Have you ever worked with a nurse who could spot trouble before it happened?   I remember a colleague telling me “I don’t like the look of that patient”, which surprised me because the patient’s blood work and vital signs were normal.  Yet, in only a short period of time the patient went into cardiac arrest.  It’s an impressive skill, one that I’ve only been able to attribute to senior nursing staff.  It isn’t easily explained, but the impact can’t be ignored.  It seems almost magical and it’s sometimes called nursing intuition.  Do these intuitive assessments constitute, or arise from, evidence?  I suppose that depends on your definition of evidence.

We tend to think of evidence as the results of research studies, or clinical guidelines. However, a broader, richer understanding of evidence and evidence based nursing practice is warranted.  Evidence based practice is an approach to clinical care that incorporates current best evidence from methodically sound research studies, the clinician’s professional expertise and the values and preferences of the patient.[1] In other words, the expertise of the clinician is an important element in the recipe of evidence based nursing.

Patricia Benner[2] carefully described the impact of experience in nursing practice.  Novice nurses differ from expert nurses in the way they interpret complex clinical situations.  “This difference can be attributed to the know-how that is acquired through experience.  The expert nurse perceives the situation as a whole, uses past concrete situations as paradigms, and moves to the accurate region of the problem without wasteful consideration of a large number of irrelevant options (p.3)”  In other words, it wasn’t magic or some other sort of mystical sense that led my colleague to predict the cardiac arrest before it happened.  It was a culmination of years of experience wrapped up into a single glance.

We can’t throw away the research articles.  We need to continue to ensure that our nursing actions lead to the best possible patient health outcomes.  However, we also can’t deny that experience is evidence.  We need to lobby for environments that promote expert nurses.  Nurses need to work extensively in their chosen clinical practice area without fear of layoff or re-assignments.  Novice and beginner nurses need to be mentored by expert nurses. Finally,  research should continue to focus not only on the most effective nursing interventions, but also on the situations that foster the development of expert nurses.

Let’s redefine, and legitimize ‘nursing intuition’ to what it deserves to be called…the assessments of expert nurses based on years of experience. In other words, a form of ‘nursing evidence’.

Roberta Heale