Nurses And Their Sixth Sense

This article was republished with permission from SCRUBS Magazine.

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 skill-set 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.

What do you think? Share your thoughts in the comments section below.


This article was republished with permission from SCRUBS Magazine.

37 COMMENTS

  1. A long time ago I was charge 2nd shift on a pre and post op surgical floor. It was a small hospital and we had a small former icu overflow room behind the nurses station. A really nice classy gentleman I helped get ready pre op was sent there to be recovered by a spare lpn who was badly needed on 3rd floor. He had a hip done and after 1.5 hours my supervisor was anxious to pull her to 3rd and bring him out to the floor. I asked her for more recovery time for him, just a feeling. Well finally she said he has got to go to the floor and he did. My feeling of something being wrong with him increased and I couldn’t explain it. I watched him like a hawk and tried to get the doc but it was Friday and he was on the golf course and probably a little 3sheets to the wind, and didn’t have a partner but i didn’t have anything but an incredibly strong feeling. Told the 2 night nurses who were sisters to watch him and they blew me off. I came up the elevator to work the next day and a little late like always and nobody was around I asked where is everybody and they told me they were in his room coding him. He died. ALWAYS listen to that voice inside no matter what!

  2. Unfortunately, I don’t think all nurses have the sixth sense. Thankfully, most do. It is sometimes hard to convince others if you don’t have enough hard data. Keep telling people what you sense; when they realize you are right, you get listened to more.

    Many years ago, I had a young ICU patient fresh from an aortic valve replacement. He was doing OK–bp, cardiac output adequate. I knew something was wrong. He was young with a strong heart and should have been doing great, not OK. I could not convince the unit resident because his numbers were OK, and the resident was pretty inexperienced. Luckily, a senior resident came by and knew exactly what I was talking about. A few minutes later, we were doing an open chest code for cardiac tamponade. I hope the resident learned something that day. The patient lived, and, miraculously did not get infected after we ripped his chest open on the unit.

  3. Indeed it is real! When teaching nursing students, I always encouraged them to use all of their senses when walking into a patient room..sight, sound, smell,taste, touch, and most of all what is your gut telling you?
    As a L&D nurse one taps into that sixth sense nearly every shift!

  4. I would argue that it is not a 6th sense, but rather, a little known upper echelon of human-run metadata analysis which few professions hone like nursing does. Part of it is empathic acuity, part is intrinsic (gained and developed knowledge), part is extrinsic (incoming data), and a large part is an ever-fluctuating melange of subjective and objective input/output. For many in this career, we came into it with preexisting talents or latencies suited to this type of information processing. Conscientious application and adaptation of our learned skill sets merely broadens the applicable circumstances and sharpens the accuracy of assessment… and it all happens so quickly that we can get looped up in believing that it is somehow not inextricably linked to the physical world around us. I have had friends or acquaintances who were completely weirded out by my ability to solve seemingly unsolvable problems, and/ or locate lost items based upon very sparse data. It’s not a sixth sense, it’s an ability extrapolate from seemingly incoherent sets of information. If you have disability, congratulate yourself on your extremely organized brain, and probably thank your parents a little, too.

  5. As having been a nurse for 45 years, I definitely had that 6th sense. I just knew before the doctors confirmed it, that patients had cancer. I could smell it, Like a dog. And yes, When there was something drastically wrong, but nobody else could confirm it. As I get older, sometimes, I wonder if it was a God given Ability. Whatever it was, I have felt for a very long time, that I was put here on this earth to be a nurse, and care for people.😍

  6. That sense that caused me to check my well monitored nursery baby before rounding to find a HR of over 200 (baby to NICU for cardio version. Baby had it x2…if I remember correctly.)
    The sense that made me change my rounding pattern, to find my patient and her husband sound asleep while their baby’s was spewing and choking on formula, in the bassinet between them. I snatched the baby up and ran for the nursery screaming for a code, the neonatologist came from the basement to the 2nd floor as if there were an elevator in the middle of the room. Baby ended up NICU but was ok after monitoring.
    The sense that made me stop assessing a mom and turn fully around, walk to a bassinet, next to dad, to find a baby with milk coming out of nose and mouth trying not to die. Baby was ok.
    The sense that made a nurse (not me) walk into a patient’s room (not her patient) just in time to catch her as she was passing out in the shower. Mom was ok.
    When I was a brand spanking newbie on Ortho/Neuro I prayed for my patients. One morning a patient says to me “wow…when are you going to get some sleep. You stayed here all night by my bedside.” I’d fallen asleep praying for her.

