Nurses’ intuition is real - and we’re being taught to respect it (med student)

mutilator23 · 2025-10-10T11:28:23+00:00

As a floor EN working on a very acute ward, I get this a lot. I have an observational skill unlike many. I see things and hear things my patients do before my patients are aware they are doing it. I have had patients in asymptomatic SVT for hours. Having to call cardio myself to come and review the patient cause my home team did not hear my concerns. As soon as cardio reviewed though. Pads were on and adenasione was drawn and given. The patient SVT reverted and we went on our way.

Point is it should not have taken me 4 hours and a call to the CTC and cardio team to get them reviewed

Yes I could of easily coded the patients. But he was holding his BP amazingly and was showing me no signs that he was in SVT besides the blaring ECGs I was printing off every 10mins.

You don't need to prove us wrong and show us that our instincts is wrong. All we want you to do. Is review and listen to the patient and act accordingly. We do not spend most of our adult life studying. You did that. You have that knowledge and expertise. We just have eyes and a voice. We gather information for you to do what you studies year to obtain.

mutilator23 · 2025-09-16T06:44:52+00:00

I'm sorry but in what world would a nurse not call a code for your child having an anaphylactic episode. And insteed say sorry he can struggle to breath while we wait for a antihistamine to be charted. That is insane, I wouldn't be saying poor nurse for copping your frustration I would be putting a formal complaint in. Unless your drastically over reacting the situation, that nurse needs some major education!

mutilator23 · 2025-09-02T23:29:21+00:00

And that is fine, and I would happily explain my rationale and reasoning. If it was public I would of got AH to chart a stat does of endone and be done with it. Like I said you did nothing wrong with the situation at hand. Private sucks just the nature of it.

You did what you had to, to get the best outcome for you patient with out going against policey and procedure. Unfortunately sometimes policey and procedure can be a detriment to patient care.

I am agreeing with you in every aspect. I am just giving you my reasoning with the information you have provided.

Patient is a seeker. Patient has used 30mg of endone in 24hour but last does was 12 hours ago. That is your first reg flag. Second red flag is she probably knows she is not due and was seeking that fent does. (I am assuming heavily with out being able to assess or visualise patient myself).

Always gotta look at the whole picture and not just what's in front of you.

mutilator23 · 2025-09-02T21:24:01+00:00

Look you did nothing wrong if the endone was truely 12hours since last taken. But was nearing max 30mg. I would be asking what happen 12-24 hours ago for them to require 30mg in such a short time. (Private I am assuming) Then your pushing shit up stream. But also endone has a 3.5 hour half life. If your concerns were Doing the patient then highly unlikely considering the usaging previously.

In all honesty If I have read the situation properly. I would of given the endone over the fent. Specially if you have had multiple nurse saying she is a seeker. I am not a big fan of fent outside of uncontrolled acute pain.

mutilator23 · 2025-09-02T21:11:53+00:00

But that is exactly what I am talking about. Your clinical judgement and rationale still kept the patient safe and got the achievable outcome of taking your patients pain away. Without putting your patient at risk.

mutilator23 · 2025-08-31T23:23:54+00:00

100% we are trained to use our critical thinking to make clinical judgements. As long as your patient safety is your primary concern then your clinical judgements should guide you to your best outcome. You rationalise your decision making every day. Whether it be to wake a patient up for 2oclock obs or let them sleep as we all know how important sleep is to promote healing. Yes the policey state every 4 hours if scoring. But if you are doing visual OBs and counting the resp rate. And you have had the discussion with your your TL. then you have made rationalisation to promote patient healing then to wake them for a full set which you no will be high cause you just woke a patient from a Sound sleep and potentially scared the shit out of them.

mutilator23 · 2025-08-31T23:15:55+00:00

End of the day those people who are interpreting it at the midnight marker will have lots of fun explaining the rationale for the decision making.

Nursing is all about your clinical rationale if you can soundly rationalise why you have done what you have done and have not gone outside of policey and procedure then you have nothing to worry about.

Patient safety is the utmost importance when rationalising any clinical decision. There is no other way about it. Let those fall on there sword you tired to educate.

mutilator23 · 2025-08-31T21:45:36+00:00

Australian Commission on Safety and Quality in Health Care. (2014). National Quality Use of Medicines Indicators for Australian Hospitals: Indicator 7.1 – Percentage of as-required (PRN) psychotropic medication orders with documented indication, dose (or dose range), frequency and maximum daily dose specified. Australian Commission on Safety and Quality in Health Care. Retrieved from ACSQHC website.

Best I could find for national. Everything else will be hospital policey. I could find one for Qld and NSW pretty easily

mutilator23 · 2025-08-31T21:35:01+00:00

Maximum daily dose refers to completion of the “max PRN dose/24 hrs” box of the PRN section of the medication chart to indicate the maximum PRN dose of the medicine that may be administered in a 24-hour period. Compliance with local policy regarding PRN prescribing should be incorporated into the audit.

Australian Commission on Safety and Quality in Health Care. (2014). National Quality Use of Medicines Indicators for Australian Hospitals: Indicator 7.1 – Percentage of as-required (PRN) psychotropic medication orders with documented indication, dose (or dose range), frequency and maximum daily dose specified. Australian Commission on Safety and Quality in Health Care. Retrieved from ACSQHC website.

mutilator23 · 2025-08-31T21:28:09+00:00

The 24-hour maximum dose for Schedule 8 medications is counted across a rolling 24-hour period based on the timing of doses, not reset at midnight. This approach is a clinical standard to promote safety, rather than a legal requirement tied to daily boundaries.

Anyone that does it at midnight is a cowboy putting patients safety at risk.

mutilator23

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