Early Warning Signs, Clinical Judgement, and Escalation in Nursing Practice

Series: Insights from Practice
Theme: Early Warning Signs & Escalation
Published by: A Nurse Like Me

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By Priscilla Oware-Amoateng
Registered Nurse | Nurse Advocate | Founder, A Nurse Like Me

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Recognising Early Warning Signs Beyond the Numbers

I triaged a patient brought in by ambulance. According to the paramedics, her observations were normal, and her other parameters were reassuring. She was taken into the Resuscitation unit, but after triage she scored yellow.

On paper, she did not appear to belong there.

However, something about her medical history and the way she looked did not sit right with me. Despite her triage score, I was not comfortable sending her out of the resuscitation unit.

After the paramedics had left, I returned to repeat her observations. She was suddenly breathless. Her oxygen saturations dropped with every attempt to speak or move. This was not the same patient I had triaged moments earlier.

She required immediate nursing care and intervention.

Had I relied on numbers alone, she would have been placed in an area that could not meet her needs.

This experience reinforced an important lesson: I have too much experience, practice, and clinical knowledge to doubt my instincts.

As nurses, we must remember that observations and scores are part of the patient’s story, but they are not the whole story. Early warning signs are often subtle and may not immediately register on charts or scoring systems.

Clinical judgement, built through practice and patient contact, is not guesswork. It is a critical component of safe care.

Early warning signs are not always loud. Sometimes, they present as a feeling you cannot ignore.

When that feeling comes, it deserves action.

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Key Learning from This Nursing Practice Reflection

• Vital signs and scores inform care, but do not replace clinical judgement
• Early warning signs of deterioration can be subtle and rapidly evolving
• Nursing instinct, developed through experience, should be trusted and escalated

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