Gut feelings guide clinical decisions by nurse practitioners

New study counters belief that using intuition in patient care comes with years of experience or is associated with gender

Intuition—often described as a “gut feeling”—factors prominently in clinical reasoning and decision-making by health care professionals. But new research from Case Western Reserve University concludes there is no relationship between a nurse's years of work experience or gender and his/her use of intuition. The findings are contrary to previous research showing intuition as associated with nurses’ level of clinical experience. “It has been accepted that experienced nurse practitioners can anticipate problems and outcomes better than one with less experience. Our results suggest that is not the complete picture,” said Deborah Lindell, co-author of the study and associate professor at the Frances Payne Bolton School of Nursing. “Intuition, while often unconscious, plays a heavy role in the delivery of health care. Nurse practitioners must make decisions based on incomplete clinical data; they may not have the luxury of conducting an in-depth analysis on every patient, especially in emergency situations,” Lindell added. “For instance, sometimes a patient’s vital signs and measurements will look fine, but a nurse practitioner will consult with a physician simply because something does not seem right,” said Lindell. “That’s intuition at work.” The study, published in the Journal for Nurse Practitioners, was based on a survey of 123 nurse practitioners and found:

• All advanced nurses—100 percent—reported being guided by intuition independent of their cumulative clinical work experience.

• Nurses experienced intuition through four dimensions: physical sensations, emotional awareness, reassuring feelings or bad feelings and spiritual connections.

• Physical sensations occurred when they sensed something was wrong with a patient, and experienced physical sensations such as nausea, a lump in the throat and hair on the neck and arms standing up.

• Reassuring feelings was the dimension experienced most often, with nurse practitioners describing a calm and peaceful feeling when they know the patient is going to be OK or became stable.

• Spiritual factors were experienced second-most often, such as sensing an energy field around the patient and having a spiritual and or deep connection with a patient and/or family.

• There was no difference by gender in the use of intuition.

“It makes sense that intuition would be used by nurse practitioners,” said Lindell. “In clinical settings, decisions often need to be made quickly using the data at hand.” The study highlights an issue that is receiving more attention among health care professionals: learning to recognize when they’re using intuition and when to use intuition versus analytical reasoning. Deborah Lindell, associate professor at the Frances Payne Bolton School of Nursing “Sometimes, how a situation appears on the surface is not its reality,” she said. “One of our challenges as health professionals is to recognize when using intuition is ineffective or when we need to deliberately move from an intuition mode to an analytic mode.” This research is among the first quantitative studies to describe the use of intuition—and the elements that influence it—by nurse practitioners, a profession based on a four-year baccalaureate foundation as a nurse. The study was conducted and co-authored by Annemarie Rosciano, assistant professor of the adult-gerontological nurse practitioner program at Stonybrook University School of Nursing. “Intuitive feelings help nurse practitioners make patient care decisions that resulted in positive patient outcomes,” said Rosciano, who conducted the study as part of her Doctorate in Nursing Practice degree at Case Western Reserve. This article was originally published Feb. 10, 2017.