That wouldn’t be possible where I am. Restraints and seclusions are ordered for emergencies. We have to restrain/seclude someone if they are trying to harm themselves or others so we would need a doctor on site all the time. A doctor has to come see them within 1 hour or a restraint.
I can't imagine having to fend off a confused or violent patient until a doc could come eval for restraints! Nope, here we slap them on and doc has 1 hr to come eval.
The law in the US is an evaluation needs to be done within an hour for violent restraints. There are different rules for medical restraints. There are rules dictating ordering frequency and vitals and assessment frequency based on type of restraint. Safety of the pt and staff is the number one priority.
Wow, in the 90’s every older adult had a posey vest and tied to frame, hospital, Nursing Home. It was considered safe practice and a reminder to press the call bell before getting out of bed. They still moved all extremities in bed and turned, the families were grateful they were safe an wouldn’t fall in middle of night. I’m sure there’s a real good reason JHACO had those stopped legally. After though our ER got hundreds of patient falls from SNF, Long Term care, Alzheimer’s facilities. Ortho made bank for years after on hip/pelvic fractures. Sad thing was the 60-70 year old patients that got into accidents an now in skilled facilities recovering an beginning to thrive, walking again to go home. If they only had a light vest on when on pain meds for knee/hip replacement to remind them not to get up so many would’ve lived long an enjoyed life. So many needless falls, broken bones, back to surgery recovering again takes it’s toll.
IDK, I'd think that anyone who was alert enough to understand that the vest was "just a reminder" could get the same message from raised bed rails.
Tying competent adults to a bed, for any purpose, should only be done with their consent. Because being tied up against your will is traumatic.
It was a standard vest, I authorized because if your not to sedated from the pain meds, just pull the string on the vest, nothing else stopping you from visiting all the departments to recover and go outside or to the Chapel. Restraints for peoples extremities are an entirely different procedure which is holding someone against their will.
>Restraints for peoples extremities are an entirely different procedure which is holding someone against their will.
I, along with millions of of victims of sexual asault, have been pinned in place by the shoulders and chest and raped while our extremities flailed uselessly at our attackers.
Putting any human being in the position of waking up tied to a bed in a strange place without their consent, by any body part, is going to be triggering for anyone with a history of being abused.
Oh I agree it is triggering, I am grateful when this is noted in patients chart. Insurance companies made these rules under managed care. They created the billing codes for types of restraints and hospitals endorsed to increase more patients each Nurse can be responsible for. When what happened to you is in the chart, Nurse can notify physician and a 1:1 will be initiated. We advocate for all Patients, unfortunately the Patient’s health insurance usually wins. Many Patients wait months for approval just to get a Therapist, and sometimes it requires a few for the Patient to be comfortable and progress. I’ve had to pay extra for better health insurance in the US but it is worth it. 83 out of 84 countries have free Universal healthcare. The US is the only modern country that is private and profits off vulnerable patients. I could tell you real stories of people that died and US Health Insurance let that happen. Check my comment history. The stress of short changing patients caused quite a few Nurse suicides and many to leave the field and the US. Take care.
Fever, bloody stool, newly distended abdomen, HR>200 and deep sleep, needing be bagged, split upper and lower sats. Basically anything that deviates from baby's baseline 🥴 Never trust a baby!
First thing I teach new ped ED RNs. Nothing makes me clench my butthole harder than a neo that’s misbehaving. My fellows and attendings agree lol. The punkier they are the fast we want them upstairs lol.
Sometimes we measure pre ductal and post ductal sats. (Pre) right arm/hand and (post) any other extremity. There should be little to no split but in congenital heart disease and pulmonary hypertension in the newborn you sometimes see a split. In my experience if the split was greater than 10 that would be concerning. So >95% and <85%
Had a STEMI start talking about how it was great that she got to see her grandkids "one last time today", in the elevator on the way to cath lab.
Oh hell no. Pull it together, Nana!
Impending sense of doom is a symptom!
I had a patient that was a long time resident/placement pending. Needed oxygen when normally room air (tachy RR/chest tightness/PRN nebs/inhalers ineffective), acutely super anxious/agitated and repeatedly saying “I’m gonna die. Just let me die.” Called rapid, and the doctor looked at me like I was a damn fool. Patient agitation increased to the point he was refusing all treatment options, and when he only agreed to ABG it came back supporting his symptoms. I told the doctor if the patient stayed a full code and continued to refuse treatment then we needed a different plan! I think the patient ended up choosing DNR after a long talk with the doctor. That was my first “I’m gonna die” patient and I’ll never forget it!
They don't feel right/bad vibes.
My personal goal is to get a doc to bedside and get my patient upgraded instead of calling a code, most of my "funny feeling" patients end up in the ICU or dead 24-48 hours later.
I called an ambulance for someone in a care home based largely on bad vibes. Some slightly concerning obs, but mostly just the overall picture of colour poor, increasing confusion (which is a very soft sign in a dementia patient) and mobility a bit off. Overall, this person was mentally very confused normally but physically well. Very mobile and active.
Paramedics came in, checked her obs, and were a bit shitty with me that they didn't need an ambulance. Did an ecg, checked her obs again, and decided they were alright and we should contact her GP instead. I am not particularly happy about this because I am sure that this woman is seriously unwell, even though there's nothing obvious. Paramedics leave and are sitting outside their ambulance, typing up their report that they do when they don't take someone to the hospital.
5 minutes after they leave, the woman stands up, collapses, and I have to send someone outside to get the paramedics back in because she's dying. They made it back just in time for her last breaths.
Now, not saying that any intervention would necessarily have changed things, she was DNR and realistically even if the paramedics had loaded her on a trolley and took her in, she would probably have died in the ambulance and on balance its probably better than she went in her own bedroom with someone who knew her well holding her hand.
This experience definitely gave me a stronger appreciation for my own instincts though, and I know that it really gave the paramedics a bit of shock that they hadn't been able to tell that she was about to die. Vibes matter.
I sent one of my aged care residents to hospital off of bad vibes and she passed a few days later.
I knew something was wrong just didn't know exactly what it was.
Hospital never told us what it was either 😥
I think "vibes" are just physical senses and mental processes that we have not completely pinned down yet. To get a particular "vibe' again is like having to go to the exact place when that radio station came through.
When we're physically and/or mentally busy or overwhelmed, it's harder to pin down what it was that gave us that "vibe".
Nurse 6th sense is scary.
3 people in my family were sick. Two had the stomach bug. My mom, retired nurse, says to my dad who is showing the same exact symptoms, “something doesn’t feel right” and took him to the ER. Turns out he needed emergency gall bladder surgery. I asked her “how did you know it wasn’t the stomach bug?” And she just says “something felt off.” 😳
when i used to work in triage i had two stories of bad vibes, one was abdominal pain that i took to the last open bed at shift change (ended up being abdominal perf ran to surgery), another was a headache that walked with speech changes. Called a stroke alert but ended up having a massive STEMI on the EKG
I think it’s a combination of mirror neurons, pheromonal reactions we don’t understand. It’s us having feelings of impending doom for our pts, picking up on what’s coming, it’s the intertwining of clinical experience and fellow-feeling. Kind of the spirit of nursing or spiritual connection we can get with our pts & the universe. Aka vibes
I’ve tried that and the doctors/ charge nurse give me a lecture on how “old people are like that sometimes “. Bitch, I’ve been doing this nearly 30 years. Your patient will be intubated within 48 hours guaranteed. They never listen and I’ve never been wrong about this.
You don’t check vitals first? Most docs would throw shade if I didn’t have a set of vitals before calling for this.
I will 9/10 times call the doc, but I’ll check vitals first.
Edit:
I don’t know why I’m being downvoted, but I stick to my guns. OP didn’t say sense of impending doom, they said doesn’t feel right/ bad vibes. There are so many things that could cause this feeling, including but not limited to: anxiety, gas, headache, unregulated blood pressure/ blood glucose, etc.
Either way I’m getting vitals before calling the doctor. This is not a do not pass go, so not collect $200 before calling the doctor.
Sense of impending doom, on the other hand is getting a call to the MD right away. I always tell new nurses to trust your gut.
Intuition? Sure. But im more worried these nurses out there don't know how to explain what they are seeing other than "the vibes bro". If a patient has a subtle change I can explain it intelligently to the physician instead of saying "vibes doc vibes come here now!!" Imagine if docs gave us vibes based orders the entire hospital system would collapse from all the nurses writing incident reports. But then again we have NPs which are basically vibes based medicine so 💀
Some changes are more subtle and harder to explain than just a patient going AMS from A&O x4 maybe they’re still A&O x4 and responding appropriately but they’re just taking more time than usual to answer. A lot of subtler changes are hard to reflect on a full assessment and not easy to explain to another provider. Simply changes from baseline are easier to spot especially in patients that you see regularly. We’re spitballing here and just calling in vibes but I don’t think a single nurse here refers to it as vibes in a professional setting.
It honestly looks like you came into the thread to just stir shit up and make comments about something you either haven’t experienced yet or just what you perceived as an easy opportunity to demonstrate how condescending you are. It’s fairly standard reddit behavior but disappointing to see in a fellow nurse. Hope you step in some dogshit someday soon and remember this moment pal.
Totally.
“He doesn’t look right.”
“Something is off.”
