Jennifer Collins NUR 505-01

September 23, 2010 Memorable Clinical Experience paper #1

Providing Quality Care In A Heartbeat
In todays clinical setting, nurses must be able to effectively apply knowledge learned from
previous experiences in order to provide quality care to their patients. Unfortunately, this often
becomes difficult for the nurse when others are not as in tuned with the situation at hand. In such
instances, the nurse must escalate patient advocacy efforts in order to properly help the patient in
need. Recently, I found myself in such a situation, after a transfer from a Telemetry unit onto an
Ambulatory Surgical floor. By relying on my previous experiences on the Telemetry floor, I was
able to recognize symptoms of congestive heart failure, which had been ignored and belittled by
my colleagues, and advocate for my patient in order to receive proper treatment. This paper will
discuss the events that led to my insight on the situation, the reasons why others did not see what
I saw, and what I learned from this experience.
The background of the event takes place at a small local hospital on an Ambulatory Post
Operative floor. On my previous Telemetry floor, the cases were more complex, often with
numerous congestive heart failure patients. I was expected to recognize symptoms and various
treatments, often involving several systems of the body. Educating these patients on the
prevention and management of the condition was important for their care. However, in the
Ambulatory Surgical setting, the scenario population for the patient population is different, as the
majority of the patients are discharged that same day, and the education and assessments involve
short term instructions relating to the healing of a specific part of the body. On one particular
day in the Ambulatory Surgical unit, I had received a 70-year old female patient that had
undergone surgery to her repair a torn rotator cuff. On assessment, the shoulder dressing was
clean, dry and intact, with extremities warm and mobile, but the patients voice was hoarse and
she began complaining of difficulty breathing, with oxygen saturation in the low 90s. My
colleagues insisted that her condition was a result of the anesthesia, and advised that I should
encourage her to use the incentive spirometer to assist in oxygen consumption. However, as I
was aware that congestive heart failure was indicated in the patients history, I became
concerned and felt that her condition was much more serious. Upon auscultation, crackles were
noted in scattered lung fields, a symptom of congestive heart failure, and on her medical
reconciliation it listed that her last dose of Lasix, a common medication used to treat congestive
heart failure, had not been taken in two whole days. Acting on my instincts, I stopped her
intravenous fluids, which had been going at a rate of 120ml/hour, and phoned the surgical
resident. The surgical resident, like my colleagues, insisted that the symptoms were only from
the effects of anesthesia, and ordered the patient to continue using the incentive spirometer. At
this time the patients oxygen saturation was 87%, and her breathing became labored. I again
phoned the surgical resident, who reluctantly came to assess the patient. I explained my
concerns due to my previous experiences, and indicated that I believed that it would be in the
patients best interest to be seen by a cardiologist. When he disagreed, I had a nursing supervisor
called, and eventually the patient was seen by a cardiologist, who diagnosed her with
experiencing a relapse in congestive heart failure, and ordered an intravenous dose of Lasix to be
administered stat. The patient thereby obtained relief and was admitted to another floor for
observation. I believe that if it wasnt for my persistence in providing a cardiac consult for my
patients condition based on my previous knowledge and experience, the patient may have
become compromised and put in critical condition.
In the medical profession, one must never make assumptions regarding someones health, but
rather be able to think critically and allow for the suggestions of colleagues. I feel that it is
common for a nurse to easily make assumptions regarding a patients condition while
consistently working on a floor with similar patient populations. I believe that the nurses and
resident that I worked with that day were accustomed to healthy patients in the ambulatory
setting who were discharged quickly and without complications, and because of this, were not
thinking critically. I additionally believe that the staff was also hesitant to agree with me
because I was new to the unit, and most likely felt they had more insight and skill in caring for
post operative ambulatory patients. From this experience, I have learned firsthand not only the
importance of advocating for your patient to ensure safe and effective care, but of escalating the
chain of command in order to facilitate the process. I further believe that my colleagues have
learned from this experience as well, as they now appear to be more open to the suggestions of
others regarding patient care.
Being receptive to the insight of others based on past clinical experiences does indeed prove vital
in providing effective nursing care. While I had recognized the symptoms in a patient that I had
observed on a previous floor, medical care still had to be delayed because I had to first advocate
for my patient to be properly assessed and treated. In the future, my hope is for all staff to be
more in tuned with the situation at hand and open to the suggestions of others, thinking critically
about what might truly be going on with a patient. In this way, we may prevent avoidable
complications, and ultimately provide quality care and sustainable health, both quickly and
effectively.