Ms. Joseph had a patient who had a right carotid endarterectomy who came out of surgery awake, alert and oriented. At night, when she took care of him, she noticed neurologic changes. The patient got confused and had unequal pupils. She told the SICU resident, but he attributed the change in the patient's status to delirium. The PA and the vascular resident who she talked to afterwards agreed with the resident.
Even so, Ms. Joseph activated the stroke team anyway. The stroke team came and did a CT scan where they found out that the patient had a "head bleed". The neurologist was able to provide prompt treatment that alleviated the patient's deterioration. In fact, he got better and was discharged from the unit.
It takes a lot of guts to follow your instincts and go against a physician's decision. Ms. Joseph clearly spoke out and was committed to her job and to the patient. She truly advocated for the patient. She provided excellent patient care which every nurse should know about.