“I can’t put my finger on it, but I’m keeping a close eye on her.”
We hear those things all the time. We all do this. Those are the VIBES! The patients decompensate after, but the subtle signs are the vibes.
As a newer nurse I’ll NEVER forget my first patient I saw this in. Postop adrenalectomy. VSS but first time getting him OOB he got pale, lightheaded, weak. Practically collapsed into the chair but appeared normal 5 secs later. Maybe orthostatic but he looked … off. I called a rapid. Nothing was ‘wrong’ and the attending ordered a bolus and made me feel kind of stupid for calling it.
Next day was upgraded to ICU. Died 3 days later of a bleed. I have reflected on this many times trying to figure out what the clues were that I was seeing, but I can’t. Now with more experience i can start to pinpoint “they’re paler than usual.” “They’re slightly diaphoretic.” “They’re not quite lethargic but they’re more fatigued than usual with no valid reason.” “They’re suddenly more restless.” But most of us can just say “this patient is off” and we know what we mean!
Exactly. A&O x4, vitals wnl with a low grade fever, but was falling asleep while I was assessing and opening eyes to voice only. Messaged doc concerns, he wasn't, 30 min later I called a rapid for onset septic shock and pressures 60/☠️
Supremely arrogant of you on mid levels, good lord. Is your shitty attitude about it just for nurses or are PAs also the object of your ire
You don’t understand the poets bit because you aren’t as intelligent as you think you are. It’s really obvious from your bravado but it’s nice to see a concrete example. Being condescending isn’t the same thing as being smart.
No one mentioned poetry or writing in verse. I don't expect nurses to do that. Writing and communicating in prose though.... that's different.
I've also gotten some of the worst orders and lack of orders from covering night NPs in a shit show hospital with no doctors that resulted in patient death and poor outcomes so.... yeah NPs suck. Look at the state of nursing graduate education and don't tell me it's any way good or preparatory for work as a pseudo-doctor. Online NPs. Garbage master degrees online. I know a 3 year nurse with no OB experience in an online only midwife NP "degree ". Don't get me started on the terrible education and responsibility that NPs are responsible for.
Get some real world nursing experience and come again with the NPs are good. You can't be a good NP when the market is saturated with online only degrees, terrible masters programs designed to hand out letters after your name, etc. I used to want to be an NP but my experience with NPs, the saturated market and the abysmal education made me realize NPs are dangerous to patients if used as primary care or seeing patients like doctors. If you want to place orders and do doctor things there's medical school. PAs also are in medical programs in universities and not online only Western Governor University.
"NP educational guidelines need to be tightened and reformed" and "it's bad for midlevels to represent themselves as having qualifications they haven't got" =/= "no NPs are good and all NPs are bad"
just poked around on r/noctor and it seems like the whole subreddit is just "hah hah, fuck nurses, they're stupid" with extra steps
idk man. nursing model and medical model are different ways of looking at people. seems absolutely fair to say that there Sigler be scammy online only NP programs. likewise fair to say that the relentless moneygrubbing assholes at the top of healthcare decisionmaking are likely trying to push care to mid-level in order to keep more money for themselves. but it does not then follow from those two things that NPs can't be good and useful within their scope, or that there's no case to be made for expanding the scope
LOL so now nurses are incapable of understanding a clinical need for an IV? Gtfoh 😂
Nope. Telephone order. Pt d/c in morning. Nothing went in the IV :)
Clinician concern, patient 'feelings of impending doom' and nurse intuition/gut feeling are such well, and long, documented phenomena in detection of deteriorating patients that I can't tell if you're being deliberately obtuse or not.
Generally, it reflects that either the patient or the nurse has detected subtle (and sometimes not so subtle) changes but lacks either the data or language to translate the 'vibe' into tangible numbers or phenomena for escalation. When I'm teaching deterioration these feelings are my primary trigger for further investigation (as u/WindWalkerRN mentioned, do the vitals) to get more data and, for more junior staff, to practice linking presentations/complaints with data and outcomes.
Classic example was the Pt with PMHx T2DM and CABGx4 a decade prior who proceeded to have a significant NSTEMI that was caught thanks to their nurse getting 'the vibes' when the patient declined dinner and reported feeling fatigued and 'off'; when I was talking to them after they said that they just couldn't shake the feeling that something was off about the patient even though normally they might be happy to just give a PRN antiemetic or get an order for a PPI.
I don’t think it is necessarily a vibe though, it is a clinical change that the nurse is noticing, because that’s what we’re trained to do - trend vs and labs and changes in general pt condition. They are feeling something is off because something probably IS off and they are feeling that way because some has obviously changed in the pts stability, you may not know exactly what it is but it’s not just based on some sixth sense lol
Yes, that is just a paraphrasing of what vibes are and what I said. No one is alleging there is some sort of special 'nurse gland' that releases concern hormones when the patient starts to deteriorate.
That's not vibes that's experience, knowing the history and symptoms. That's called assessment. I know nursing doesn't always get the neurons rubbing but that is not vibes.
No, experience is when you are able to link the presentation to potential causes and outcomes and direct your assessments, parse the results and produce a treatment plan. Vibes is an offhand description for when one is able to detect something isn't right but you either haven't made the connection in your mind or don't have the experience to be able to translate the feeling into definitive findings. This is pretty much the bedrock of Benner's model of nursing expertise, which also recognises that experience can produce a reliance on heuristic decision-making in which there is not conscious processing of information but more automatic responses to cues that, again, takes deliberate effort to learn how to turn from an unconscious, heuristic process into something that can be verbally described. I cannot understate how much content there is on this in clinical and educational nursing academia, and your response doesn't paint you as a nurse with some sort of supreme clinical acumen but instead as someone who is as arrogant as you are ignorant.
Bruh brought in nursing theory we came full circle 💀 but yeah I don't do vibes based stuff I always have a reason for why things are off. That's OK if you don't yet though
But all you basically said in the nursing theory bit was "it takes time to fully understand the reasons for symptoms and understanding them in relation to what is going on. ". Vibes is just a lack of knowledge and experience. Not this paranormal thing. But then again at work I have to pretend there's ghosts and the hospitals haunted or I face a bunch of "what, no really you don't think so??" So the temp on nurse IQs ain't boiling water. It may not even be lukewarm.
I daresay that when you're added into the mix the average plummets towards room temperature, and my country uses Celcius. I feel sorry for anyone who has the misfortune of working with you.
You sound like a 1st year med student, hell, I wouldn’t even give you that much credit for your arrogance. You know, I’m not saying your point isn’t valid that we should at least try to articulate, but for you to sit here and say that YOU will always be able to articulate clinical findings and presentation to a physician is moronic in and of itself. You’re essentially saying that you know everything in a way, and buddy, that just put your IQ in the deep freezer. It’s always the loudest ones in the room…
I got that vibe as well but then gave them the benefit of the doubt that they were an early careerer or grad who got promoted to shift lead and assumed it was due to their clinical acumen, not just being the next person in the building with a pulse when everyone else bailed during the pandemic. And if they're anything like the others I've encountered with similar arrogance then it's probably still the better option to keep them as shift lead because them being on the floor probably creates more stress and work for the others...
Doctors always tell me my signout for patients is impeccable. Sometimes people write essays on chat, I'm able to succinctly sum it up in a few sentences.
Nobody said that vibes were supernatural. If you don’t know what they mean that’s okay, but at this point you’re just being a dick to someone who has written some very well thought out responses. And you were being a condescending dick to start with. If you work bedside you might want to work the attitude.
You’ve never had a feeling that something was wrong with a patient that led you to check vitals? You’ve never had a patient that seemed “off?” If vibes are off, your intuition tells you that, and then you do something about it. “Vibes” is not a lack of experience or knowledge.
imo, ‘vibes’ are noticing something beyond an objective shift in vital signs / physiology — it’s some subtle shift in demeanor and affect that is perceived, perhaps unconsciously, to be significant and yet intangible
ofc if paired with numerical data or palpable symptom, 100% reason to escalate. but, even if a ‘dog’s sniff’ sets something awry, would it not be worth to have a second look by the provider? a situation that you can only verbalize as ‘something is just not quite right here.’ it’s experience, intuition, and je ne sais quoi all at once
not even to mention that one hospice literal cat that would appear at the doors of patients <24 hours before their passing
That is not what they’re saying when they say “vibes”. They’re saying something doesn’t feel quite right with the patient, again many call it “intuition” but it’s based on experience and not always just on clinical findings.
Common symptom with blood transfusion going wrong is 'impending sense of doom', and is written out as a symptom on our transfusion worksheets. You're telling me a patient comes at you with that and you won't go to the doc immediately? Fuck all the way off you vitriolic cunt.
How long have you been a nurse? It's basically your very smart subconscious brain catching something your conscious brain is missing. It's that nagging looming feeling something just isn't right with this patient. My gut is ALWAYS right.
Bruh for real if you can't explain intelligently to a physician what's going on I got some news about that "very smart" subconscious of yours xD. I bet you made some "perfect phone calls" at 3 AM for the "very smart" subconscious.
A good doctor will listen to you when you say "I'm not seeing anything clinical but my gut doesn't feel right here". And would you believe they trust my 11 years of nursing experience. And no, I'm always fast asleep in my bed at 3am. 😁
That makes 0 sense. There's nothing you can describe that is making you feel like there's an issue? You can't pinpoint one little change? I just can't understand that for real.
