Nursing intuition

[mountainjc]

When did it show up? How did I develop this? I'm not sure. I am a year out of nursing school working on a very busy cardio-renal-pulmonary unit. We see basically everything. Maybe I developed this from my other experienced co workers? Subconsciously learning to see what they see. But what else do you call it when you think a patient is going to crash but have no other reasoning but " a gut feeling". I had an elderly male gentleman that came to us for generalized weakness. I had been with him for 5 nights. In that time he had been diagnosed with myestenia gravis. When I first met this man he was talking, a little hoorifice maybe, definitely understandable however. By the 5th night it's like he would try to talk but he could not get the words out. He said he was having trouble breathing. I checked his continuous pulse ox. It was reading 100% on 3L. Listened to his lungs. They were clear. I put his bipap on that was available to him just to give him some relief. It worked. Checked the pulse ox again. 100%. Blood pressure and pulse normal. So why am I still having this nagging feeling that some thing wasn't right? He took his bipap off too go to the rest room and his sats dropped to the 80's. That has never happened before: he was on room air 5 days ago and doing just fine. Again I check his vitals and listen to his lungs. Put the bipap back on and everything was normal again. There is something wrong here. I called in a more experienced nurse. I said I know all his vitals are stable but something is wrong and I can't tell you what it is. She said to keep and eye on him, make sure he keeps the bipap on, and call if something changed. My shift ended and I gave the oncoming nurse report who has also had him for the past two days. I say he has been declining slowly for the past 5 days. Please keep a very close eye on him. Something is wrong here.... fast forward 12 hours and I'm back. The day nurse find me immediately and she said " you were right he coded today". I wish I could have pinpointed what was spiking my senses and maybe then I could have avoided this. But I'm glad that this sense has found me. It really makes me feel like I'm on the right path.

[llg, PhD, RN]

Yes, you are on the right path. Learning to recognize subtle signs and patterns is a big part of developing expertise. Learning to take those instincts and translate them into solid assessments and action plans is one of the main things that separates the beginner nurse from the expert nurse.

Congratulations!