That nagging feeling...

[dudette10]

Ever walk into a room and think, "Something isn't quite right?" I'm sure you have, and I personally hate that feeling. I want to know WHY I feel that way, and sometimes, I don't! There isn't enough there to call a rapid response, and I often wish there was something--anything--to justify that nagging feeling...

A patient I had today gave me that awful feeling. I eventually acted upon it, and an ICU eval was in progress as I clocked out.

Ever just go, "Oh, I'm just gonna make the call and see what comes of it"? I hemmed and hawed on this guy until I made the call. I figured, "My job is to monitor and know when something isn't right; it's the docs' job to figure out what it is."

Give an example of when something "just wasn't right," and tell me how it turned out.

[Ruby Vee, BSN]

I've only been a nurse for a year. Many many times I have had "feelings" that something wasn't right, but each time I seemed to be wrong. I'm still trying to hone my nursing sense, but my anxiety keeps getting in the way!

It usually comes with experience. Those who tell you that they developed it as a student or a new grad may be fibbing a bit -- some do, but most don't. I had to see a few bad things happen before I began to develop my nursing "sixth sense." And I had to see some people who looked like things OUGHT to be about to hit the fan NOT have it hit the fan a few times first before I learned to tell the difference. If that makes any sense.

You have to have some false positives and some false negatives before you develop that sixth sense.

[Tenebrae, BSN, RN]

I'd rather a doc says to me "you are being over cautious" than "why the hell did you not call me X time ago"

When i was district nursing we got alot of community palliative care patients. I started getting a sense of when the end was near for each patient.

[BecomingNursey]

I work ER so just a glance from the triage desk and I get that "sense". I had a patient one day who's husband was wheeling her up to the triage desk with "foot pain". She was fine. Her husband behind her, on the other hand was gripping his chest and almost hit the floor until I grabbed him and shoved him in a wheelchair. He then went unresponsive. I left the wife (the actual registered patient) sitting there and told her I was taking her husband back to see a doctor immediately. I wheeled through the doors, told the charge nurse I needed a doctor and registration and our team started working on him. He still had a pulse and his CBG was fine. Triage was busy that day so I never found out what he got admitted for. But his wife (remember, the actual registered patient) ended up being discharged. The husband (random guy wheeling his wife up in wheelchair that goes unresponsive) ended up being admitted. Lol

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

[nursel56]

The topic of intuition in nursing has always fascinated me. I think it comes with experience, and it was never something I could "try" to do on purpose. I know this happens on the medical side sometimes too -- there are those doctors who always order everything in the book and those who, when they do order everything in the book you pay attention. Then there are those who you just have to bite your tongue so you don't tell the more ego-driven types who dismiss your concerns "I told ya so!"

[Here.I.Stand, BSN, RN]

This was while I was on orientation in another hospital First thing in the morning, we were getting ready to extubate 20-something heart transplant recipient. He was extremely restless, so we got him on Precedex to keep him calm as we weaned the vent settings. Over the next few minutes he'd escalated to flailing around. I had that nagging feeling that something was wrong, and apparently he did too. We approached the bedside, trying to reassure him, when I looked down at his chest tube.

The entire tubing was filled with pure venous blood, with almost a liter in the container. His anastomosis had a huge leak. Fortunately the surgeon was on the unit, and my preceptor yelled at her to get in there. The surgeon called the OR on her cell and brought him straight down. The patient made it. :)

[Here.I.Stand, BSN, RN]

This was while I was on orientation in another hospital. First thing in the morning, we were getting ready to extubate 20-something heart transplant recipient. He was extremely restless, so we got him on Precedex to keep him calm as we weaned the vent settings. Over the next few minutes he'd escalated to flailing around. I had that nagging feeling that something was wrong, and apparently he did too. We approached the bedside, trying to reassure him, when I looked down at his chest tube.