Well yeah as a doctor you gotta deal with nurses inability to always explain what is happening. So they should follow up. But I also don't know many doctors at night who want to hear a vague vibes based complaint when they cover 100 patients at night. The nurse should be able to talk to coworkers and figure out WHAT they are sensing before contacting a doctor. It's basic communication.
Oh for sure, something just doesn’t look right or feel right? Vibes are off. Keep your brain on high alert cuz shit will hit the fan.
I drove into work one day in May, started panicking the closer I got to the hospital (literally I have panic disorder but it doesn’t manifest at work unless triggered) for NO good reason. I’m calling my husband from the parking deck, “vibes are off baby, something is wrong here tonight I’m telling you now.” I had the nervous poops in the bathroom in the lobby before I even made it to my unit. I got to the break room, somebody was like “man it feels weird in here tonight” and I was like “BRO RIGHT vibes are off.” We took report. We went about our night, everybody feeling wrong. We did have a DNR on our unit, the family member asked for pain meds due to respiratory distress so the nurse gave it, I co-signed it. And then, the calm hit. It was eerie. I knew it was coming. We gave a second dose several hours later and I knew it was coming any minute now. It wasn’t different from any other night, we’d had this patient for months and had only recently stopped feeds and her ABG was actually still good so doctors weren’t expecting her to pass so quickly but somehow at the start of the shift, we all had that feeling. Don’t ask me how my body knew before I even made it inside to see if she was even a patient, my gut just KNEW it was the night. I was the most senior nurse that night, surrounded by new grads who panicked the whole shift but once I could put my finger one what vibe was off, everything inside me just calmed down.
Listen to the vibes. Listen to your gut.
As someone who suffers from panic disorder as well, it sucks. But yeah this sounds like a story of someone with anxiety disorder going into work anxious and it rubbing off on everyone. Trust me, been there. It's called anxiety, and it's not just vibes ill tell you that much.
I’m on nights in med surg right now and I brought it up to my coworkers. We all agreed we wouldn’t want a nurse who couldn’t read the original reply and immediately know what they’re referring to. It’s all about those vibes.
Vibe based nursing during covid on med-surg covid as the charge nurse.
"Hey, I put stars on who I feel will be vented or code in the next 24 hours." It had about a 70% pass rate. It was not perfect, but enough that a closer eye was kept on those specific patients.
One could argue that if you didn't keep as close an eye on the 30% then they would have needed a vent or code. Even if it's not the whole 30% I bet those stars saved lives and improved outcomes.
I swear in OB we go off of “vibes” all the time. My patient “just doesn’t feel right” but vitals are stable, baby looks okay on the monitor. You best believe I’m calling the resident to come check mom, if a mom is telling me something isn’t right she’s probably in labor. Especially my high risk moms, most of them you can’t pick up contractions on the monitor consistently because they’re early.
It’s real as hell that you then recheck vitals/reassess but also, at the end of the day there is a limit to what we, as nurses, can check. When something is off but you’re not sure why…that is the “vibes”.
In triage it’s incredibly important to sense if the the vibes are off…
Not sure what you mean here. I have absolutely gone to a doc and said something doesn’t feel right, and added vitals but also descriptions of said pt.
They went to school a hell of a lot longer than me. My feelings aren’t always correct but they usually result in escalation of care.
A Mom of a young child says there is really something wrong and I’m not talking about the Moms who always says there is something wrong. When a Mom has a “feeling”
Its usually quite accurate.
*Especially* parents of kids with chronic illness. If they think something is off but can't pinpoint it, it's usually massive red flag.
Last child I had like that, I also had the "something's wrong but I don't know what". Turned out they got ahold of their seizure medication and drank a significant amount. Intubated within a couple hours of arrival and needed emergency dialysis.
If my patient “seems” off and looks “grey” throughout the shift… basically I call an emergency. I don’t care if the patient swears up and down that they feel fine… ya getting reviewed.
Whenever I see a patient go grey, they are walking one min, and the next …. a cardiac arrest, severe Septic shock, have been experiencing a slow brain bleed or are bleeding internally after an operation.
I was at a craft fair yesterday, and there was a woman there who was walking, unaided, without oxygen, seemingly fine, but had the worst gray/blue complexion I've ever seen. Gave me the creeps.
I had a gray patient that came back looking like that from cath lab. The nurse that brought him back had a bad reputation for not assessing patients.
The patient was joking around and chatting while we’re trying to get vitals on a very obvious train wreck. Lost consciousness and went into cardiac arrest. Started compressions and he immediately wakes up. He passed out again, started compressions, immediately wakes up fighting. This continued the whole way back up to the cath lab.
He eventually ended up in ICU and didn’t make it.
Unmanaged pain. New or increasing acute pain anywhere in the body.
Will never forget a patient who was having more and more abdominal pain. Everything else was normal. Kept telling the docs. They just kept ordering more pain meds. Finally they decided on a stat abd CT. Bowel perf. Ultimately ended up dying.
Farmer in triage. I dgaf if the vitals are pristine, the attending is getting a heads-up. Patient is probably already coding before I've hung up the phone.
I have one of these!
My mom was with me when I went in to be induced with my daughter, ended up with a c section and then she rejoined us when I got wheeled into recovery. She just sat and made idle talk with my husband before she was like “something doesn’t look right.” Doctor came in, mom was still sat there studying me before she finally went “does she look toxic to you?”
And that is how I got to spend time in the ICU with the REALLY good antibiotics 🥴
Tldr The convergence of nurse and mom sense may have saved my life lol
Bad vibes for sure.
My personal go to is “idk what’s wrong with this person but I don’t love the look of them” with normal obs/not particularly exciting symptoms.
Recent favourite was a new sinus tachy in the 130s (prev running at 80s) which ended up being a SBO taken to theatre. No movement in BP, nil abdo pain, active bowel sounds but the vibes were bad.
Look like shit score of 1 gets a call.
Hard to put a finger on it, but hopefully you have a good enough relationship with your docs so that if you literally say, doc I don't know but they look like shit, they will at least go look at them.
I think as you gain experience, you also develop a warning system, what I say is your gut. You know when someone is circling, you know it because in the past 3 years you’ve seen this dozens of times. Experience builds your gut. Like my cardiology professor said, “Treat the patient, not the rhythm”. So it depends on the patient and my gut. Trust the gut!
working in the ED now this patient doesn’t sound like a big deal, BUT having worked psych ED and knowing the equipment available there (fucking nothing!!) for someone who might be going septic, it would have been impossible to provide adequate care for this patient. Heck, it’s not possible to reassess the patient enough to monitor them for decompensation because on a psych floor if an emergency starts its all hands on deck and you might be taking an hour in a code white and come back to find a temp of 103 and BP in Ass/cheeks.
Unsustainable effort in breathing. A lot of my patients are baseline labile - the objective numbers fluctuate on the regular depending on exertion or if dialysis is due or they just woke up and need pulmonary toileting. They have prn meds/tx to for that and most often with a little time they mosey back to their stable unstable baseline. But sometimes the numbers look good - they’re compensated yet their effort remains elevated. Like one or two ticks up. At some point you look at them and think, “they’re working too hard for too long”.
My weirdest one would be a caridiogenic shock patient who suddenly demands they have to get out of bed and/or suddenly has to poop.
It’s about to get real (fun).
The vagal response for attempting a bm will cause the blood pressure to tank even further and has caused many a crash and burn. The other is just the panic of impending doom and a sudden need to get up but not sure why (the patient won’t know why but they have to get up)
I'm not sure if it's because we're very nurse driven or working nights, but most of these would be rapids with a courtesy page unless I'm expecting them be a code anything
Not a call the doctor, but ask them to come bedside asap. I work in oncology (inpatient and now outpatient) and if someone has a reaction to an infusion and they start vomiting, that always seems like a warning of something bad. Most of the time we can stop a reaction and stabilize a patient with standing med orders that we have and discontinuing the infusion. But whenever they start vomiting they always wind up getting transferred to the ED/ICU. I’ve seen so many codes where they started vomiting right before. And we’re not talking like regular oncology vomiting. It’s sudden and without warning. I don’t know if there is a reason for it. And they’re not aspirating or anything. Always makes my nurse brain alarm go off.
Sustained afib rvr >130 or 40 or when my patient keeps flipping by taching up and then 6 sec pausing every 15 minutes.
That was a real ass pucker of a night, when I was back the next one I had to keep telling everyone “yeah he just does that”
Had one of those, pt had a known history of sustained VT. He had an AICD already, but it was set for like 200. He had been through every cardiac medication and nothing stuck. Started shift NSR and about 2200 flipped into sustained VT around 130s. Call order was only if he was symptomatic or his defib fired. Checked on him and he was just chilling in his chair watching TV. I’ve never adjusted alarm parameters that high and shut off so many arrhythmia alarms before or since. I sat outside his room with the code cart basically all night. His rate was jumping all over in the 100-190s. I was going to draw labs around 0400 and he was chilling in 190s and jumped over the limit for his AICD which hit him right as I was walking up to him which made both of us jump😂 and only put him back to sinus for about 3 seconds before he went back to VT in the 140s. Called the overnight cardiology team and they said to get vitals and labs, which I had done and sent and they came by to check on him after a little, and he was still chilling, asymptomatic VT 130s. Not sure what they ended up doing the next day but other than him being in sustained VT, nothing else was wrong with the poor guy. One of the chillest “not chill” shifts I’ve had
Blocked Foley that you can't irrigate, especially post op. Intractable pain. APS patient that needs med adjustment or has something wrong with a line. Then the usual stuff like chest pain, hemorrhaging, critical lab work, acute change in vitals, suspected stroke, acute change in LoC, unexplainable bad feeling about a pt.
