Real Life Isn’t Always a Case Study
When I was in nursing school, I spent a lot of time studying symptoms and patterns. Chest pain meant you need to rule out a heart attack. A high blood sugar reading meant you talked about diabetes. A sore throat means you swab for strep or covid. These frameworks make sense on paper. But once I started working in an outpatient internal medicine clinic, I realized quickly that real life doesn’t always follow the textbook.
Patients walk in with stories that don’t line up perfectly. Someone comes in with fatigue, lightheadedness, and some chest tightness—but their vitals are stable and their EKG is normal. Another patient says they feel “weird” but can’t quite explain it. Many textbooks say, “Pay close attention when a patient says something just feels wrong,” but experience teaches you how to take that seriously. These gray areas can be tricky, but they’re also where nursing judgment becomes really important.
Listening Differently
In the clinic, I’ve learned that one of my most important tools isn’t a vitals cart or a syringe—it’s listening. Really listening. That includes what patients say out loud, what they hint at, and sometimes even what they avoid mentioning. When symptoms are vague or hard to define, being able to pick up on tone, mood, or body language matters.
I had a patient recently who came in for a routine follow-up. Nothing urgent on the surface—just a blood pressure recheck. But while I was going through the usual questions, I noticed she was unusually quiet and she didn’t seem like herself. So I gently asked, “How have things been feeling for you lately?” That’s when the real story came out: she was stressed, not sleeping, and hadn’t been taking her medications consistently because she just didn’t have the energy. That wasn’t her chief complaint, but it changed how we approached her care.
Teamwork in Uncertainty
One of the things I appreciate most about working in primary care is how collaborative it is. When symptoms don’t match a classic picture, we rely on each other—nurses, medical assistants, and providers alike—to piece things together. I’ll often bring my observations to the provider before they see the patient. “They denied shortness of breath but their oxygen sat was on the low end.” Those details can change the whole direction of the visit.
I’m very lucky that the providers I work with value that input, and they often ask follow-up questions based on what I’ve seen or heard. That kind of communication turns a visit from a checklist into a more nuanced conversation. When you often find yourself working in gray areas, that’s exactly what patients need.
Trusting My Gut
Being a new nurse, I often feel hesitant to speak up when something feels “off” but doesn’t have a clear clinical explanation. It’s taken time—and a lot of encouragement from more experienced colleagues—for me to trust that instinct. Now, if I feel uneasy about something a patient says, even if the objective signs seem fine, I always follow up.
I always take extra time to understand a patient’s concerns. I’ve seen it lead to a surprise positive Covid test, or a specialist referral. Even though it rarely leads to a dramatic discovery, I’ve found that patients appreciate when you take their concerns seriously—even the ones that are hard to name.
Embracing Uncertainty
There’s definitely discomfort in not knowing exactly what’s going on. In school, uncertainty often felt like failure. But in real-world nursing, uncertainty is part of the job. I’ve learned to live with it, to ask better questions, and to reassure patients that we’re going to keep working with them even when answers aren’t immediate.
Sometimes the best thing I can say is, “Thank you for bringing this up. I’ll loop in the provider so we can figure this out together.” That helps patients feel supported, not dismissed. It also builds the kind of trust that makes them more likely to come back, to share more, and to stay engaged with their care.
The Human Side of Primary Care
What I love most about working in outpatient medicine is that I get to see people over time. When someone comes in with something vague or unclear, it’s not a one-and-done encounter—we follow up and work to understand their needs. I get to be part of that longer story, and I get to help connect the dots in ways that don’t always happen in fast-paced or acute settings.
Patients often come to us because they don’t want to wait until it’s an emergency. They want to catch something early, to understand their health better, or just to make sense of what they’re feeling. That’s where nursing shines. We sit in that space of not-knowing, and we help make it feel less scary.
The longer I work in outpatient care, the more I realize that medicine isn’t always about clear-cut answers. It’s about patterns, relationships, observations, and a bit of intuition. The gray areas still make me nervous, but most of the time, that’s where we work. It’s my responsibility to help patients and the team navigate through them
When symptoms don’t fit the textbook, it means the patient needs someone who can look past the script. Someone who can listen, ask questions, and truly listen to the answers. I’m proud to work in a building full of those people. I know that when I don’t have the answers, I have the skills—and a great team—to help figure it out.