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Nursing intuition: What they don’t teach you in nursing school

November 20, 2012

It doesn’t just happen once either, it happens every time something bad is going to happen.  I know I’m not taking crazy pills. I’m sure every nurse has gotten this feeling AT LEAST five times in their career. So what is it?  That unsettling feeling when something is missing, off or strange about your patient. It can’t be quantified or measured with labs, it’s a feeling.

Nursing students

I have 3 specific examples of nursing intuition:

1. I was in charge of flow in the ED when a patient was rolled into one of our trauma rooms from triage. I was alarmed because normally the communication between the flow and triage nurse is open, but I had no idea a patient needed one of these rooms.  When I asked the triage nurse what had happened she said that he was complaining of chest pain, looked bad and NEEDED to go the trauma rooms because “he looked like he was having a heart attack.” Sure enough, within 5 minutes of being roomed, an ekg was done on the patient and was positive for a STEMI (st elevated myocardial infarction, or heart attack for short.) She had been a nurse for at least 20 years and seemed to be able to distinguish a patient in distress.  I was a bit bewildered because she hadn’t even done the triage or taken vitals.

2. I was floating (helping out without a designated patient assignment) in a section and was helping to take care of a patient with a hemoglobin of 7.1. The patient was polite, charming and had a pleasant demeanor since arriving to the room in the ED.  I had a strange sense of doom and discomfort from about half hour of meeting the patient.  Approximately 2 hours later, the patient ended up coding and dying.

3. A coworker told me about the time she was taking care of a young man that came in for shortness of breath.  The patient had a history of asthma and appeared to be having an asthma attack.  Multiple breathing treatments and steroids were given to the patient and his symptoms resolved.  The RN still felt uneasy about sending the patient home even though he no longer had any symptoms.  She informed the doctor and they came up with the idea to do an echo on the patient.  Turns out he had an ejection fraction of 35%  Yikes!!!! Normal is over 50%.  They referred him to cardiology and hopefully figured out a way to save his life before he had an MI.

Thanks for reading! Have a great day!

Questions for you:  Has this ever happened to you or your coworkers?  Ever experienced that uneasy feeling that something is wrong with your patient even though it may not have been warranted?

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3 Comments leave one →
  1. Food Stories permalink
    November 20, 2012 11:05 am

    This has definitely happened in my career and it can’t be taught … Great post 🙂

  2. Tricia permalink
    November 20, 2012 12:31 pm

    Intuition has happened many times during my 19+ year nursing career and thankfully for the advantage of my patients. Even at times I had to disagree with more experienced outspoken nurses. Like the above comment posted it can’t be taught, but in its absence there is the habit of self-reflection.

    • December 8, 2012 2:19 pm

      It’s pretty interesting how it just happens! It happened to me again the other day when I had a really really sick patient and no one to help me…..I ruffled everyone’s feathers to get them in to stabilize the pt before they coded.

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