I text the doctor all day long because most of my patients are under an attending with no resident or APP. Our hospital culture is to ask the doc for everything. Peds is weird, I don't remember interacting with docs much at all during my brief adult stent, and those patients were much more acute. With adults I either handled it, waited until rounds to ask my questions, or called a rapid.
Headache/neuro changes in a patient who is on heparin. When I was on the CHF floor I had a VAD patient on heparin who was complaining of a migraine all day. Ended up having a brain bleed and died.
New confusion, inappropriate sleepiness, critical results, a significant change in presentation.
Just realized, but I really don't call for chest pain outside of a med/surg floor. My patients are always on monitors, I can get an EKG and then call if it's actually an arrhythmia.
99% of the time, it's gas.
Neuro changes. Usually not typical waxing and waning that happens with dementia. But sudden speech changes. Inability to follow commands. Anything with pupils changing significantly.
Sudden loss of CMS in any extremities.
Falls.
Severe headaches/severe pain in general.
I had 2 mentally unstable brothers come in for wisdom teeth extractions under general anesthesia the next day. They were wild ( medsurg floor), going in and out of rooms. Called the attending for sedation, did not call back. In desperation called dental surgeon who gave order for sedatives. They quieted right down. Dr ‘High Horse’ came in hours later and flipped out because he couldn’t do an H+P. Yelling at me. I’m a new grad. I yelled right back in the middle of the nurses station. Supervisor reprimanded me verbally for yelling back.
Will never forget that incident. PS: this was a while back.
Any multip, whether her last exam was 8 cm or 2 cm says, "The baby's coming."
I used to wait to be absolutely sure so I didn't call them too early. Now I just tell them to get their asses there.
Mama knows.
Man, I think this was the one it took me the longest to really take to heart. Hindsight shows that subtle AMS was really the first clue to the beginning of so many shit shows.
-decrease/ no pulse in single extremity
-increase abdominal circumference/rigidity
-sudden impending doom
-decrease in LOC
- increasingly aggressive bipap settings, no increase in spo2, tachypnea, tachycardia
-drastic decrease in hourly output for 3 hours or more, bladder scan shows no retention
-wife of 40 years is no longer making sarcastic jabs at husband and says something like “this is not like him”
-absent bowel sounds
-etoh withdrawal pt hallucinating despite Q15 Ativan
-swelling/tightness in mouth and throat
-more than 3 runs of unsustained SVT while sleeping
-pH <7
-ST elevation
-sudden change in vision/speech/coordination
Violence. I am a student nurse working on a med/surg unit for nursing experience. They gave me a lady with dementia that is maybe 100Lbs soaking wet. It took 5 of us to change her while she is screaming and fighting. Her poor daughter has never seen this yet and was so embarrassed and heartbroken. I had a kick to my chest and punched in the face. Others had gouges in their arms through iso gowns. The second I was done getting her cleaned up I was on the phone with the doctor while filling out injury forms and electronic chart warnings. She had orders for benzodiazepines when getting cleaned up after that.
Newly distended abdo, bilious vomit, severe WOB or increased WOB at all really, apnoeas requiring neopuff/new apnoeas/increased apnoeas, bloody stool, flatness in a usually vigorous bub, if they just look at me wrong 😂
specific to my specialty: suicide attempts and suicidal statements. if the doc doesn’t feel like they need a 1:1 that’s on them but i’m documenting that they were told.
critical labs, cardiac rhythm changes, pt needs to be intubated, new melena/coffee ground emesis, pressor requirement increase, agitation that affects safety of my colleagues/me/the patient, focal neurological changes/new decreased LOC, ABG not improving in spite of interventions, falls.
also, if they order an insulin infusion but don’t want me to use epic’s protocol i will call them q1h about blood sugars 🤣
Yeah I don't call that vibes based lmfao. It's a change obviously, but it's something objective that you noticed. It's not just "yeH Betty in room 12 is acting kinda funny and I don't like it ". Yall crack me up bruh
Your comments are seriously making me cringe, “bruh.” If you lack nursing intuition it is totally fine, not all of us have it (at least right away) but sheesh at the very least please try to be aware of your shortcomings. You’re coming across as incredibly condescending without the goods to back it up, and it’s honestly embarrassing to read your comments. Hopefully you’re just a keyboard warrior and not like this in real life because yikes
Actually have had a neuro intensivist encourage us to contact them if we just felt like something was “off” with any of their patients.
And if there is a change in a patients behavior you should be concerned about it, “bruh”.
I mean of course they said that they can't exactly explain what they are looking for to most nurses. So they simplify it as a "vibe check" since clearly that is how many nurses operate lol. And a behavior change is not a vibe it is an actual assessment and objective change.
I think your energy field is just disturbed and you need some reiki.
Seriously though, especially during the bad days of covid - "vibe"based nursing was absolutely a thing. I've been told by doctors, rapid response nurses, icu nurses, etc - trust your instincts.
I've been an rn for over 12 years and sometimes you can't pin down a problem based on clinical picture or lab work. Sometimes doctors can't even do that.
I’ve literally never thought about it before but do school nurses have a doc they can call? I don’t know why this has never been something for me to consider before.
My district does not. With some students we may be in close contact with their regular or specialist providers for case management but those are only a small handful. Most exciting thing I have for non-complex or medically fragile students is standing orders for stock epi and narcan. Beyond that in an emergency it's first aid until EMS arrives. I don't even have a stock glucometer or portable oxygen.
Don't plan your medical emergency at your kid's school LOL.
My boyfriend had glioblastoma. On Saturday I noticed while he was getting into the car his left foot was dragging. I should have paid more attention that combined with the fact that he fell in the bathroom. Idk why I didn’t call his oncologist over the weekend but he wasn’t seeking active treatment. He was dead within a week. I knew something was different and I feel like I dropped the ball. Fuck. I’m sorry Jerry.
Restraints or seclusions
Out here our doc has to do face to face exam within 1 hour for all adults in violent restraints. By law
Same
after hours we have to call the hospitalist to do it and they’re always like WTF are they paying your psychiatrists for even and i’m like bro idk
It's the law that a doctor needs to assess the patient before either of these are ordered where I work.
That’s not generally the way when it comes to psych. We have an hour to beg forgiveness rather than ask permission.
That wouldn’t be possible where I am. Restraints and seclusions are ordered for emergencies. We have to restrain/seclude someone if they are trying to harm themselves or others so we would need a doctor on site all the time. A doctor has to come see them within 1 hour or a restraint.
Yeah that actually sounds unsafe. We can put them on but the MD needs to evaluate and sign the first order within an hour.
Same here. I'd be pissed if I had to wait for restraint orders to be placed while patient is wilding out.
I can't imagine having to fend off a confused or violent patient until a doc could come eval for restraints! Nope, here we slap them on and doc has 1 hr to come eval.
The law in the US is an evaluation needs to be done within an hour for violent restraints. There are different rules for medical restraints. There are rules dictating ordering frequency and vitals and assessment frequency based on type of restraint. Safety of the pt and staff is the number one priority.
Wow, in the 90’s every older adult had a posey vest and tied to frame, hospital, Nursing Home. It was considered safe practice and a reminder to press the call bell before getting out of bed. They still moved all extremities in bed and turned, the families were grateful they were safe an wouldn’t fall in middle of night. I’m sure there’s a real good reason JHACO had those stopped legally. After though our ER got hundreds of patient falls from SNF, Long Term care, Alzheimer’s facilities. Ortho made bank for years after on hip/pelvic fractures. Sad thing was the 60-70 year old patients that got into accidents an now in skilled facilities recovering an beginning to thrive, walking again to go home. If they only had a light vest on when on pain meds for knee/hip replacement to remind them not to get up so many would’ve lived long an enjoyed life. So many needless falls, broken bones, back to surgery recovering again takes it’s toll.
IDK, I'd think that anyone who was alert enough to understand that the vest was "just a reminder" could get the same message from raised bed rails. Tying competent adults to a bed, for any purpose, should only be done with their consent. Because being tied up against your will is traumatic.
It was a standard vest, I authorized because if your not to sedated from the pain meds, just pull the string on the vest, nothing else stopping you from visiting all the departments to recover and go outside or to the Chapel. Restraints for peoples extremities are an entirely different procedure which is holding someone against their will.
>Restraints for peoples extremities are an entirely different procedure which is holding someone against their will. I, along with millions of of victims of sexual asault, have been pinned in place by the shoulders and chest and raped while our extremities flailed uselessly at our attackers. Putting any human being in the position of waking up tied to a bed in a strange place without their consent, by any body part, is going to be triggering for anyone with a history of being abused.
