We talk about it all the time, and I know that the more I use it, the more it's helpful. What am I talking about? Our nursing intuition!
Why do we have it? Maybe it's a common personality trait nurses possess even before we become nurses. Or maybe it's our education and experience that causes us to have an eagle’s eye about patient symptoms, etc. Whatever the reason, I am grateful to have it.
In my role, I am often asked to train, educate, and lead others. These are things I love to do so much, I returned to a place I used to work at in order to continue them. I love being able to train, educate, advise, and build new team members in nursing, oncology, and hematology. I don’t have all of the answers for sure, but one thing I stress for new nurses, or nurses new to oncology, is to use their judgment and intuition. Here are some classic situations that validate this point:
The nursing student:
I was fortunate enough to train a second-career nursing student; she was older than the average 20-something in the university program. After we had a discussion in one of our post-conference sessions about not being afraid to question, probe, or use your judgment and intuition, she demonstrated why.
She was caring for an elderly woman who was in after a small bowel obstruction and post-surgical intervention. The elderly woman was quiet and didn’t ask for much. This student followed behind the staff nurse in her assessment, decided to look a little closer, and discovered this woman had been bleeding from the rectum -- new bleeding.
A rapid response was called and this patient was likely saved from further complications. When I asked later what prompted her to get a fellow student nurse and move this patient in order to fully view her from behind, she answered, “Well, I was just doing a thorough assessment, but something kept telling me to look more closely at her bottom.”
Nurse Practitioner orientation:
This NP is being oriented to one of the oncology and hematology offices in our city. She is being trained by several staff members, NPs, and MDs. I am part of her training/orienting team. She came to me the other day to ask about a question she had discussed with one of the other NPs.
It was in regard to a young breast cancer patient I had just seen and just ordered an echocardiogram on. This patient had already completed four cycles of dose-dense Adriamycin and Cytoxan, and was currently receiving dose-dense Taxol. She was going to have radiation to her right chest area, and I had ordered an echocardiogram to establish a baseline after she completed her dose-dense Taxol cycles, but before she proceeded for radiation treatment. I had discovered she hadn't had an echocardiogram done yet, and the physician agreed she needed one and was glad that I had recommended it.
Ironically, the NP being oriented actually had questioned this earlier in this patient’s course, but she said she was told by a fellow NP (unfortunately) that an echocardiogram is not always necessary. I shared with the orienting NP that her intuition was correct, that getting an echocardiogram would be ideal for a young female who was going to receive dose-dense Adriamycin (which is known to be cardiogenic), and also radiation to the chest. I assured her next time to go ahead and order the echocardiogram, or talk with the patient’s primary oncology physician about it.
I applauded her judgment and intuition, which was spot on. I also informed her that an echocardiogram is not going to hurt the patient; it will only provide the oncology team with more information.
These are just two examples of nurses using their intuition as part of their arsenal for caring for those who are critically ill. The few times that I didn't listen to my intuition, I later regretted it!
Do you consistently listen to your intuition at work, or do you find that you dismiss it or label it as “worry”?