Nurses and their sixth sense

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Nurses do indeed have a sixth sense. No, I didn’t misspell “sick” sense. I mean, we have an instinct that civilians don’t have.

The nursing “sixth sense” is that moment when your gut gets those “butterflies,” or when A plus B does not equal C.

It’s a part of that ever-important skillset of critical thinking, but it’s also a separate entity altogether. Maybe you can call it a form of ESP:

ESP is also sometimes casually referred to as a sixth sense, gut instinct or hunch, which are historical English idioms. The term implies acquisition of information by means external to the basic limiting assumptions of science, such as that organisms can only receive information from the past to the present.

So. ESP. It’s one of those skills that seasoned nurses just “have.” I’m not sure if it’s something we witness, repeat, learn, see, or simply acquire through experience. Maybe it’s just that tried and true “learn as you go” skill? Honestly, I really don’t know how it’s acquired, I just know it exists.

In fact, I’m more sure than ever after this past semester of classes. This “instinct” was referenced several times during my clinical rotation and during a couple lectures in the nurse practitioner program I’m attending.

The question was posed, “Does the patient look sick?” Ask any nurse, in any area of nursing, and they understand this statement. You just know when something is off. It’s a hard concept to describe, let alone teach.

I also had a physician explain to me that she values this skill more and more each time it is used. When a nurse gets that sense that “something is not right” from her patient, she takes it seriously. So seriously she makes that patient a priority. The physician confessed that nine out of 10 times, the nurse’s instinct saves the patient from something serious.

I think all nurses eventually possess this skill. I guess I’m just wondering how we get it, and why? This isn’t to say that this sixth sense only comes with time. The more experienced nurse will definitely have a sharper sixth sense, but even a new nurse has the ability to “know” when something is not right.

Do we learn it in nursing school? Maybe, but I’d be hard-pressed to find it in any textbook, lesson plan, skills challenge, or written exam.

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16 Responses to Nurses and their sixth sense

  1. Litlmatt

    You might start to learn this in school, but I have learned more and more in my first year on the job. I work in adult ICU and we tend to get “that funny feeling” that something just isn’t right. I believe Dr’s trust us more because of this and the fact that we call them while we’re doing everything in our power, we can do. We DO call them if it is necessary, but not for things like a stool softener at 0300! Then when we do call in the middle of the night because we’re just worried about our Pt. they tend to take us seriously.

  2. TFishRN

    I find this article a little disappointing. Professional Registered Nurses are highly trained critical thinkers with exceptional physical assessment skills. To downplay our talents as “ESP”, “instinct”, or “Sixth Sense” diminishes the truth behind what is most likely going on. An observant RN, coupled with the skills and talents I mention above will notice small deviations from the norm, perhaps a slight slur in speech, a touch more lethargy, a smidge of cyanosis around the lips all may tell a story that something is wrong. Sometimes these may all come together in a subtle manner to give the RN a “feeling” but a true professional should not stop there. A feeling should kick that critical thinking into high gear, assess the patient, what meds were just given, how does this particular disease process manifest itself, etc.
    When RNs collaborate with physicians as fellow healthcare professionals, using evidence based practice rather than hocus pocus to communicate, the profession in general will be better off. As a RN for nearly 20 years, I am very familiar with the notion of having a “feeling”, but I encourage all RNs to not stop there. Trust your feeling, but employ all your faculties before just chalking it up to your Sixth Sense and running to a MD to figure out what is really happening. Providing a report of the nuanced differences you are noticing along with any other relevant information (meds, disease progression, etc) will gain you far more respect with your fellow nurses and doctors.

    • CBells

      Good timing on this article. I’ve been thinking about this a lot lately. I recently graduated nursing school, and it seems like only once it was over I started noticing my “sixth sense” in life. I’ve been having these hunches and predictive thoughts that always seem to come true. I think it’s a combination of the critical thinking skills we learn in nursing school, but also life experience, not just nursing experience, and having an intuitive sense by nature, which I think most people who go into nursing already have. I have yet to start my first nursing job, but I am one of the ones who went back to school for nursing later in life. I can’t even imagine how much this sense will expand once I begin working and learn how to apply it to my patients. I feel incredibly lucky to have cashed in on this new and exciting ESP-like sense! I trust myself and my instincts much more these days, which will allow me to fully focus on my patient and less on worrying about myself and whether I’m noticing the right things on them.

      • Granny RN

        You are indeed fortunate to have recognized this ability so early in your career. Some people NEVER seem to ‘get it’!
        Always remember to ‘trust your feelings’. Your patients will be the better for it and your doctors will trust your assessments and your opinions/suggestions when you call them.
        Congratulations and welcome to Nursing!

