We’ve all seen those medical drama shows like Grey’s Anatomy or Nurse Jackie. Where the main characters are doctors or nurses, who are more often than not in disagreement with one another over the course of action to take while a patient’s life hangs in the balance. There’s dramatic music, blow out fights that involve shouting, and then the character quietly reflects while at war with doing what is “right” versus what their “gut feeling” is telling them. We all hang off the edge of our seats, waiting to find out what happens and we ask ourselves what we would do if we were in that situation. Most people sigh in relief because they probably won’t ever have to make these kinds of life or death decisions.
Unless you’re a nurse, in which case, you’ve probably found yourself there a couple of times. Only, you’re not surrounded by dramatic music, strikingly attractive doctors, and an audience watching. It’s just you, your patient, and your fellow nurses who you know have your back (or should anyway). So what does going with your “gut feeling” even mean? What does it look like in real life? Try to picture the following scenario, which is a real-life example:A nurse's gut feeling is an important tool in the evaluation and management of a patient's condition. Click To Tweet
A Nurse’s Gut-Feeling
You’re working on a medical-surgical floor where you’re juggling six patients and their families. You are behind with your med pass and a new admission just arrived. One of your patients has a diagnosis of pancreatitis and is believed to be going through alcohol withdrawal. In report, the off-going nurse stated that his heart rate was fast and that he has been running a temperature. She tells you that this was “normal” for him and it was just a part of the disease process. She advised that you make frequent CIWA assessments and give him lorazepam as needed to “keep him subdued.” A few hours into the shift, you notice that his temperature has increased to 100.1, his blood pressure has been trending down, and his heart rate is sustaining in the 120’s. Your stomach lurches as you experience a gut feeling that this is not normal. Your gut tells you that the patient is septic. The on-call physician is annoyed when you call him. He orders a liter bolus of normal saline, and nothing more. The doctor tells you not to call him back unless the patient’s condition worsens. Knowing the orders probably won’t do much, you’re not all that surprised when the patient’s condition remains unchanged. So here you are, faced with a difficult decision. You know the patient isn’t getting the care he deserves, and no one is doing anything about his possible septic condition. However, you also received clear instructions not to call the provider back unless he gets worse.
What do you do with that gut feeling?
The real world of nursing is messy, to say the least. Patient situations are complicated, there’s a hierarchy of authority you have to go through, and often you are at risk for getting chastised regardless of what decision you make. As nurses, we often experience gut feelings about our patient’s condition. Intuition doesn’t come with years of experience either according to a study by Case Western Reserve University. Sometimes, we pick up on subtle signs that don’t seem to fit the situation and we can’t shake the feeling that something is wrong. One of the most important things that we can do as nurses is to listen to our intuition and use it to advocate for our patients. Sometimes acting on our intuition can result in angering a physician, but in the end, if it saves our patient’s life, getting yelled at is worth it!
What would you do in this situation? Nurse Born would love to hear about a time that your gut feeling guided you in the care that you provided your patient?
About the Author:
I am currently a registered nurse, working on an orthopedic/trauma med-surge floor at a Level II trauma center. I’ve been a nurse for almost two years now, having completed my bachelors in nursing at the University of Tennessee, Knoxville (go vols!). I also have a bachelors degree in Exercise Science, so I really love getting to combine my two degrees to help provide holistic care for my patients.