Err on the Side of Caution

I mentioned in a previous post about as RNs, we should exercise critical, independent thinking skills and use protocols as a guidance in helping us do that. The following is an example of how one of our nurse's did just that.
The nurse received the call on a weekend morning from a worried mother regarding her 14 year old son who had been experiencing right sided lower abdominal pain for 24 hours. The only other symptom the child had was abdominal pain on urination. The mom called because the pain appeared to be getting worse, and the child did not sleep well the night before. He had been drinking fluids well, but a had a decreased appetite. He had no other symptoms classic of appendicitis. There was no fever, no vomiting, no pain on palpation, nothing.
One might interpret the symptoms as possible a kidney or bladder stone or maybe even a UTI since there was pain on urination. However, the nurse used the protocol as a guide, and erring on the side of caution, sent the child to the ED for evaluation as the protocol recommended. The child was subsequently diagnosed with acute appendicitis and had an appendectomy later that afternoon.
Often, I find nurses wanting to read too much into the problem and try to second guess or diagnose what they think the problem is. That is not within our scope of practice to diagnose. Our position as effective triage nurses is to recognize there is a potential problem and to determine what needs to be done to get the patient safely to the next level of care, doing so with caution and being intuitive that there could be a potentially worse situation than what we even realize.
Does this mean send all patients to the ED? Of course not. It means using good listening skills, being an excellent critical thinker, and "going with your gut". Just because all the symptoms are not present to give a disposition of ED does not mean that is the best decision to make. If your instinct is telling you that the patient needs a higher level of care, it is best to seek that option for them, and what is the worst that could happen? The patient is seen unnecessarily in the ED. That sure beats the alternative of hearing later that the they suffered undo harm because the nurse did not pick up on the subtle symptoms. Remember, all patients are individuals and do not always present with textbook signs.