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.
I can't go into too much detail because it's very fresh, but I recently had a situation where this happened and the outcome was negative. I had a patient who appeared fine except for one minor symptom. I called the physician who wasn't concerned because he felt this symptom could caused by the patients diagnosis. I felt like okay, sure, it could. Except that this patient has been here over a week and this symptom suddenly appeared, never documented before. I got some new orders and it was very mildly investigated with disinterest on the physicians part. I mean he was a stable patient. But this bothered me. I was on pins and needles all night long checking VS q2 hr and watching his tele strip constantly. Documented everything. Shift change happens and the patient goes off to a scheduled surgery (think simple I&D or digit amputation). He died in the OR.
It crushed me. I will never know if that symptom was related to his death. My gut told me all night that he was wrong, something was off, but I had no evidence aside from one small symptom and my gut. I wish I had advocated more. I will never know if I could have done anything to change what happened.
My coworker's story, but it was a sad situation and we all helped out. Patient had a history of a stroke, and my coworker thinks something's just not right with him. Calls the team, but there was nothing to report symptom-wise, and they didn't come evaluate him. He fell asleep for a couple hours, then woke up to go to the bathroom, and of course then he's extremely weak on one side and behaving inappropriately. My coworker was really upset that she didn't fight for the docs to come see the patient earlier, but even she admitted she couldn't articulate what was wrong with him at that time. His neuro status resolved in an hour or so without any interventions, but the next day he was RRT'd for hypertensive crisis and then the day after we coded him and he didn't make it.
Specializes in Oncology; medical specialty website.
My first job was in psych.; that was thirty years ago. I was caring for a patient in seclusion. She repeatedly asked me to tell the doctor she needed a particular med for a chronic condition she had; due to her psych meds, it was imperative she get that med. I asked the doctor over the course of several days to please prescribe the med, to no avail. One night as I came back from dinner, the patient went into distress.
I repeatedly paged the psych. on call, who did not answer my pages. I tried paging the intern and residents on call to get the patient transferred off our unit as she was clearly unstable and no longer appropriate to be on psych. After several hours, we finally got her transferred.
Later that night during a procedure, she coded and died. I was devastated. At one point while I was trying to get her transferred, she grabbed my hand and said, "Please don't let me die."
I was later told by risk mgmt. that the way I documented painted a clear picture of how hard I tried to get medical intervention for the patient, and that the fault for her death was on the doctors' shoulders.
Her death was unnecessary. If she'd gotten the medication she needed, she probably would have walked out of the hospital, instead of going out in a heorifice.
Specializes in NICU, PICU, Transport, L&D, Hospice.
When I was a young nurse in the NICU my older mentor advised that I should never just ignore a "gut feeling".
She told me that my gut was simply trying to tell me what my brain had not yet processed adequately to verbalize. It is our educated subconscious trying to get our conscious thought caught up. That the gut feeling was motivation to slow down and look more closely, listen, consider...
That advice has NEVER failed me and I have shared it with scores of nursing students and young nurses alike.
Karou
700 Posts
I can't go into too much detail because it's very fresh, but I recently had a situation where this happened and the outcome was negative. I had a patient who appeared fine except for one minor symptom. I called the physician who wasn't concerned because he felt this symptom could caused by the patients diagnosis. I felt like okay, sure, it could. Except that this patient has been here over a week and this symptom suddenly appeared, never documented before. I got some new orders and it was very mildly investigated with disinterest on the physicians part. I mean he was a stable patient. But this bothered me. I was on pins and needles all night long checking VS q2 hr and watching his tele strip constantly. Documented everything. Shift change happens and the patient goes off to a scheduled surgery (think simple I&D or digit amputation). He died in the OR.
It crushed me. I will never know if that symptom was related to his death. My gut told me all night that he was wrong, something was off, but I had no evidence aside from one small symptom and my gut. I wish I had advocated more. I will never know if I could have done anything to change what happened.