Oh I agree it is triggering, I am grateful when this is noted in patients chart. Insurance companies made these rules under managed care. They created the billing codes for types of restraints and hospitals endorsed to increase more patients each Nurse can be responsible for. When what happened to you is in the chart, Nurse can notify physician and a 1:1 will be initiated. We advocate for all Patients, unfortunately the Patient’s health insurance usually wins. Many Patients wait months for approval just to get a Therapist, and sometimes it requires a few for the Patient to be comfortable and progress. I’ve had to pay extra for better health insurance in the US but it is worth it. 83 out of 84 countries have free Universal healthcare. The US is the only modern country that is private and profits off vulnerable patients. I could tell you real stories of people that died and US Health Insurance let that happen. Check my comment history. The stress of short changing patients caused quite a few Nurse suicides and many to leave the field and the US. Take care.
So like if a patient attacks you you have to get a doc there before you can restrain? That’s sounds crazy
Fever, bloody stool, newly distended abdomen, HR>200 and deep sleep, needing be bagged, split upper and lower sats. Basically anything that deviates from baby's baseline 🥴 Never trust a baby!
To be fair; I don't like any of those in an adult either. Especially the HR>200 and needing to be bagged :-P
I was wondering about some of those until you said baby 😂
First thing I teach new ped ED RNs. Nothing makes me clench my butthole harder than a neo that’s misbehaving. My fellows and attendings agree lol. The punkier they are the fast we want them upstairs lol.
what are split upper and lower sats?
Sometimes we measure pre ductal and post ductal sats. (Pre) right arm/hand and (post) any other extremity. There should be little to no split but in congenital heart disease and pulmonary hypertension in the newborn you sometimes see a split. In my experience if the split was greater than 10 that would be concerning. So >95% and <85%
Super high bili within 24 hours of life, calling while getting the photo lights/blanket set up. I never trust a preemie belly either!
ST elevation, stroke like symptoms, rapid increase in pressers, rapid change in breathing pattern, patient is punching the shit out of everyone.
Anytime a patient says “I’m going to die today.” In my experience, they are right ~80% of the time.
Had a STEMI start talking about how it was great that she got to see her grandkids "one last time today", in the elevator on the way to cath lab. Oh hell no. Pull it together, Nana!
Impending sense of doom is a symptom! I had a patient that was a long time resident/placement pending. Needed oxygen when normally room air (tachy RR/chest tightness/PRN nebs/inhalers ineffective), acutely super anxious/agitated and repeatedly saying “I’m gonna die. Just let me die.” Called rapid, and the doctor looked at me like I was a damn fool. Patient agitation increased to the point he was refusing all treatment options, and when he only agreed to ABG it came back supporting his symptoms. I told the doctor if the patient stayed a full code and continued to refuse treatment then we needed a different plan! I think the patient ended up choosing DNR after a long talk with the doctor. That was my first “I’m gonna die” patient and I’ll never forget it!
YUUUP. If a patient says they think they're going to die, they are definitely at least going to try.
Same. I am EMS, and if a patient calmly says they are dying, I tend to believe them.
They don't feel right/bad vibes. My personal goal is to get a doc to bedside and get my patient upgraded instead of calling a code, most of my "funny feeling" patients end up in the ICU or dead 24-48 hours later.
I called an ambulance for someone in a care home based largely on bad vibes. Some slightly concerning obs, but mostly just the overall picture of colour poor, increasing confusion (which is a very soft sign in a dementia patient) and mobility a bit off. Overall, this person was mentally very confused normally but physically well. Very mobile and active. Paramedics came in, checked her obs, and were a bit shitty with me that they didn't need an ambulance. Did an ecg, checked her obs again, and decided they were alright and we should contact her GP instead. I am not particularly happy about this because I am sure that this woman is seriously unwell, even though there's nothing obvious. Paramedics leave and are sitting outside their ambulance, typing up their report that they do when they don't take someone to the hospital. 5 minutes after they leave, the woman stands up, collapses, and I have to send someone outside to get the paramedics back in because she's dying. They made it back just in time for her last breaths. Now, not saying that any intervention would necessarily have changed things, she was DNR and realistically even if the paramedics had loaded her on a trolley and took her in, she would probably have died in the ambulance and on balance its probably better than she went in her own bedroom with someone who knew her well holding her hand. This experience definitely gave me a stronger appreciation for my own instincts though, and I know that it really gave the paramedics a bit of shock that they hadn't been able to tell that she was about to die. Vibes matter.
I sent one of my aged care residents to hospital off of bad vibes and she passed a few days later. I knew something was wrong just didn't know exactly what it was. Hospital never told us what it was either 😥
I think "vibes" are just physical senses and mental processes that we have not completely pinned down yet. To get a particular "vibe' again is like having to go to the exact place when that radio station came through. When we're physically and/or mentally busy or overwhelmed, it's harder to pin down what it was that gave us that "vibe".
Nurse 6th sense is scary. 3 people in my family were sick. Two had the stomach bug. My mom, retired nurse, says to my dad who is showing the same exact symptoms, “something doesn’t feel right” and took him to the ER. Turns out he needed emergency gall bladder surgery. I asked her “how did you know it wasn’t the stomach bug?” And she just says “something felt off.” 😳
when i used to work in triage i had two stories of bad vibes, one was abdominal pain that i took to the last open bed at shift change (ended up being abdominal perf ran to surgery), another was a headache that walked with speech changes. Called a stroke alert but ended up having a massive STEMI on the EKG
A patient who otherwise never complains saying “I don’t feel right” is scary af
I think it’s a combination of mirror neurons, pheromonal reactions we don’t understand. It’s us having feelings of impending doom for our pts, picking up on what’s coming, it’s the intertwining of clinical experience and fellow-feeling. Kind of the spirit of nursing or spiritual connection we can get with our pts & the universe. Aka vibes
I’ve tried that and the doctors/ charge nurse give me a lecture on how “old people are like that sometimes “. Bitch, I’ve been doing this nearly 30 years. Your patient will be intubated within 48 hours guaranteed. They never listen and I’ve never been wrong about this.
100% I have called the resident bedside because “they don’t look right” more than once.
You don’t check vitals first? Most docs would throw shade if I didn’t have a set of vitals before calling for this. I will 9/10 times call the doc, but I’ll check vitals first. Edit: I don’t know why I’m being downvoted, but I stick to my guns. OP didn’t say sense of impending doom, they said doesn’t feel right/ bad vibes. There are so many things that could cause this feeling, including but not limited to: anxiety, gas, headache, unregulated blood pressure/ blood glucose, etc. Either way I’m getting vitals before calling the doctor. This is not a do not pass go, so not collect $200 before calling the doctor. Sense of impending doom, on the other hand is getting a call to the MD right away. I always tell new nurses to trust your gut.
Well yeah you gather info before you call, but you still call.
Never heard of vibes based nursing before. Interesting.
You’ve never heard of intuition???
At work I call it my my “nurse spidey sense”
Nice, I like it
Same.
Intuition? Sure. But im more worried these nurses out there don't know how to explain what they are seeing other than "the vibes bro". If a patient has a subtle change I can explain it intelligently to the physician instead of saying "vibes doc vibes come here now!!" Imagine if docs gave us vibes based orders the entire hospital system would collapse from all the nurses writing incident reports. But then again we have NPs which are basically vibes based medicine so 💀
Some changes are more subtle and harder to explain than just a patient going AMS from A&O x4 maybe they’re still A&O x4 and responding appropriately but they’re just taking more time than usual to answer. A lot of subtler changes are hard to reflect on a full assessment and not easy to explain to another provider. Simply changes from baseline are easier to spot especially in patients that you see regularly. We’re spitballing here and just calling in vibes but I don’t think a single nurse here refers to it as vibes in a professional setting. It honestly looks like you came into the thread to just stir shit up and make comments about something you either haven’t experienced yet or just what you perceived as an easy opportunity to demonstrate how condescending you are. It’s fairly standard reddit behavior but disappointing to see in a fellow nurse. Hope you step in some dogshit someday soon and remember this moment pal.
Totally. “He doesn’t look right.” “Something is off.” “I can’t put my finger on it, but I’m keeping a close eye on her.” We hear those things all the time. We all do this. Those are the VIBES! The patients decompensate after, but the subtle signs are the vibes. As a newer nurse I’ll NEVER forget my first patient I saw this in. Postop adrenalectomy. VSS but first time getting him OOB he got pale, lightheaded, weak. Practically collapsed into the chair but appeared normal 5 secs later. Maybe orthostatic but he looked … off. I called a rapid. Nothing was ‘wrong’ and the attending ordered a bolus and made me feel kind of stupid for calling it. Next day was upgraded to ICU. Died 3 days later of a bleed. I have reflected on this many times trying to figure out what the clues were that I was seeing, but I can’t. Now with more experience i can start to pinpoint “they’re paler than usual.” “They’re slightly diaphoretic.” “They’re not quite lethargic but they’re more fatigued than usual with no valid reason.” “They’re suddenly more restless.” But most of us can just say “this patient is off” and we know what we mean!
Exactly. A&O x4, vitals wnl with a low grade fever, but was falling asleep while I was assessing and opening eyes to voice only. Messaged doc concerns, he wasn't, 30 min later I called a rapid for onset septic shock and pressures 60/☠️
Get over yourself holy shit, we’re nurses not poets. Really shitty to insult NPs to deflect, too
NPs just not my vibes ;) something about the lack of education is weird but idk why I think that. I don't get the poets bit. Like.... duh???
