I am an advanced practice nurse educator and I work with nurses in the Pediatric Intensive Care unit.  I can never stress enough how their assessment skills are paramount.

Just this weekend a child was admitted with a brain tumor.  Surgery was scheduled for Monday as the surgeons are very busy and there did not appear to be a reason to go to the OR emergently. 

However, the child's behavior changed quickly and the nurse alerted the physician immediately.  The child then quickly decompensated and needed to be intubated and have other emergency treatment at the bedside while waiting for the surgeon to rush in.  The staff was amazingly professional and did everything correctly, calmly, and supporting the family. 

The child had surgery, the whole tumor was removed and now the child is eating and walking around.  The lack of a quick recognition of an aberrant neurological assessment would surely have produced a different outcome.  The bedside nurse is a hero and I am proud to have taught her what she needed to know just the day before.