    • nurse4ever

      I find it the last comment disturbing and a bit condescending…she implies that only RN’s are “critical thinkers” or “observant”. In my proud 12 year career as an LPN, I have found that ANYONE can get “the feeling”, regardless of the title. Remarks and thinking like hers are one of the reasons that LPN’s/LVN’s and CNT’s/CNA’s are frowned upon in the medical field. Unless the teaching has changed, I thought it was everyone’s responsibility to take care of a loved one?!?

      • Granny RN

        You are correct. We ARE supposed to work as a team. I have, when given the choice, decided to keep an experienced and reliable Nursing Assistant over an RN. One learns to also trust the instincts of others after many years…

  3. juliem24

    There was some research done on this in the late ’80s. It involved pattern recognition and two other variables which I cannot remember. Anyone else remember this? It was very interesting, giving objective credence to an otherwise subjective topic.

    • Granny RN

      What you refer to was known as ‘Nurses Intuition’. Numerous articles may be found online by typing those words into any search engine.
      One such publication from Lippincott may be found at:
      Here is the title:
      State of the Science: Intuition in Nursing, a Generation of Studying the Phenomenon

      Lynn Rew EdD, RN, AHN-BC, FAAN
      Edward M. Barrow MS

      Advances in Nursing Science
      January/March 2007
      Volume 30 Number 1
      Pages E15 – E25

      And yes, I HAVE been around that long…

  4. jas

    I’ve found most doctors trust RNs “sixth sense” after they work with us for awhile. I have called a Dr. and given him all the assessment I have and things I’ve ruled out, then tell him I can’t put my finger on it but the pt has changed in some way. I don’t feel that is “running to a MD to figure out what is really happening” is degrading to us. Sometimes it takes a Dr. to order the necessary test to figure out what’s going on. As you said TFish, RNs and Drs. should work together as professional collegues and I think most of us do.

  5. Granny RN

    The human brain is the most complex and remarkable COMPUTER ever made! I have heard it said that ‘Instinct is when your brain starts acting like a computer-taking all of the stuff that has been received (like verbal/nonverbal observations, lab values, patients’ history, etc.) and begins to ‘spit out’ a response’. Most experienced nurses know and learn to trust this ‘feeling’. The response you give is also referred to as ‘critical thinking’.
    This is NOT a supernatural or ‘Mentalist’ thing. It is simple survival taken from the primitive areas of the brain to the Next Level. Remember that a Boeing 787 is STILL just an airplane and the same laws of physics apply to a Cessna single-engine 2-seater. Take away all of the fancy stuff and just FLY THE THING.
    That is what you are doing when you respond to your ‘inner instincts’. Trust the Maker!

  6. jp

    Gang, it is not that we HAVE the intuitive powers, we’re not more magical than everyone else — we’re just part of the half that LISTEN to our experience based intuition. Half of the world is good at data gathering, they prove a point to themselves & others by seeking evidence. Others intuitively know the end answers & must seek the evidence that supports what they already know. Most nurses buy into the fact that they are just strongly intutive and they ask the rest of the team to just go along with them on blind faith. This brand of nurse must learn not to be disapointed when others wouldn’t go with them — many people are just not wired that way. Seek out the evidence & then make your pitch. You get to the same end, it just takes evidence to get others all on board.

  7. Granny RN

    And THA, my fellow nurses, is how we Make A Difference.

  8. msjudie

    Years of working post surgery taught me to recognize subtle signals of complications, especially PE’s. Filling in at an LTAC, I noticed a patient with those signs and called her Cardiologist. Unbelievably, he answered his own phone on a Sunday morning. Gave all the relevant data and ended with; She just doesn’t look right.” He asked if I was the day nurse and I told him I was the night nurse. His response was; “Wait, you stayed over to call me? Get her in ICU now!” He obviously took my “feeling” seriously. Turns out she did have a PE and it was caught in time to save her.

  9. Mamamouse

    While I agree we all use our critical assessment skills there are other “skills ” we build up over time. We aren’t always aware at a conscious level of using them, but they are still a part of our skills. We perceive minute changes in consciousness, skin colour, hydration status, and odor, just not always with our conscious mind. There are whole studies of pheromone reactions with perfumes, body odors, and secretions. We aren’t aware of the wffects of pheromones on our reactions in our personal lives, so why would we recognize them in our work environment? How many times have we heard a colleague say she smells death on a room, or blood? That colleague isn’t always an RN either. Some of my most gifted CNAs could pick up on those nuanced changes, too. Those with our assessment skills make up our unique abilities.