He was pale, and his altered level of consciousness communicated in the report was obvious. As other nurses assisted me in placing his ECG leads, the BP cycled a second time. The CRNA on call happened to be on the floor, and I let the resident know that I’d like an arterial line and signaled the CRNA. As the arterial line was placed, I half-joked with the CRNA, “are you sure this is an ART line, not a SWAN?” as the reading was that low. I immediately assessed heart sounds, and there it was, the “whoosh, whoosh, whoosh,” the classic washing machine sound of a blown mitral valve.
I’d read about it, heard about it during a Laura Gasparis lead conference, but never heard it in real-time—but there was no doubt. My gut told me this patient needed surgery now.
I looked at the resident requesting an ultrasound and that the cardiothoracic team be called. She was not convinced of the urgency, to which I responded, “they need to be here now, trust me.” Reluctantly, she made the call. The surgery went well; the patient survived and later returned to the unit with treats and a “heartfelt” thank you. Not one of us took credit for that day—we simply said, “you are welcome.”
This “gut feeling” we call clinical judgment that results in sound clinical decision-making is not something we graduate with from nursing school. For me, it was the result of the nurse faculty who challenged me in the simulation and skills lab, with thought-provoking didactic classes, and most importantly, prepared me for clinical rotations.
There were days in nursing school I felt frustrated, disillusioned, scared, and even at one point wanted to quit. The faculty did not give up on me. I am forever grateful, and I remind them often to this day. It is their best practices that I recalled as I became nurse faculty.