The entire tubing was filled with pure venous blood, with almost a liter in the container. His anastomosis had a huge leak. Fortunately the surgeon was on the unit, and my preceptor yelled at her to get in there. The surgeon called the OR on her cell and brought him straight down. The patient made it. :)

[prmenrs, RN]

When I first started working NICU, I went to a seminar-sort of Neonates 101. I was so surprised to hear the Chief of Neonatology tell all the docs in the audience that if ever a nurse called them and said, I don't know what is wrong, but you need to come!, get out of your nice warm bed and run!

[Ruby Vee, BSN]

I work ER so just a glance from the triage desk and I get that "sense". I had a patient one day who's husband was wheeling her up to the triage desk with "foot pain". She was fine. Her husband behind her, on the other hand was gripping his chest and almost hit the floor until I grabbed him and shoved him in a wheelchair. He then went unresponsive. I left the wife (the actual registered patient) sitting there and told her I was taking her husband back to see a doctor immediately. I wheeled through the doors, told the charge nurse I needed a doctor and registration and our team started working on him. He still had a pulse and his CBG was fine. Triage was busy that day so I never found out what he got admitted for. But his wife (remember, the actual registered patient) ended up being discharged. The husband (random guy wheeling his wife up in wheelchair that goes unresponsive) ended up being admitted. Lol

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

My father-in-law accompanied my mother-in-law, who didn't drive, to her first post partum doctor's visit. He was sitting in the waiting room, waiting for her when he suffered a massive MI and died. Right there in the OB/GYN waiting room. How said!

[blah_blah_blah]

This isn't a nursing story, but rather a story about a mother's intuition. My dad was diagnosed with PPH in 1990 (before I was born) and he needed a double lung transplant. Needless to say, he was in and out of the hospital quite often. He spent most of his time in pittsburgh presbyterian hospital (about 6 hours away from home) and this is where he eventually had his transplant done. Anyway, he was in Pittsburgh for god knows what while the rest of my family was home. I assume it was some routine procedures or else my grandparents and mom would have been with him. My grandmother told me that that night around 2 or 3 AM she woke up from a deep sleep with a horrible feeling. She called the hospital to see if her son was okay and they told her that they were just wheeling him in for emergency surgery.

[Gooselady, BSN, RN]

I did psych for 17 years before working acute care, so getting that 'spidey' feeling was pretty rare, as the patients were medically stable as a rule. Now getting the spidey sense that a patient is going to go off and act out, yeah, got that one down, but not so much the medical side of things until I worked medical oncology. THEN I got to experience what you all are talking about. Many mention 'the hairs standing up on the back of their neck" or a "gut feeling", and that's exactly right, it is a physical sensation as much as this mental 'uh oh . . '.

And that weird sense of just walking into a room and taking one look at a patient and 'knowing' something is wrong, even though I'd not worked with her or seen her before. I was still pretty new to med onc, and kept finding myself going and standing in her room and staring at her, or thinking about her, seeing images of her in my head. At mid shift she spiked a 40C temp and by the end of the shift was in ICU and septic and ventilated. I'll never forget it. Mainly, it was a spidey sense because her VS were fine, she was alert but distracted, felt weak and exhausted after getting out of bed to the BR, but she was pancytopenic. Turns out she had strep sepsis, and came back to med onc after a few days.

I still can't put my finger on what 'bothered' me about her. A few years later I had the 'pleasure' of guiding a fairly new nurse through her own first encounter with the hair standing up on the back of her head. I told her to listen to it, and I'd help her with the doc. Her patient ended up on the unit the NEXT day with a near-bowel perforation caused by her chemo.

[bebbercorn]

I second everyone that says to trust your gut. That being said, I recently jumped several puts in line with a pt with whom I thought had noticeable facial droop. The doc agreed, we got her to CT... no CVA. Sometimes, it's a wrong feeling. But if you are right, and you don't speak up, you'll forever regret it. ​

[silverbat]

I always say that when you listen to a heart it doesn't say "lub dub, lub dub, gonna have an MI" Although that would come in nice and handy!!!!