By Anita Amoah, RN

Insights from Practice | January Theme: Early Warning Signs & Escalation

Some of the most important early warning signs in healthcare don’t appear on monitors, charts, or investigation results. They come from the patient.

Listening to patient concerns is a core part of safe, professional nursing practice. Yet, in busy clinical environments, those concerns can be unintentionally minimised when clinical indicators appear “normal.”

This reflection, shared as part of Insights from Practice, highlights why patient-reported experiences must be treated as clinical information, not background noise.

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The Practice Insight

In a dialysis setting, a patient with known vascular access issues repeatedly raised concerns about their graft. The patient felt strongly that something was wrong and requested that a new access be placed.

Clinical assessment suggested that the graft was functioning. The patient was discharged with documentation stating that the access could be used for dialysis.

It wasn’t.

When cannulation was attempted, the graft had already failed and caused severe, ongoing nerve pain. What the patient had been trying to communicate earlier became evident only after repeated difficulty and avoidable distress.

This situation reinforces a critical lesson: clinical assessment and patient experience must be interpreted together.

Patients living with long-term conditions such as kidney failure often recognise subtle changes in their bodies long before failure becomes obvious to clinicians. Pain patterns, altered sensation, or discomfort during cannulation are not insignificant — they are early warning signs.

A graft may appear patent on examination, but persistent pain during cannulation is not normal and should never be ignored.

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Why This Matters for Safe Care

Early warning signs are not always dramatic. They are often quiet, subjective, and easy to dismiss especially when documentation suggests everything is “within range.”

In high-risk areas like dialysis, failing to listen closely to patient concerns can lead to:

• delayed recognition of access failure
• repeated painful procedures
• nerve injury
• loss of trust between patient and clinician

Listening does not always mean agreeing immediately.
But it does mean pausing, reassessing, and escalating concerns appropriately.

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Key Learning Points

• Patient-reported concerns are early warning signs, not obstacles
• “Working” on paper does not always mean safe in practice
• Persistent pain during cannulation requires reassessment
• Shared decision-making protects both patients and clinicians

Early warning signs don’t always show up in investigations.
Sometimes, they speak — and our responsibility is to listen.

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Reflection for Practice

What patient concerns have you learned to take more seriously through experience?

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About Insights from Practice

Insights from Practice is a monthly reflection series by A Nurse Like Me, sharing short, practice-based lessons from nurses to support safer care, professional reflection, and shared learning.

Each month focuses on a theme connected to patient safety, professionalism, and real-world practice. One reflection is published weekly.

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Would You Like to Contribute?

Submissions are open for upcoming themes.

If practice has taught you something that could help another nurse notice earlier, escalate sooner, or care more safely, your insight is welcome.

📝 150–250 words
🩺 Based on real practice experience
📅 Rolling submissions

👉 Submit your Insight here:
Click here

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