Natalie, an experienced L&D nurse, examines her patient and says “Something's not right, let’s get Dr. Reynoso in here and put the surgery team on alert”. Dr. Reynoso was paged and didn’t need to hear any more than that Natalie was on the case and was concerned. He came right away and within a short time determined a C-section was needed.
In another part of the hospital, a MedSurg nurse is worried about his post-op patient but can’t point to any abnormal labs or vital signs. Later in the shift the patient becomes septic. Coincidence?
Sometimes there’s no explanation for situations like these other than nursing intuition. Nursing intuition is when your patient goes to surgery and somehow you know he’s not coming back. You call from home to check on him, and, sure enough, he arrested in ICU after surgery and died.
Some people are naturally more intuitive than others. Everyone knows a married person who says they immediately knew when they first spotted their spouse that they would be married (I did!). Sometimes people who are intuitive may be highly sensitive, discerning, and feel other’s emotions. But nursing intuition is different in that it’s more of a skill born by expertise.
At any given time, nurses are called upon to make fast decisions that require great skill in complex patient situations. We have to decide whether to call an RRT, call a provider, and if we need to monitor the patient more closely. Used during uncertainty and when all the data needed is lacking, nursing intuition is a tool in the expert nurse’s toolbag.
Is nursing intuition a thing?
Not everyone would say so. Some say it’s not rational, hasn’t been proven, and is therefore unscientific. In this time of evidence-based care, how can it be OK to base nursing decisions on a feeling?
No one wants to be wrong in hindsight or make a big deal out of something that turns out to be nothing. You want to be able to say something more in the way of a rationale than “I had a feeling”. But what can be said about nursing intuition?
What is nursing intuition, and is it a valid component of nursing practice?
Intuition: What it’s not
There are no nursing intuition classes in nursing school. It’s not something you can study for nor is it information you can memorize. It’s a by-product of experience. It can’t be forced or rushed.
Experienced nurses may urge new nurses to “Just trust your gut”. But this can lead to confusion and self-doubt in a new nurse. If a new nurse is having visceral feelings, what they most likely are feeling is fear and anxiety, not a spidey sense that predicts a patient's condition.
If you have developed nursing intuition, you most likely know it.
Intuition: What it is
Intuition is a function of experience or repeated experiences, knowledge, and pattern recognition. It’s an “irrational and unconscious way of knowing” sometimes described as a bad feeling, or a gut feeling. But it’s a feeling based on experience, not a lucky guess.
Walking down the hall, Jessica glimpsed the patient’s face in room 4221. She stopped in her tracks, and rushed in the room yelling “I need help in here”. She had no vital signs, his bedside monitor showed a normal sinus rhythm, he was conscious...so what caused her to react? Later she said, “It was his face. He was just about to arrest”. She couldn’t describe it further, but something in the color of the face, maybe the slackness, a fixed gaze, or change in energy field that she sensed alarmed her. Jessica has seen many, many codes and has the ability to understand a situation immediately without the process of conscious reasoning.
Expert nurses have a nonlinear grasp of the situation. Novice nurses perform in a linear fashion, while expert nurses absorb information in a holistic manner. A novice nurse performs an assessment step-by-step, listening to breath sounds, palpating the abdomen, and so on. An experienced nurse palpates the abdomen while simultaneously noting that the skin is warm and dry, chatting and assessing the patient’s level of orientation, examining the IV site, gauging the level of anxiety and noting a lack of peripheral edema.
Nurses pick up on clues, sometimes not even consciously, and synthesize what they’re seeing. Cue clustering is making connections between and synthesizing pieces of information without conscious thought.
Intuition: How it’s used
Nurses who self-report that they have intuition say they value it. It gives them confidence to advocate for their patients, prevent codes and get the best treatment. Once they get positive feedback from their intuition they keep relying on it. They follow their intuition more often and trust themselves.
What examples do you have of using nursing intuition in your practice?
Best wishes,
Nurse Beth
Hassani, P., Abdi, A., Jalali, R., & Salari, N. (2016). Use of intuition by critical care nurses: a phenomenological study. Advances in medical education and practice, 7, 65–71.
amoLucia
7,736 Posts
^^^^ Oooooh! You struck an old memory for me. Had a 4 bed pt unit and 2 of the bed positions should NOT have been like they were by the windows. I remember walking in to do first rounds and that lady in B bed was next to the window. In report, she just SOUNDED unstable and most needing to be watched.
As I walked into the room, I just stopped and immed decided to rearrange the room. There was just NO room to bring anything in to that B bed space. Well, staff wasn't happy with me, but within 1 hour, DANG! if that lady didn't code!
Crash cart fit, full code team able to be bedside, IV poles, resp equip, too.
Staff was dumbfounded (I, too, was surprised), but I just KNEW the bed needed to be moved!
E S P - I can't prove it, but I can't disprove it either!
I believe it and know I have it.