4.0: Introduction

Figure 4.1 Health-care providers collaborate to ensure quality patient care. (credit: “Collaborating in the ER: Reservists assist, learn in community hospitals” by Senior Airman Jonathan Stefanko/US Air Force, Public Domain)

Picture this: You are a newly graduated nurse fresh off orientation in a critical care unit. You get reports on two of your patients: one who is on a ventilator after a head injury, and the other who is being treated for heart failure. The nurse giving you the report mentions that the patient with heart failure has been receiving a large dose of diuretic medications and has been having some irregular heartbeats on 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 check. As you suspected, the patient’s potassium level is very low, likely from the high dose of diuretics being administered—certain diuretics cause a loss of potassium. You quickly get in contact with the treating provider to recommend potassium replacement to get 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 new nurses to have. This chapter explores the shift in nursing practice and education that is currently taking place to put more emphasis on clinical judgment to better prepare new graduates for situations like this.