NursingLink

News >> Browse Articles >> Nurse Features

All Nurses Are Leaders

A Quiet Night

Katie graduated nursing school three years ago and works the night shift on a busy telemetry unit in a community hospital. Tonight is her big night…her first time in charge. She had been trained and mentored for this moment by her nurse manager John. He consistently expressed confidence in her abilities and encouraged Katie to take on new challenges. As Katie clocked in that evening, she drew a deep breath and said a silent prayer, “I hope that it will be a quiet night tonight.” While making out the patient assignments she discovered that they would be working a nurse short; which meant that she would be carrying a full patient load in addition to her charge responsibilities. However, she knew and trusted the team that she would be working with.

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.”

Katie smiled.

---