This post is for all the people who’ve ever told me (or other nurses) that I’m “too smart to be ‘just’ a nurse.”  There are a lot more of these people than you might think!  In some twisted way I guess some people think this is a compliment.  (Newsflash: it’s not!  It’s actually quite insulting.)  Obviously the people who say such things have no idea why it’s so incredibly important to have a very intelligent nurse.  So let me educate you as to why if you or your loved one are ever sick, you better hope against hope that your nurse is every bit as intelligent as your doctor:

Because I’m the one who called the doctor to tell him that your sodium was rising rapidly & thus we needed to stop the hypertonic saline drip you were on & change it to regular saline.  And I did this because I have the smarts to know that no matter how critically low your sodium was initially we can’t replace it too quickly or we can cause serious brain damage.

Because I’m the one who noticed that your creatinine, an indicator of kidney function, was off the charts & realized that, with your history of diabetes combined with your current dehydrated state, this was a serious problem that needed to be addressed immediately.  So I’m the one who called the doctor & made sure you had IV fluids ordered & a nephrology consult to further explore your renal failure.  I don’t want to know how much worse your kidneys could have been damaged if I’d just assumed the admitting doctor was aware of the problem & waited till the next doctor happened to look at your chart the next day.

Because I’m the one who noticed you were lethargic & slow to respond to my questions, so I checked your blood sugar, found it was dangerously low, & corrected it so that you didn’t end up in a hypoglycemic-induced coma . . . or dead.

Because I’m the one who begged for a palliative care consult because it was obvious to me that your mother was dying & furthermore that she was READY to die, & I wanted her to have the peaceful death she deserved.

Because I’m the one who noticed you were on a boat-load of narcotics but didn’t have a stool softener or laxative ordered, so I called the doctor to remedy this situation because I didn’t want you to develop severe constipation or worse yet a post-op ileus due to such a “simple” oversight.

Because I’m the one who recognized your mother was having a massive heart attack & demanded the doctor come to see her, even though it was the middle of the night & he had to come in from home, so that I could ensure she was transferred to the ICU where she could receive all the care she so desperately needed.

Because I’m the one who reminded the doctor to discontinue your blood thinner the night before your heart cath so you wouldn’t bleed out during the procedure the next day.

Because I’m the one who reminded the doctor to order a physical therapy consult so your dad could improve his strength & mobility prior to being discharged home with you.

Because I’m the one who noticed all of your morning lab results were a bit questionable, so I demanded that the lab re-draw them to ensure accuracy.  (And thankfully for your sake the first set was wrong.)

Because I’m the one who noticed your mother’s urine was cloudy & foul-smelling so I made sure she had a urine sample sent & antibiotics started to treat her UTI before she became even sicker than she already was.

Because I’m the one who reminded the doctor that certain medications like Ambien (a commonly prescribed sleeping pill) are really bad for elderly people, so I asked her to order something milder like Remeron instead.

Because I’m the one who noticed that your blood sugar was low on your morning labs (but not so low that lab called it to me as a critical result), so I rechecked it & found it to be even lower, dangerously low in fact.  I corrected this by giving you D50, basically sugar water, in your IV.  But I shudder to think what might have happened if I’d overlooked that low blood sugar on your morning labs.

Because I’m the one who noticed that your dad was having trouble breathing & decreased urine output, so I called the doctor & ensured he had a STAT chest x-ray done & some Lasix given because I realized he was probably going into acute heart failure . . . & that couldn’t wait till the doctor rounded the next day.

Because when the doctor tried to explain what was going on with your body & you didn’t understand a word of it, I’m the one who translated the words into plain English & helped you understand your condition so you would be less frightened.  This is because I have the intelligence to understand your medical condition but also the ability to translate that into simple terms that anyone can understand.

Because I’m the one who noticed that your blood pressure was low &, knowing this could affect your body’s ability to perfuse all of your vital organs, I made sure the doctor ordered a fluid bolus to help increase your blood pressure.  But I also closely monitored your urine output & your respiratory status to make sure we weren’t overloading you with fluid & risking sending you into heart failure.

In case you’re wondering, these are all scenarios I have truly encountered as a nurse.  And these are just a small fraction of the things I & my fellow nurses do on a daily basis to help provide excellent care to our patients & their loved ones.

If it isn’t apparent to you yet, let me just explain that, especially at night, there is no guarantee when a doctor will next see you or even look at your medical record.  Not to mention if you’re lucky doctors spend maybe 30 minutes a day with you, whereas nurses are with you for hours & hours each day, so inevitably we know you much better.  This is why it’s so incredibly important to have a very intelligent nurse because we’re the ones who are meticulously following your vital signs & lab results & keeping the doctors up to date on your condition so that nothing important is missed.  We’re the ones double-checking all your orders & making sure they make sense & that nothing has been overlooked.  I say none of this to make doctors look bad or appear incapable; I just realize that patient safety is every bit as dependent on intelligent nurses as it is on intelligent doctors.  Once you realize this too, I sincerely hope you will never again tell me (or anyone else) that I am “too smart to be ‘just’ a nurse.”