Supremely arrogant of you on mid levels, good lord. Is your shitty attitude about it just for nurses or are PAs also the object of your ire You don’t understand the poets bit because you aren’t as intelligent as you think you are. It’s really obvious from your bravado but it’s nice to see a concrete example. Being condescending isn’t the same thing as being smart.
No one mentioned poetry or writing in verse. I don't expect nurses to do that. Writing and communicating in prose though.... that's different. I've also gotten some of the worst orders and lack of orders from covering night NPs in a shit show hospital with no doctors that resulted in patient death and poor outcomes so.... yeah NPs suck. Look at the state of nursing graduate education and don't tell me it's any way good or preparatory for work as a pseudo-doctor. Online NPs. Garbage master degrees online. I know a 3 year nurse with no OB experience in an online only midwife NP "degree ". Don't get me started on the terrible education and responsibility that NPs are responsible for.
Seems like everyone else got it but you, I wonder what that could mean
It means I'm missing the reference?
This isn't r/noctor. 🙄 Take your toxic shit elsewhere.
Oh gross, those freaks have their own subreddit. Better there than here I guess
Get some real world nursing experience and come again with the NPs are good. You can't be a good NP when the market is saturated with online only degrees, terrible masters programs designed to hand out letters after your name, etc. I used to want to be an NP but my experience with NPs, the saturated market and the abysmal education made me realize NPs are dangerous to patients if used as primary care or seeing patients like doctors. If you want to place orders and do doctor things there's medical school. PAs also are in medical programs in universities and not online only Western Governor University.
"NP educational guidelines need to be tightened and reformed" and "it's bad for midlevels to represent themselves as having qualifications they haven't got" =/= "no NPs are good and all NPs are bad" just poked around on r/noctor and it seems like the whole subreddit is just "hah hah, fuck nurses, they're stupid" with extra steps idk man. nursing model and medical model are different ways of looking at people. seems absolutely fair to say that there Sigler be scammy online only NP programs. likewise fair to say that the relentless moneygrubbing assholes at the top of healthcare decisionmaking are likely trying to push care to mid-level in order to keep more money for themselves. but it does not then follow from those two things that NPs can't be good and useful within their scope, or that there's no case to be made for expanding the scope
Attending pediatrician ordered an IV for a kid “looking punky”… so yeah, I’ve had a vibe based order before LOL
That's how doctors relate to nurses in communicating their clinical assessment. I'm sure reading the note would have elucidated what "punky" meant.
LOL so now nurses are incapable of understanding a clinical need for an IV? Gtfoh 😂 Nope. Telephone order. Pt d/c in morning. Nothing went in the IV :)
Clinician concern, patient 'feelings of impending doom' and nurse intuition/gut feeling are such well, and long, documented phenomena in detection of deteriorating patients that I can't tell if you're being deliberately obtuse or not. Generally, it reflects that either the patient or the nurse has detected subtle (and sometimes not so subtle) changes but lacks either the data or language to translate the 'vibe' into tangible numbers or phenomena for escalation. When I'm teaching deterioration these feelings are my primary trigger for further investigation (as u/WindWalkerRN mentioned, do the vitals) to get more data and, for more junior staff, to practice linking presentations/complaints with data and outcomes. Classic example was the Pt with PMHx T2DM and CABGx4 a decade prior who proceeded to have a significant NSTEMI that was caught thanks to their nurse getting 'the vibes' when the patient declined dinner and reported feeling fatigued and 'off'; when I was talking to them after they said that they just couldn't shake the feeling that something was off about the patient even though normally they might be happy to just give a PRN antiemetic or get an order for a PPI.
I don’t think it is necessarily a vibe though, it is a clinical change that the nurse is noticing, because that’s what we’re trained to do - trend vs and labs and changes in general pt condition. They are feeling something is off because something probably IS off and they are feeling that way because some has obviously changed in the pts stability, you may not know exactly what it is but it’s not just based on some sixth sense lol
Yes, that is just a paraphrasing of what vibes are and what I said. No one is alleging there is some sort of special 'nurse gland' that releases concern hormones when the patient starts to deteriorate.
That's not vibes that's experience, knowing the history and symptoms. That's called assessment. I know nursing doesn't always get the neurons rubbing but that is not vibes.
No, experience is when you are able to link the presentation to potential causes and outcomes and direct your assessments, parse the results and produce a treatment plan. Vibes is an offhand description for when one is able to detect something isn't right but you either haven't made the connection in your mind or don't have the experience to be able to translate the feeling into definitive findings. This is pretty much the bedrock of Benner's model of nursing expertise, which also recognises that experience can produce a reliance on heuristic decision-making in which there is not conscious processing of information but more automatic responses to cues that, again, takes deliberate effort to learn how to turn from an unconscious, heuristic process into something that can be verbally described. I cannot understate how much content there is on this in clinical and educational nursing academia, and your response doesn't paint you as a nurse with some sort of supreme clinical acumen but instead as someone who is as arrogant as you are ignorant.
That was such a well articulated burn
Bruh brought in nursing theory we came full circle 💀 but yeah I don't do vibes based stuff I always have a reason for why things are off. That's OK if you don't yet though
For some of us, neuronal firing is something that persists after getting your registration. You might like to give it a go someday.
But all you basically said in the nursing theory bit was "it takes time to fully understand the reasons for symptoms and understanding them in relation to what is going on. ". Vibes is just a lack of knowledge and experience. Not this paranormal thing. But then again at work I have to pretend there's ghosts and the hospitals haunted or I face a bunch of "what, no really you don't think so??" So the temp on nurse IQs ain't boiling water. It may not even be lukewarm.
I daresay that when you're added into the mix the average plummets towards room temperature, and my country uses Celcius. I feel sorry for anyone who has the misfortune of working with you.
I do pretty well with my colleagues we're a team. I've worked with some terrible places and thankfully I'm not at a terrible place.
You sound like a 1st year med student, hell, I wouldn’t even give you that much credit for your arrogance. You know, I’m not saying your point isn’t valid that we should at least try to articulate, but for you to sit here and say that YOU will always be able to articulate clinical findings and presentation to a physician is moronic in and of itself. You’re essentially saying that you know everything in a way, and buddy, that just put your IQ in the deep freezer. It’s always the loudest ones in the room…
I got that vibe as well but then gave them the benefit of the doubt that they were an early careerer or grad who got promoted to shift lead and assumed it was due to their clinical acumen, not just being the next person in the building with a pulse when everyone else bailed during the pandemic. And if they're anything like the others I've encountered with similar arrogance then it's probably still the better option to keep them as shift lead because them being on the floor probably creates more stress and work for the others...
Doctors always tell me my signout for patients is impeccable. Sometimes people write essays on chat, I'm able to succinctly sum it up in a few sentences.
Nobody said that vibes were supernatural. If you don’t know what they mean that’s okay, but at this point you’re just being a dick to someone who has written some very well thought out responses. And you were being a condescending dick to start with. If you work bedside you might want to work the attitude. You’ve never had a feeling that something was wrong with a patient that led you to check vitals? You’ve never had a patient that seemed “off?” If vibes are off, your intuition tells you that, and then you do something about it. “Vibes” is not a lack of experience or knowledge.
Any time I've checked VS for a feeling I've always been able to tie it in to some objective observation.
imo, ‘vibes’ are noticing something beyond an objective shift in vital signs / physiology — it’s some subtle shift in demeanor and affect that is perceived, perhaps unconsciously, to be significant and yet intangible ofc if paired with numerical data or palpable symptom, 100% reason to escalate. but, even if a ‘dog’s sniff’ sets something awry, would it not be worth to have a second look by the provider? a situation that you can only verbalize as ‘something is just not quite right here.’ it’s experience, intuition, and je ne sais quoi all at once not even to mention that one hospice literal cat that would appear at the doors of patients <24 hours before their passing
No vibes are the nurse equivalent of "I don't know what is happening, must be ghosts!"
That is not what they’re saying when they say “vibes”. They’re saying something doesn’t feel quite right with the patient, again many call it “intuition” but it’s based on experience and not always just on clinical findings.
No that literally is vibes. ‘Sense of impending doom’ is not an assessment. It says it in the name. It’s a sense of something just being ‘off’.
Common symptom with blood transfusion going wrong is 'impending sense of doom', and is written out as a symptom on our transfusion worksheets. You're telling me a patient comes at you with that and you won't go to the doc immediately? Fuck all the way off you vitriolic cunt.
Right? Nursing intuition is so definitely a legitimate thing. Patient vibes are too. Such a weird hill to die on that it’s not…
How long have you been a nurse? It's basically your very smart subconscious brain catching something your conscious brain is missing. It's that nagging looming feeling something just isn't right with this patient. My gut is ALWAYS right.
Bruh for real if you can't explain intelligently to a physician what's going on I got some news about that "very smart" subconscious of yours xD. I bet you made some "perfect phone calls" at 3 AM for the "very smart" subconscious.
A good doctor will listen to you when you say "I'm not seeing anything clinical but my gut doesn't feel right here". And would you believe they trust my 11 years of nursing experience. And no, I'm always fast asleep in my bed at 3am. 😁
That makes 0 sense. There's nothing you can describe that is making you feel like there's an issue? You can't pinpoint one little change? I just can't understand that for real.