  7. What is frustrating is when all the alarm bells go off and the doctor in charge refuses to pay attention or take any action. Had one patient in that situation, doctor kept saying, “write a report and send it to me in the morning.” Fortunately, I called 911 instead and the patient spent 3 days in ICU with cardiac tamponade before coming home a week later.

  8. The neonatologists in our NICU say that they pay close attention when we report that a baby is getting sick. In my 45 years in the NICU I often just knew that my tiny charge was going to be very sick sometime in the next few shifts. I have seen this “sixth sense” in action especially in the

  9. I think we as nurses pay attention to body language. We don’t automatically accept when someone says they are fine. We also notice skin color, facial expression, any nervous mannerisms, and behavior that is not the norm for that person. I do believe it is a combination of learning and experience.

  10. One of the neonatologists was fond of saying that the nurses in the NICU could tell when a baby was getting septic two days before the labs showed the shift. After 45plus years in nursing, I definitely know that the best nurses have this instinct or sixth sense.

  11. Our “6th” sense is also called intuition. Intuition has been studied by big corporations, like GE, and the government. Intuition is the ability to process a lot of information on an unconscientious level and come up with an assessment and plan. Intuition is based on education and experience, so intuition improves in accuracy with the more we work and learn. In one study I read, ICU nurses were asked why they did something like set up emergency intervention systems a few minutes before their patient actually crashed when the patient “looked fine” when they walked into the room. Apparently the interview took up to 3 hours and the researcher ended up with 2 or 3 pages of seemingly disjointed jointed facts that when put together justified the nurses decision. I did a paper on this during my BSN just to irritate our Professional Nursing instructor. She ended up giving me an A.

  12. It isn’t ESP: it’s experience. You don’t get it from books. The more you have seen over the years, the more you have a sense that something isn’t right.

    • Not for everyone. For some of us..it’s more than that. God….the Holy Ghost intervening the patients behalf….it’s not just experience.

  13. I believe Bedside nurses, especially ICU nurses have this amazing ability because they are with the patients more than the doctors. An ICU nurse will assess her patient for sure more than 12 times and depending on the acuity of the patient we assess them very frequently. Any little change of a patient condition the nurse will notice. The Attendings take it seriously when we tell them about it. The residents have not much exposure until they will hear this from the Attendings.

  14. I’ve been retired for several years now, but the one thing that stands out for me is this: when a patient who has/had been rude, impolite, abusive etc suddenly apologizes for their behavior, look out. So many times when a patient apologizes they die within a day or so. I’m not talking about a rude comment once in a while, but the patient who’s behavior is so bad no one wants to be assigned to them.
    Two examples stand out: while a student nurse in a psych hospital, my patient would make sexual comments, pinching butts and breasts. One day he apologized to me. The next day my teacher told me to pick a new patient, that he had died the night before. Then I was caring for a teen with cancer that had relapsed multiple times. She was a full care patient, with several IV meds & lines, deliberately incontinent and always cussing you. Her family had stopped visiting, despite her prognosis. One night I took care of her, turning, cleaning, giving her meds etc. She apologized to me for her past behavior. When giving report, I mentioned that they needed to watch her, stating that she was apologizing. The younger nurses scoffed at me. A few hours later, I received a phone call from that younger nurse saying that she had died.
    Is this 6th sense or is it an acquired sense coming from experience?

  15. Looking at a medication list and current symptoms a patient is having and knowing they are not taking the medication as prescribed. Simple education can change everything.

  16. The sixth sense that tells you to check one more time even thought you’ve already checked several times. That gut instinct… something just isn’t quite right .. listen to the patient, even if they are confused, they are telling you something

  17. I have had this 6th sense very early on in my life. I would get this heavy feeling in my gut, I knew something was wrong…I would act without even knowing why consciously…each time my gut was right. I could name several instances in detail. I have learned over the years to pay very close attention to this feeling. It is very powerful. I believe the more you become aware of this feeling, this knowing, it gets stronger…you learn to notice it sooner and act on it. In my nursing career, I have saved many lives by recognizing that feeling.

