All Nurses Are Leaders
Laura Wisniewski, RN. BS, CIC
It was 5:15 AM and despite the hectic pace, the shift had gone surprisingly well. She thought to herself, “I only have to make it another hour and a half until John takes over charge”. However, something told her to check on Mr. Gonzales one more time before beginning her charting.
Mr. Gonzales was sitting on the side of his bed and appeared restless. Although he had anti-anxiety medication ordered, she decided to investigate further and reassess him. He denied having any chest pain or pressure. There were no changes on his cardiac monitor. His vital signs were normal with the exception of a slightly elevated respiratory rate. His lungs sounds were clear, but diminished. His oxygen saturation was down from 98% to 94%, still within normal limits. Yet, her gut told her that something was wrong.
Katie raised the head of the bed and assisted Mr. Gonzales into a more comfortable position. While she closely monitored and simultaneously reassured her patient, she asked Dale to page Dr. Thompson and Lorrie from respiratory therapy STAT. She also asked Simone to cover her other patients and Mark to call Mrs. Gonzales and update the nursing supervisor.
Katie used the SBAR (Situation, Background, Assessment and Recommendation) method to communicate with Dr. Thompson over the telephone. Dr. Thompson seemed quite unimpressed. He told her, “Mr. Gonzales tends to be very nervous”. “I will be in to see him when I make rounds at 7:30.” She calmly and assertively recommended STAT ABGs (arterial blood gases) and that he come in now to see Mr. Gonzales. He agreed.
As Dr. Thompson walked into Mr. Gonzales’ room, Lorrie handed him the abnormal blood gas results. Despite receiving additional oxygen via a face mask, Mr. Gonzales was now exhibiting obvious signs of respiratory distress. Dr. Thompson ordered a STAT portable chest x-ray and transfer to the ICU. Christine quickly gathered Mr. Gonzales’ belongings and assisted Katie with the transfer. Mark held Mrs. Gonzales’ hand while explaining the changes in her husband’s condition as he escorted her to the ICU waiting room.
It was 6:45 AM when Katie sat down to chart as her mentor John arrived on the unit.
“It looks like you’ve had a quiet night.”