The sixth sense (or how all nurses are a little bit psychic)

In the world of nursing there is a long accepted "nurses intuition" or sixth sense, which means that even when all the evidence points to the contrary we can often look at a patient and say:

"Now ... I don't like the look of him."

Not in the sense that we think are patients are ugly you understand, but in that once you've seen a fair few sick people everyday for a few years, you start to get a feel for when someone's taking, or about to take, a turn for the worse. They could have perfectly health observations but something about that patient tells you to do an ECG or bleep a doctor or at the least keep a closer eye on them for a while.

Which is great, psychic nurses - excellent!

This becomes a difficulty however, when you realize that a patient looking "a bit iffy" isn't exactly quantifiable, we live with a medical system, and I work within one, which relies on things being quantifiable and score-able. In the NHS we have the EWS or Early Warning Score system, which gives you a score for the patients observations, which ideally is 0 - anything above a three and a doctor must be informed.

If you are curious - an EWS chart!

Which is great, it's a fairly fail safe way of monitoring a patients overall health and spotting a problem quickly. However, it really doesn't account for the sixth sense, in which many nurses, doctors and other health care professionals can look at an outwardly healthy patient and know that there is something up. If you can't justify investigations then the general consensus is that you shouldn't be doing them, which is fair enough - you don't replace your car's battery just for fun, or re-tile your roof just for the sheer hell of it. So why would you do an ultra-sound on a patient with no signs of cardiac problems?

But I worry, surely we're ignoring a vital skill that health care professionals pick up subconsciously, a vital skill bred from long experience and acres of knowledge. We're in danger of forgetting that that patient is a human being, with a very complex body that can do all sorts of crazy stuff to confuse us, and see them as a car - which doesn't need to go to the garage until that red light starts flashing. Tools and charts and scoring systems are good, when used in conjunction with common sense and humanity. But rely on them solely and you will a) loose the heart of the NHS and b) miss out on excellent medics who know something is wrong - but can't do anything about it.

The makings of a good nurse: practical or theoretical!

Textbook good nurse:
Florence Nightingale 

What does make a good nurse? 

Answers on a postcard please. Because, really, truly, I don't know! You see the problem is, what is on paper as a good nurse  doesn't always translate into a good nurse in practice.

The nursing courses today are all degree courses, which is fantastic in empowering nurses and giving us a broad skill set that means we can work as skilled, well trained healthcare professionals. However, it also makes the occupation much more, exclusive. Suddenly people who would make awesome nurses, who could more than cope with the drugs calculations, the dressings, the comforting patients and the long hours, but can't write an essay to save their life, or reference an article for that matter. Does that make them a bad nurse? Or unsuitable for the occupation?

Not in my opinion, but then again I'm biased. I am terrible at essays, I love my lectures, love my placements and without sounding like a smug idiot - I think I'm a damn good nurse. Obviously I'm a second year nurse - I've got a long way to go, but I feel that I do do a good job when I'm on duty. I make sacrifices for the work and I love it (not making sacrifices, I mean the job!) but arguably I may never make it to being staff nurse because I really struggle with my written work.

Is it fair? Is it right? And is it the best way of selecting the best nurses in the country - especially when I for one know student nurses who are piss-poor at placement and awesome at exams and therefor are going along like super-stars ... when actually they might not make the best nurses.

Just to show that I'm not an embittered old harpy - I also have some lush friends who are brilliant on placement and brilliant at their assessments and will make brilliant nurses!