28.0: Introduction
Picture this: You’re a new graduate nurse fresh off orientation on a critical care unit. You get report on two of your patients, one of whom is on a ventilator after a head injury, and the other is being treated for heart failure. The nurse giving you report mentions that the patient with heart failure has been receiving a large dose of furosemide, a diuretic medication, and has been having some irregular heartbeats, according to the monitor. Reflecting on your nursing knowledge, you remember that abnormal potassium levels can affect the heart’s rhythm, so you pull up the patient’s chart to see what their potassium level is. The potassium level is very low, likely from the high dose of diuretics being administered. You quickly get in contact with the treating clinician to ask for a potassium replacement and regulate the patient’s levels back to normal. Had you not made this connection, the patient could have experienced cardiac arrest or other life-threatening symptoms related to their low potassium level. You used your nursing knowledge to make a clinical judgment call that most likely saved your patient’s life. The ability to critically think and exhibit clinical judgment in practice are imperative skills for nurses to have. This chapter explores the shift in nursing practice and education that is occurring currently to better prepare new graduates for situations like this.