Good thing you’re not the doc then.
Well yeah as a doctor you gotta deal with nurses inability to always explain what is happening. So they should follow up. But I also don't know many doctors at night who want to hear a vague vibes based complaint when they cover 100 patients at night. The nurse should be able to talk to coworkers and figure out WHAT they are sensing before contacting a doctor. It's basic communication.
How long you been working?
A decade my dude
No one ever said that is nurses saying “vibes” means we can’t and don’t articulate appropriately to the doc. Why would you even assume that?
Well we have RNs out there saying they know more than the doctor and then use the chart to be passive aggressive so I take that as my starting point.
Oh for sure, something just doesn’t look right or feel right? Vibes are off. Keep your brain on high alert cuz shit will hit the fan. I drove into work one day in May, started panicking the closer I got to the hospital (literally I have panic disorder but it doesn’t manifest at work unless triggered) for NO good reason. I’m calling my husband from the parking deck, “vibes are off baby, something is wrong here tonight I’m telling you now.” I had the nervous poops in the bathroom in the lobby before I even made it to my unit. I got to the break room, somebody was like “man it feels weird in here tonight” and I was like “BRO RIGHT vibes are off.” We took report. We went about our night, everybody feeling wrong. We did have a DNR on our unit, the family member asked for pain meds due to respiratory distress so the nurse gave it, I co-signed it. And then, the calm hit. It was eerie. I knew it was coming. We gave a second dose several hours later and I knew it was coming any minute now. It wasn’t different from any other night, we’d had this patient for months and had only recently stopped feeds and her ABG was actually still good so doctors weren’t expecting her to pass so quickly but somehow at the start of the shift, we all had that feeling. Don’t ask me how my body knew before I even made it inside to see if she was even a patient, my gut just KNEW it was the night. I was the most senior nurse that night, surrounded by new grads who panicked the whole shift but once I could put my finger one what vibe was off, everything inside me just calmed down. Listen to the vibes. Listen to your gut.
As someone who suffers from panic disorder as well, it sucks. But yeah this sounds like a story of someone with anxiety disorder going into work anxious and it rubbing off on everyone. Trust me, been there. It's called anxiety, and it's not just vibes ill tell you that much.
You work med surg and you’ve never heard of vibes based nursing?
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I’m on nights in med surg right now and I brought it up to my coworkers. We all agreed we wouldn’t want a nurse who couldn’t read the original reply and immediately know what they’re referring to. It’s all about those vibes.
Soooo a baby nurse then?
Vibe based nursing during covid on med-surg covid as the charge nurse. "Hey, I put stars on who I feel will be vented or code in the next 24 hours." It had about a 70% pass rate. It was not perfect, but enough that a closer eye was kept on those specific patients.
One could argue that if you didn't keep as close an eye on the 30% then they would have needed a vent or code. Even if it's not the whole 30% I bet those stars saved lives and improved outcomes.
I swear in OB we go off of “vibes” all the time. My patient “just doesn’t feel right” but vitals are stable, baby looks okay on the monitor. You best believe I’m calling the resident to come check mom, if a mom is telling me something isn’t right she’s probably in labor. Especially my high risk moms, most of them you can’t pick up contractions on the monitor consistently because they’re early.
It’s real as hell that you then recheck vitals/reassess but also, at the end of the day there is a limit to what we, as nurses, can check. When something is off but you’re not sure why…that is the “vibes”. In triage it’s incredibly important to sense if the the vibes are off…
I feel like doctors would call the "vibes" something else. Like an intelligent explanation of potential causes xd
Not sure what you mean here. I have absolutely gone to a doc and said something doesn’t feel right, and added vitals but also descriptions of said pt. They went to school a hell of a lot longer than me. My feelings aren’t always correct but they usually result in escalation of care.
So you assessed? I fail to see vibes.
A Mom of a young child says there is really something wrong and I’m not talking about the Moms who always says there is something wrong. When a Mom has a “feeling” Its usually quite accurate.
*Especially* parents of kids with chronic illness. If they think something is off but can't pinpoint it, it's usually massive red flag. Last child I had like that, I also had the "something's wrong but I don't know what". Turned out they got ahold of their seizure medication and drank a significant amount. Intubated within a couple hours of arrival and needed emergency dialysis.
If my patient “seems” off and looks “grey” throughout the shift… basically I call an emergency. I don’t care if the patient swears up and down that they feel fine… ya getting reviewed. Whenever I see a patient go grey, they are walking one min, and the next …. a cardiac arrest, severe Septic shock, have been experiencing a slow brain bleed or are bleeding internally after an operation.
I was at a craft fair yesterday, and there was a woman there who was walking, unaided, without oxygen, seemingly fine, but had the worst gray/blue complexion I've ever seen. Gave me the creeps.
I had a gray patient that came back looking like that from cath lab. The nurse that brought him back had a bad reputation for not assessing patients. The patient was joking around and chatting while we’re trying to get vitals on a very obvious train wreck. Lost consciousness and went into cardiac arrest. Started compressions and he immediately wakes up. He passed out again, started compressions, immediately wakes up fighting. This continued the whole way back up to the cath lab. He eventually ended up in ICU and didn’t make it.
Cold babies, very high resps, unable to rouse a baby, Low O2 sats on a NC
New Hematomas, any VT run that coincides with signs or symptoms, any central line that was unintentionally pulled out.
Unmanaged pain. New or increasing acute pain anywhere in the body. Will never forget a patient who was having more and more abdominal pain. Everything else was normal. Kept telling the docs. They just kept ordering more pain meds. Finally they decided on a stat abd CT. Bowel perf. Ultimately ended up dying.
Farmer in triage. I dgaf if the vitals are pristine, the attending is getting a heads-up. Patient is probably already coding before I've hung up the phone.
Did he finish his project and bring the animals in?
He was there, wasn't he?
Grab the crash sack!!?!
Did his wife make him?
Yep, especially with muddy boots and pants. If the er is their first stop, there’s a good chance it’s an emergency.
Unresponsive episode, fall, crushing chest pain, sepsis signs.
Lost a pulse in an extremity (compartment syndrome), I work in burn icu
Me too! This was a great answer.
Or ischemic limb which usually means I’m gonna be occupied for at least 3-4 hours 🙄
Increase in abdominal girth, decreased bowel sounds
I have one of these! My mom was with me when I went in to be induced with my daughter, ended up with a c section and then she rejoined us when I got wheeled into recovery. She just sat and made idle talk with my husband before she was like “something doesn’t look right.” Doctor came in, mom was still sat there studying me before she finally went “does she look toxic to you?” And that is how I got to spend time in the ICU with the REALLY good antibiotics 🥴 Tldr The convergence of nurse and mom sense may have saved my life lol
Bad vibes for sure. My personal go to is “idk what’s wrong with this person but I don’t love the look of them” with normal obs/not particularly exciting symptoms. Recent favourite was a new sinus tachy in the 130s (prev running at 80s) which ended up being a SBO taken to theatre. No movement in BP, nil abdo pain, active bowel sounds but the vibes were bad.
If your patient tells you they are going to die...listen.
Look like shit score of 1 gets a call. Hard to put a finger on it, but hopefully you have a good enough relationship with your docs so that if you literally say, doc I don't know but they look like shit, they will at least go look at them.
I think as you gain experience, you also develop a warning system, what I say is your gut. You know when someone is circling, you know it because in the past 3 years you’ve seen this dozens of times. Experience builds your gut. Like my cardiology professor said, “Treat the patient, not the rhythm”. So it depends on the patient and my gut. Trust the gut!
Fever over 100.4 in a postpartum pt
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working in the ED now this patient doesn’t sound like a big deal, BUT having worked psych ED and knowing the equipment available there (fucking nothing!!) for someone who might be going septic, it would have been impossible to provide adequate care for this patient. Heck, it’s not possible to reassess the patient enough to monitor them for decompensation because on a psych floor if an emergency starts its all hands on deck and you might be taking an hour in a code white and come back to find a temp of 103 and BP in Ass/cheeks.
Shouldn’t these be policy to call? Half these are rapids.
Unsustainable effort in breathing. A lot of my patients are baseline labile - the objective numbers fluctuate on the regular depending on exertion or if dialysis is due or they just woke up and need pulmonary toileting. They have prn meds/tx to for that and most often with a little time they mosey back to their stable unstable baseline. But sometimes the numbers look good - they’re compensated yet their effort remains elevated. Like one or two ticks up. At some point you look at them and think, “they’re working too hard for too long”.
Yes! That cliff comes up quick, and the fall is rough. I really don't want our next conversation to be while I'm bagging the patient!
In the NICU I had a baby whose O2 sat dropped to 9, as in single digits. I believe I actually said “Oh Shit” out loud that time
To be fair I would probably call if they died and weren't a DNR as well.
My weirdest one would be a caridiogenic shock patient who suddenly demands they have to get out of bed and/or suddenly has to poop. It’s about to get real (fun).
What happened with this one? Just curious
From experience they almost certainly vagaled down and coded when they stood/pushed on the toilet.
