EACH DAY, YOU TAKE CARE of patients by administering medications, performing assessments, planning interventions. Do you want to challenge yourself a bit? For each intervention, ask yourself questions: Why did you select the dose of pain medication that you did? What clues did you see that led you to know that your patient was getting into trouble? How didyou know to call the surgeon instead of the anesthesiologist? Where is the patient going after discharge from the PACUwhy there? So often, we get into routines. We follow rules. We follow procedures. We admit our patients, get reports, take vital signs, and follow written orders untilourpatientsreachourrequireddischargecriteria. At that point, we move our patient to either an ICU, postopunit,phase-tworecovery,orhome.Routines are good. Routines ensure continuity of care. Routinesensuresafetyaswefallintocomfortablebehaviors required in the care of postoperative patients. BUT.routines can also cause us to stop looking, to stop asking questions, to miss critical clues. Take, for example, the patient who is tachycardic postoperatively with a heart rate of 118 bpm. The textbooks say that a ‘‘normal heart rate’’ will be 60-100 beats/minute. The new nurse will know something is wrong. The more experienced nurse will know to look for the cause before deciding on an intervention. Experienced nurses know well that tachycardia may be a sign of pain. But tachycardia canalsobea signofhypoxemia.Our responses as experienced nurses will be very different if the cause is pain as opposed to hypoxemia. If we make the wrong choice and select an intravenous opioid as our treatment, and the cause is hypoxemia, our choice could have devastating consequences. Tachycardia may also be the result of shivering, vomiting, or hypovolemia. Each is treated very differently from hypoxemia and pain. So, back to the question.how do you know? To know is defined as ‘‘to perceive, or understand as fact or truth; to have established or fix in the mind or memory, to be aware of, to be acquainted with something by sight, experience or report and to understand from experience.’’ 1 With experience, you come ‘‘to know’’ the cause of the patient’s elevated heart rate and exactly what intervention is required.