  18. I understand the nursing sixth sense completely. I have had premonitions numerous times. One case in particular stands out in my early career. I remember standing next to a patient getting a flash of another patient I had previously. During sleep I woke up knowing he was going to have a pulmonary embolism and I had to get him heparin. In the morning, the patient’s resident was gone before I could talk with him. His medical doctor came in and I was now questioning whether he was a set up for a pulmonary embolism- no prophylactic heparin, no AE stockings and the patient had varicose veins. He told me to call the resident. In the mean time the tech was walking him in the hall when I caught up to the patient. He said “Sue, I don’t feel so good.” Which were the exact words my other patient said before she died. He went very pale and went into severe respiratory distress. I sat him down in the chair the tech had asked the wife to push behind him because he had gotten very tired the day before. I called the code. His medical doctor came running down the hall screaming “No!” And thumped him in the chest. The patient started breathing again and we walked him to his bed. I shared my dream with the receiving RN in CCU. Later she told me the results of the VQ scan showed multiple bilateral Pulmonary emboli but he was alive.

    After that experience, I learned to trust my nursing sixth sense. That little voice in my head that says to check the labs first, or that a patient does not look good.

    I had an LPN with 30 yrs of experience keep telling me something was not right with a young patient. VSS but we called the intern to see her anyway. She had a severe case of chicken pox. I gave her a menstrual pad because she said she had started her period before I left at 7:30 pm, VSS. I passed along to the receiving RN that something was not feeling right to me about her and to monitor her closely. 9:30PM the RN helped her to the BR. Coming back she told me she was looking at full blown DIC and the patient was transferred to the ICU. The patient died there.

    I was meditating in the chapel at our hospital when I was prompted to pray for the patients and staff in the unit I worked on. 10 mins later I was shocked out out my meditation and I stumbled to the door. Just as I put my hand on the door to push it open I heard the code called on my unit for a patient I had taken care of the day before. When I was able to speak with the charge nurse for report later I said “You defibrillated him before you called the code.” “ Yes, the resident was on the unit. How did you know?” He lived.

    One night we were very short handed. I was standing at the nurses station when I felt a tug on my shoulder. There was no one there. It was strong enough that I followed it. The last room on the corridor. The feeling stopped as I walked into the room just as a man began to hemorrhage.

    These events all happened very early in my career. I encouraged staff to talk openly when they had dreams or knowings about patients. I met other nurses at nursing conferences that had similar experiences of knowing and learning to trust their sixth sense.

  19. Malcom Gladwell has a great book on this Blink. Think without Thinking. How your subconscious is analyzing situations well before you realize it.

  20. This “sixth” sense is real!! I have used it many times as a Nurse and as a family member. That gut feeling that says something is amiss. I know, my drive to work usually entails a prayer for God to give me more knowledge that I have learned, more ability than has already been developed and the ability to understand what I see and hear from my patient’s. God has never let me down. Sometimes I leave a situation with a patient and ask myself “where did that knowledge come from, how did I know what to do?”, the answer is God always comes through. As a Nurse, I love and care for my patients but God loves and cares even more than I do, and that lesson never leaves me. I am called to be a Registered Nurse, and I work for the ONE who called me.

    • My thoughts exactly. ‘Dear Lord, please use me today to care for Your children’. Some days, I joked, be careful what you ask for! He used me right up today!’ 😊

  21. My sixth sense is early infection or serious complications. I’m able to spot subtle shifts. I’m not always immediately clear, but something flags in my consciousness, sending me poring through recent data.

  22. Oh indeed it it exists in the same way you don’t say the Q-word outload but bigger. I remember when I was doing emergency Department one particular day it was a well paced day, I was walking down the hall, there no ems calls, nothing when I suddenly had this verboding overwhelmed feeling everthing seemed t stop. I took a quick look around nothing and then the bay doors opened and here came a fireman baby in arms doing cpr 🙁 no time to think much about it. Some times I think it’s a matter of attention we may pick up very subtle changes that are not enough to chang vital signs or make alarms go off but you know they’re there. I’ve learned not to ignore those things and I hover more closely and I haven’t ever regreted it. Follow your gut.

