Name the first nursing judgement you made that made you feel like you knew what you were doing.

[iRNman, BSN]

In the grand scheme of things it might have been insignificant, but it was the first moment where you thought, dang I got this!

Mine was when an MD started a pt on Lasix whose potassium had been steadily declining. Just called and asked him if he wanted to order some supplemental potassium. I was his favorite nurse after that. Every time I had his pt he'd say, "aww you've always got my back!"

[OldDude]

Pediatric ER...working triage...14 year old comes in with his mom at 2:00 am on a school night. He had to go pee at midnight, felt dizzy, fell down, told mom, here they are. Another kid had him by the arm at school, swinging him around in a circle, let him go and he collided anterior first with a chain link fence, no redness, bruising, no pain. Still, I start to get a blip on my radar screen. So I put him in as "urgent." Sent to registration and returned to waiting room in my line of sight where I noticed he laid his head on his mother's shoulder and was dozing off. My radar was still blipping. Soon thereafter I looked over at him and noticed a fine sheen of perspiration on his forehead and alarms starting going off in my head. I grabbed a wheelchair and took him immediately to the back. On the way I yelled for other nurses and the MD. He was unsteady on his feet, dizzy, pale, clammy, etc. We couldn't get a BP on him so we put him in Trendelenburg, got an IV and starting pouring on the fluid. He improved somewhat and he was off to CT. At CT the Radiologist stated, "Call the OR, this child has a ruptured splenic artery and is bleeding to death in front of our eyes!" Thing's starting popping after that and he walked out of the hospital a few days later alive and well...less one spleen.

That's when I realized how important it is to listen to your "nursing gut instinct."

[Davey Do]

In this Peanuts comic, the OldDude is Linus and I'm Charlie Brown. I guess that makes iRNman Lucy:

OUTSTANDING catch!

[iRNman, BSN]

Wow that's incredible!

[Dreagrl3]

@OldDude

I happened to stumble upon this thread. First of all, excellent job!! I'm still learning and was wondering what went off in your head when you saw the perspiration. I cannot wait to be that good!! =)

[River&MountainRN, ADN, RN]

My moment was when I was working in primary care and the physician essentially asked me to run a whole appointment by myself. Totally not kosher (because the MD actually wanted me to do the entire/complete physical, saying that he'd "just sign off on it because you know what you're doing"), so I stood my ground (another "grown up nurse" moment for me, feeling confident to stand up to an almighty MD) and refused, but it was flattering that the MD, who was otherwise known as a stickler for rules, had that kind of confidence in me.

[OldDude]

15 hours ago, Dreagrl3 said:

@OldDude

I happened to stumble upon this thread. First of all, excellent job!! I'm still learning and was wondering what went off in your head when you saw the perspiration. I cannot wait to be that good!! ?

One of the signs of hypovolemia is cool/clammy skin. That sign can also signal hypoglycemia...both of which need immediate attention. This kid presented with neither of these conditions so there was no "normal" reason for him to start sweating. With no intervention he could have died while sleeping right there on his mom's shoulder...listen to your "gut" feelings and best of luck with your nursing future!!

[Dreagrl3]

@OldDude

Thank you for replying and the well wishes!

[Ruby Vee, BSN]

I was a two-year nurse working a new job in the famous, big city teaching hospital. Staffing sucked and we were always floating somewhere. The nursing supervisor wanted me to float to MICU and do charge. "There are some LPNs and travelers there that work there all the time, but we need a staff RN to do charge." I told her I wasn't qualified to do charge in the ICU; I'd never even SEEN an ICU. She persisted, said it would be her license if anything went wrong. I stood my ground. Finally, she said she'd fire me if I didn't go. I said "OK. I'd rather lose my job than my license," and started packing up my work bag.

I don't know what happened in the MICU, but the supervisor backed down. Of course, the next night I floated to the Neuro floor. The report went something like, "In the first bed is Mr. X. He's seizing. He's been seizing all day. In the next bed is Mrs. Y. She just came back from surgery. We don't know what she had done. In the next bed . . . ." And Oh, yes -- I was in charge.