“For it may safely be said, not that the habit of ready and correct observation will by itself make us useful nurses, but that without it we shall be useless with all our devotion” (Florence Nightingale, 1859/2012, p. 112)1

Dr. Tim Gieseke authored an excellent article in a past issue of WAVE – “Stop Sepsis Now,” and identified two useful resources for nursing staff to assist them in the timely assessment of sepsis. While sepsis remains a leading cause of death and financial burden throughout the healthcare system, its early identification is especially challenging to accomplish in the nursing home setting. Regardless of the inexperience of staff or inadequate staffing levels, there is a more fundamental skill deficit that warrants our attention. 

Much of nursing involves the performance of repetitive skills (sometimes disparagingly referred to as tasks) that may become boring and insufficiently valued. Routinely noticing a person’s cognition, consumption of food, and their patterns of elimination may not be interesting to notice over time. However, if nursing staff value being astute observers of a resident, performing basic nursing skills may become very interesting.

The importance of careful observation that precedes any documentation of signs or symptoms of sepsis is illustrated in the following scenario that was shared with me. A resident was identified on admission as being at high risk for sepsis. The charting system used had a sepsis monitor embedded in the treatment sheet that included the indicators referred to in Dr. Gieseke’s article. What the nursing team, collectively, failed to observe, communicate within the team, document, and report to the physician was that the resident was not producing urine for more than ten hours. The resident went to a hospital, was identified as being septic, and died shortly thereafter.

This unfortunate scenario illustrates why it is important for nursing staff to remain observant of a resident who is identified as being at risk of sepsis. “Sepsis is life-threatening organ dysfunction and dysregulated host response (that) differentiates sepsis from other infections” (Sand & Kuqi, 2023, p.3).2  It may be that the sepsis manifests itself in ways that are not expected. In a practice setting where there are too few professional nurses (i.e., registered nurses) and qualified staff development educators, one thing every healthcare provider can do is to complement nursing staff members who remain observant while performing the most ordinary nursing skills. A resident who is septic might be identified sooner because of it, and their life may be saved. 

1. Nightingale, Florence (1859/2012). Notes on Nursing: What it is and what it is not. (p.112). Snowball Publishing.

2. Sand J & Kuqi A.  Current challenges in sepsis documentation and coding: A review of the literature. Perspectives in Health Information Management, 2023 September 1; 20(3):1g. PMCID: PMC10701636.