  23. yes this is so true; sometimes I will be making rounds and notice a change in facial color ; right away I start VS.If the patient is a diabetic I will question last BS, then get one.9 out off 10 times the MD as to be notified.

  24. I recently retired from a 56 year nursing career! Developing the best observation & assessment skills possible! Be attentive & intentional & yes, pay attention to that “gut” instinct 6th sense! “Know” your patients! I had one of the best clinical professors in the field, who could walk in a patient room, eyeball them head to toe, and within a few minutes give you an accurate assessment of the patient status! Flo Focer

  25. We had moved the MICU to another floor while it was revamped. The morning of our move back to our beautiful new unit, I was told my patients would be going first. I told the charge I didn’t think Pt A should go first. Something was off. But, we went anyway. Me and Pt A. As the elevator doors closed on my transport team, his esophageal varices blew. All alone, I put folded newspapers on my head (this was pre-full body PPE) opened his lines wide, and pushed the code button. Eventually they returned and we got the Miller-Abbott tube down and traction going. Our new unit was christened “Debbie’s Doings” for the awful ‘redecorating’!

  26. And then there is the nurse who does not know why she knows that the patient will not survive. How could I assess an outpatient during an interview for his upcoming open heart surgery and see nothing that clues me in as to the outcome. But, hours later, I know…. This has happened more than once. Knowing…without knowing how I know. Patients too know when they are coming to their end, have seen it happen too many times.

  27. The sixth sense is a learned instinct from our numerous experiences with patients and situations. Critical thinking at its finest!

  28. I am reminded of the movie “World According to Garp” (1982). Glenn Close (who, in my humble opinion played the best role of her career in that movie) played Jenny, a nurse and the mother of Garp (Robin Williams). Every time there was a significant change in the story, Jenny would say ‘I know that, I’m a nurse’ immediately before it happened. Make some popcorn and watch it – I hope you enjoy it as well.

    L.A. Nelson MS RN NHDP-BC
    New Mexico

  29. This “sixth sense” is a hallmark of what Patricia Benner would describe as an “expert nurse”. Malcolm Gladwell describes how it plays out in multiple professions in his book “Blink”. The secret to success in any endeavor lies in paying attention. We’re trained to do it and we find new ways to do so whether we plan to or not.

  30. It’s not a sixth sense. It’s the result of years of experience. We may not be able to put it into words, but we know something is wrong.

  31. We learn the signs and symptoms associated with multiple “sick” states, like color change with sepsis. Nurses perceive even a slight change in color to decern the decent into sepsis.

    We learn, not always perceived as learning, bit we learn. And that, ny friends, is our sixth sense.

  32. I agree that this sixth sense is present in at least most nurses. I feel that the nurses I have known over the years have an innate ability to be more observant of people/things around them. Having seen many of these skilled medical people in action has convinced me on more than one occasion that they are like the mothers that have “eyes in the back of their heads”. They just have it…they know it…they feel it…they trust it… And thank the Lord they do have this ability and bravely stick to their hunches or many patients may not have survived their ordeals.

  33. I think it is partly that you are gathering info without even knowing it. And then you have to learn to trust that gut instinct. I think that is why seasoned nurses seem to possess the skill more so, the newer nurse has it she just has not learned to tune into it and to trust it! I always say what’s worse, having a hunch and not following it and the outcome could have been avoided OR having a hunch, being extra cautious and aware and it turns out to be nothing. I say the latter is the better of the choices. Always err on the side of caution!

  34. This sixth sense is indeed very true and almost all nurses have a sixth sense. Some of this instinct new nurses already have, simply from being around family and friends. A great deal of a new nurses early sixth sense comes from life exposure. It seems that the more a person has been around different people, races, cultures, and incomes, the faster this sense comes to them. It starts waking up as nurses read charts, look at and assess patients. Nurses start noticing everything about a patient without ever knowing it. I mean everything from all nonverbal cues to a person`s shoestrings (if they have them). Next thing you know they can look at someone and realize something is wrong!

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