From the beginning, nursing school teaches us to rely on protocols — to follow the rules, stay within the lines, and provide care “by the book.” But no one prepares you for the moment when textbooks aren’t enough.
A patient’s medical crisis altered my view of nursing forever and shifted my perspective from a strictly book-based approach to knowing when to rely on my gut instincts.
Years ago, I was working at a long-term care facility when I was introduced to an older female patient with a medical history of congestive heart failure, uncontrolled Type 1 diabetes, neuropathy, chronic body pain, and a few other diagnoses. While she was relegated to a wheelchair, she was as feisty as they come.
The nursing books teach us that when communicating with a patient, a nurse should display empathy and compassion and speak in a soft, clear, slow tone to avoid offending the patient and to build trust.
Try telling that to this patient. Her “coping skills” were to berate, harass, and use colorful language whenever I provided care. To top it off, she responded best when I mirrored her energy — direct, bold, and a little unfiltered.
Our banter became our preferred form of communication. It seemed to give her a sense of normalcy while deemphasizing the medical conditions she refused to let define her.
The patient’s only significant health challenge while at the facility was her blood sugars, which were often well into the 400s most days and dropped into the 90s late at night. Based on this presentation, the books advised continuous monitoring for changes in her condition.
One day, I started my shift by checking on my feisty patient. When I walked into her room, I saw her sitting in the wheelchair, facing away from the door. I expected a snide remark about my hair, scrubs, nursing skills — whatever she felt like sparring about that day. But as I began my side of the banter, she turned to me with a look of despair in her eyes and didn’t say a word — a huge red flag.
Something was off. I thought she might be agitated or having a bad day. I handed her the afternoon pills she was prescribed. After asking her several times to take the medication cup, I eventually placed it in her hands and asked her to put the pills in her mouth.
When she slowly attempted to put the pills in her mouth and missed, I knew for sure that something was wrong. This wasn’t agitation — it was something deeper, something critical.
I was in the middle of my first medical crisis as a nurse. I attempted to go by the book and use my critical thinking skills to consider all the possibilities.
Could this be a stroke? What do I do? Do I call a code? Run for help? What if it's not a stroke? Why can’t I remember what the textbooks say?
But my instincts demanded that I stop, take a breath, and focus. What diagnosis could explain this? Diabetes? I thought it was unlikely, but my gut urged me to rule it out.
On autopilot, I began to assess her. She was conscious and able to follow simple commands. I grabbed orange juice and Glucopaste from the fridge and began treatment. Once I confirmed she could swallow, I continued for 10 minutes until she returned to baseline — as sarcastic as ever.
I figured out that the patient had been skipping lunch despite receiving her scheduled insulin. Given her condition, missing even one meal was enough to crash her blood sugar. I included my findings in my report and asked the next shift to monitor her intake and notify the doctor if she skipped a meal.
The next day, I started my shift by checking on her and was horrified to see the same symptoms. “You have got to be kidding me,” I muttered. I followed the same protocol and stabilized her, then called the doctor directly, who was unaware that she had been skipping meals. He updated her sliding scale orders.
After the second episode, her blood sugar remained stable.
A few weeks later, I took a new job but stayed on at this facility as a pool nurse. Later, I learned she had been moved to a specialized care wing. I visited her one day after work. We talked and she hugged me goodbye. That was the last time I saw her.
In nursing, you always remember your first crisis situation. Over the years, I’ve thought about her often and wondered what happened to her. I learned so much that day.
I once believed that avoiding errors by following established procedures to the letter was the most important part of nursing care. I hadn’t realized that the connection between a nurse and a patient is just as important, if not more so.
My feisty patient gave me more than just confidence in handling future crises — it reshaped how I saw my role as a nurse.
The connection I built with her became the foundation for how I approached every patient afterward. It was a turning point that showed me great care isn’t just about following the book. It’s about seeing, hearing, and truly understanding the human in front of you, no matter the colorful language they choose to use.
