hospital with people waiting hours to be transferred from the ER to their quickly cleaned and turned room on a floor. ER manages patients until they come up but only does full admission/non emergent meds if the patient waits more than a 12 hour shift to be moved. That's the system, we can't change it, so when you comment, don't get off track about the system please; after all, this thread is about MY MOMENT! :yes:

A new patient arrived to our floor late in the previous shift. Admission orders had been written by MD several hours prior. Report was that patient was admitted with EMR diagnosis listed (noted as "B" later in the post), rounds completed with previous nurse. Pt resting, A&Ox4, asymptomatic for "B" at this time, relevant history obtained from pt whom I quickly assessed head to toe shortly after report. I like to check the newbies out first thing. If they need a more focused assessment, I do that during med pass.

I looked at multiple things in the chart which had been casually mentioned during report; Something isn't adding up. Reviewed initial H&P completed by MD to further familiarize myself with pt - multiple significant comorbidities/histories - some of which the pt left out during our assessment. Presented to the ER with "A" complaint, but the admitting diagnosis on the EMR to our floor was "B", related to symptoms that had taken place in the ER prior to admission orders being written, with testing for "A" appearing negative. Reviewed f/u labs (some that had been done in ER - post H&P/admission orders but during holding pattern, some just after arrival to our floor), tests that had been done, consults completed since the initial H&P in ER. This person's initial "A" complaint had evolved and was now confirmed/validated, as was the EMR "B" admitting diagnosis; person had both A&B, it was just the initial "A" complaint had fallen off to the wayside at some point as "B" became more pressing in the interim (How I hate HIPAA right now). My light bulb moment when I put it all together was "OH WOW, HOUSTON, WE HAVE A PROBLEM!"

I did not panic. There were no shouts of "I NEED HELP OVER HERE." I did not run up the hallway in a distressed frenzy with fire blazing from my heels to find my charge nurse. I was calm and collected in my process. I had already assessed my patient; I knew there was no distress at this time. I paged the on call MD. I calmly walked up the hall to the main nursing station, to get the patient's paper chart while pushing my computer station which had EMR ready to go. While waiting for call back, I quickly looked up a few more things in the EMR chart including the history of consulting MDs on previous visits. The on call MD happened to be the admitting MD from hours earlier. I refreshed him on the pt using SBAR, advise him of the puzzle pieces I'd put together. I guided him down from his "WHAT!" moment when he realized there was a problem and yelled in my ear; I realized he was not yelling at me, more that he was flabbergasted by the situation. I quickly and calmly requested my entire list of tests, consults, and additional monitoring needs, to which he added two things "just in case". I hung up the phone proud that I had handled the entire thing without having to call my charge or rapid response for help.

Of course, I did share it with my charge what was going on once I got off the phone. She was at the computer on other side of the desk area while I was on the phone. She'd heard the MD's rather loud "WHAT" in my ear, had looked up with a raised eyebrow. When I got to the end of my short briefing, she smiled, saying "You've arrived."

I smiled. I got the patient what was needed, went on about my shift. NO PANIC. NO DISTRESS. NO RISE IN BP OR HR. Just a moment of clarity as I walked down the hall thinking to myself - Yeah, I think I'm finally putting this ALL together! YEAH BABY! If I was able to jump in the air and click my heels together, I probably would have.

(For all the negative Nancys out there. No, I don't think I can do it all. YES, I still ask for help when needed. Please just be happy for me that I had a moment where I felt it all come together as a nurse; kindly keep your negative comments to yourself.)

Specializes in L&D, OR, ICU, Management, QA-UR, HHC.

This is how it's supposed to feel. You did good. Store this one away in your data bank for the day when it doesn't work out so well. I love that your charge nurse said "you've arrived". Soon you'll have more of these than not. Congrats.

I found this post again tonight when I've been having some "what if" moments. It made me remember why I do this.

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