Common sense, not so common

It seems with patients continually being admitted and discharged, numerous medications to give, IVs to tend to and the myriad of other tasks to accomplish, nurses have lost the ability to problem solve or think critically and in some cases use common sense. Is this a symptom of the increasingly high census and acuity of patients? Or is it something they are forgetting to teach in nursing school? Perhaps it is a combination of issues. Being a nurse today is harder and more demanding than it was 10 or 15 years ago; but if ever there was a time that prioritizing and problem solving were needed, clearly it is now.

Recently my 90 year old grandmother was admitted for a bowel resection secondary to a tumor in her ascending colon. She was a model patient. Considering her age she did remarkably well. Despite her strong recovery from surgery, she developed a few complications post-op day 2. My concerns were not so much the physiologic responses to surgery, but the way in which the nurses reacted to these changes in her condition. The inability to recognize signs and symptoms of delirium, dehydration and bowel obstruction were worrisome. It was I that assessed the changes in her mental status and realized that she was having a reaction to the Benadryl, which is known to cause acute agitation and hallucinations in the elderly. It was I that assessed her fluid deficit secondary to severe diarrhea and suggested that the physician be called to re-evaluate her labs and repleat fluids and electrolytes. And again it was me that assessed her increasingly rigid abdomen and suggested that a post-op radiological exam be obtained.

There is a paradox in nursing. We as a profession want to be viewed as intellectual and autonomous professionals, but do not want the responsibility of communication and collaboration. There is a difference between ‘bothering’ the physician with a question that can wait until rounds or a change in the patient’s condition that warrants intervention. It has not been my experience that a physician was annoyed to know that the patient’s condition was deteriorating.

Assessment, intervention and evaluation are important concepts of problem solving, not too mention part of basic nursing practice…which of course is just common sense.