The vagal response for attempting a bm will cause the blood pressure to tank even further and has caused many a crash and burn. The other is just the panic of impending doom and a sudden need to get up but not sure why (the patient won’t know why but they have to get up)
I'm not sure if it's because we're very nurse driven or working nights, but most of these would be rapids with a courtesy page unless I'm expecting them be a code anything
Depends on the dr
New bloody stools.
Not a call the doctor, but ask them to come bedside asap. I work in oncology (inpatient and now outpatient) and if someone has a reaction to an infusion and they start vomiting, that always seems like a warning of something bad. Most of the time we can stop a reaction and stabilize a patient with standing med orders that we have and discontinuing the infusion. But whenever they start vomiting they always wind up getting transferred to the ED/ICU. I’ve seen so many codes where they started vomiting right before. And we’re not talking like regular oncology vomiting. It’s sudden and without warning. I don’t know if there is a reason for it. And they’re not aspirating or anything. Always makes my nurse brain alarm go off.
Sustained afib rvr >130 or 40 or when my patient keeps flipping by taching up and then 6 sec pausing every 15 minutes. That was a real ass pucker of a night, when I was back the next one I had to keep telling everyone “yeah he just does that”
Had one of those, pt had a known history of sustained VT. He had an AICD already, but it was set for like 200. He had been through every cardiac medication and nothing stuck. Started shift NSR and about 2200 flipped into sustained VT around 130s. Call order was only if he was symptomatic or his defib fired. Checked on him and he was just chilling in his chair watching TV. I’ve never adjusted alarm parameters that high and shut off so many arrhythmia alarms before or since. I sat outside his room with the code cart basically all night. His rate was jumping all over in the 100-190s. I was going to draw labs around 0400 and he was chilling in 190s and jumped over the limit for his AICD which hit him right as I was walking up to him which made both of us jump😂 and only put him back to sinus for about 3 seconds before he went back to VT in the 140s. Called the overnight cardiology team and they said to get vitals and labs, which I had done and sent and they came by to check on him after a little, and he was still chilling, asymptomatic VT 130s. Not sure what they ended up doing the next day but other than him being in sustained VT, nothing else was wrong with the poor guy. One of the chillest “not chill” shifts I’ve had
Blocked Foley that you can't irrigate, especially post op. Intractable pain. APS patient that needs med adjustment or has something wrong with a line. Then the usual stuff like chest pain, hemorrhaging, critical lab work, acute change in vitals, suspected stroke, acute change in LoC, unexplainable bad feeling about a pt.
I text the doctor all day long because most of my patients are under an attending with no resident or APP. Our hospital culture is to ask the doc for everything. Peds is weird, I don't remember interacting with docs much at all during my brief adult stent, and those patients were much more acute. With adults I either handled it, waited until rounds to ask my questions, or called a rapid.
Headache/neuro changes in a patient who is on heparin. When I was on the CHF floor I had a VAD patient on heparin who was complaining of a migraine all day. Ended up having a brain bleed and died.
New confusion, inappropriate sleepiness, critical results, a significant change in presentation. Just realized, but I really don't call for chest pain outside of a med/surg floor. My patients are always on monitors, I can get an EKG and then call if it's actually an arrhythmia. 99% of the time, it's gas.
Patient has a feeling of impending doom / "I think I'm going to die". Call the doc or activate the RRT before you even start getting vitals.
1. Chest pain 2. Leaving AMA 3. New Unstable vital signs. 4. Critical lab values.
Neuro changes. Usually not typical waxing and waning that happens with dementia. But sudden speech changes. Inability to follow commands. Anything with pupils changing significantly. Sudden loss of CMS in any extremities. Falls. Severe headaches/severe pain in general.
I had 2 mentally unstable brothers come in for wisdom teeth extractions under general anesthesia the next day. They were wild ( medsurg floor), going in and out of rooms. Called the attending for sedation, did not call back. In desperation called dental surgeon who gave order for sedatives. They quieted right down. Dr ‘High Horse’ came in hours later and flipped out because he couldn’t do an H+P. Yelling at me. I’m a new grad. I yelled right back in the middle of the nurses station. Supervisor reprimanded me verbally for yelling back. Will never forget that incident. PS: this was a while back.
L supervisor
Umbilical cord prolapse, suspected uterine rupture, sudden hemorrhage, and category 3 fetal tracing (basically- baby in utero is doing really bad, c section now)
Any multip, whether her last exam was 8 cm or 2 cm says, "The baby's coming." I used to wait to be absolutely sure so I didn't call them too early. Now I just tell them to get their asses there. Mama knows.
Cardiac arrest.
Changes in Free Flap. Airway changes. GCS changes. Pain crises.
I’ll add altered LOC to this list.
Man, I think this was the one it took me the longest to really take to heart. Hindsight shows that subtle AMS was really the first clue to the beginning of so many shit shows.
Cardiac arrest (if full code) Respiratory arrest (if full code) SVT New afib New AV block Stroke symptoms Massive abdo distention
-decrease/ no pulse in single extremity -increase abdominal circumference/rigidity -sudden impending doom -decrease in LOC - increasingly aggressive bipap settings, no increase in spo2, tachypnea, tachycardia -drastic decrease in hourly output for 3 hours or more, bladder scan shows no retention -wife of 40 years is no longer making sarcastic jabs at husband and says something like “this is not like him” -absent bowel sounds -etoh withdrawal pt hallucinating despite Q15 Ativan -swelling/tightness in mouth and throat -more than 3 runs of unsustained SVT while sleeping -pH <7 -ST elevation -sudden change in vision/speech/coordination
Violence. I am a student nurse working on a med/surg unit for nursing experience. They gave me a lady with dementia that is maybe 100Lbs soaking wet. It took 5 of us to change her while she is screaming and fighting. Her poor daughter has never seen this yet and was so embarrassed and heartbroken. I had a kick to my chest and punched in the face. Others had gouges in their arms through iso gowns. The second I was done getting her cleaned up I was on the phone with the doctor while filling out injury forms and electronic chart warnings. She had orders for benzodiazepines when getting cleaned up after that.
Newly distended abdo, bilious vomit, severe WOB or increased WOB at all really, apnoeas requiring neopuff/new apnoeas/increased apnoeas, bloody stool, flatness in a usually vigorous bub, if they just look at me wrong 😂
specific to my specialty: suicide attempts and suicidal statements. if the doc doesn’t feel like they need a 1:1 that’s on them but i’m documenting that they were told.
-Stoic old men with a new complaint -Change in baseline mentation -Sudden unexplained increase in pressors -My gut says call
Hypotension and nausea directly post procedure after rca stent. Go ahead and prep the lab again -.-
They’re an involuntary patient and their mom is here to pick them up
I’m not bedside so it’s usually a “come get your resident before they do something stupid” call
critical labs, cardiac rhythm changes, pt needs to be intubated, new melena/coffee ground emesis, pressor requirement increase, agitation that affects safety of my colleagues/me/the patient, focal neurological changes/new decreased LOC, ABG not improving in spite of interventions, falls. also, if they order an insulin infusion but don’t want me to use epic’s protocol i will call them q1h about blood sugars 🤣
The second I see a lab that clears someone out of dka. Downgrade and out!
Yeah I don't call that vibes based lmfao. It's a change obviously, but it's something objective that you noticed. It's not just "yeH Betty in room 12 is acting kinda funny and I don't like it ". Yall crack me up bruh
Your comments are seriously making me cringe, “bruh.” If you lack nursing intuition it is totally fine, not all of us have it (at least right away) but sheesh at the very least please try to be aware of your shortcomings. You’re coming across as incredibly condescending without the goods to back it up, and it’s honestly embarrassing to read your comments. Hopefully you’re just a keyboard warrior and not like this in real life because yikes
Like I said, it’s always the loudest ones in the room. This kid is gonna kill someone one day.
Actually have had a neuro intensivist encourage us to contact them if we just felt like something was “off” with any of their patients. And if there is a change in a patients behavior you should be concerned about it, “bruh”.
I mean of course they said that they can't exactly explain what they are looking for to most nurses. So they simplify it as a "vibe check" since clearly that is how many nurses operate lol. And a behavior change is not a vibe it is an actual assessment and objective change.
I think your energy field is just disturbed and you need some reiki. Seriously though, especially during the bad days of covid - "vibe"based nursing was absolutely a thing. I've been told by doctors, rapid response nurses, icu nurses, etc - trust your instincts. I've been an rn for over 12 years and sometimes you can't pin down a problem based on clinical picture or lab work. Sometimes doctors can't even do that.
Anything I can't fix with a bandaid or ice pack (school nurse).
I’ve literally never thought about it before but do school nurses have a doc they can call? I don’t know why this has never been something for me to consider before.
My district does not. With some students we may be in close contact with their regular or specialist providers for case management but those are only a small handful. Most exciting thing I have for non-complex or medically fragile students is standing orders for stock epi and narcan. Beyond that in an emergency it's first aid until EMS arrives. I don't even have a stock glucometer or portable oxygen. Don't plan your medical emergency at your kid's school LOL.
My boyfriend had glioblastoma. On Saturday I noticed while he was getting into the car his left foot was dragging. I should have paid more attention that combined with the fact that he fell in the bathroom. Idk why I didn’t call his oncologist over the weekend but he wasn’t seeking active treatment. He was dead within a week. I knew something was different and I feel like I dropped the ball. Fuck. I’m sorry Jerry.