Learning to “Trust Your Gut” as an ICU Nurse

Within 20 minutes of meeting this patient, I knew something wasn’t right. I just didn’t know what. Luckily, the team had just arrived to start morning rounds.

“I want to start by saying something isn’t right with this patient. I don’t know exactly what it is, but I have this odd feeling something else is going on. Like we are missing something or something bad is going to happen.”

I am fortunate enough to work with providers who listen and respect the moments when I am waving my red flag in the air, saying: WARNING! WARNING! They knew this wasn’t my usual method of presenting during multidisciplinary rounds.

When you looked at this patient on paper, they seemed “fine.” All of their lab values were within normal limits, they were alert and pleasantly confused (which was not new; they had some confusion at baseline), and their vital signs were rock solid.

Fast forward to the end of my shift and this patient…

• was on Heated High Flow Nasal Cannula 60 L and 60% FiO₂ from 2 L Nasal Cannula in the AM
• had a base deficit move from – 2.7 to – 8.5
• had a lactic level of >9.0 (which went even higher during nightshift)
• had an episode of brown emesis for no obvious reason
• went on a CT scan of the chest/abdomen/pelvis
• had their antibiotics broadened back out
• had a critical serum glucose drop from mid 100’s all day to 32 (with no change in the patient’s mentation🫠)
• received 1.5 L of LR with norepinephrine on standby

Long story short, my gut was right, and it helped save a life. There isn’t a doubt in my mind that if I had simply ignored my intuition, this patient would have deteriorated worse than they did, and when they did…it may have been too late. This is just one of many stories where my intuition was a crucial component in caring for critically ill patients.

What is “Trusting Your Gut” as a nurse?

In nursing, trusting your gut is your intuition telling you that something isn’t right. It may not always be based on factual complex data, but something in the pit of your stomach is telling you that something is off. It is this magical skill we develop over time that helps guide care. It is our red flag, warning sign, little voice inside, or simply put…. just “a feeling or knowing”.

A nurse’s intuition has been shown to be powerful enough to be recognized as a vital indicator of predicting potential or early patient deterioration². There are many micro-moments as ICU nurses where we are guided by our gut, and it would be a disservice to deny its use in our day to day practice. However, typically when we recall moments regarding a strong sense of intuition it is related to dramatic or emergent events versus those that are subtle, or when our gut was wrong².

Where does it come from?

Fun fact…this has been studied as far back as the late 1970’s¹! If you are a new ICU nurse, you may not have a strong sense of intuition…yet!

This “gut feeling” is less about feelings and more about having an informed sense of knowing developed through experiences and clinical knowledge.

Intuition is based on a few components:

1. Pulling from past experiences.
2. Unconscious recognition and processing of small red flags or patterns
3. Having baseline clinical knowledge
4. Remaining curious and questioning things when they happen
5. Listening, trusting, and speaking up based on your gut feeling…even if it ends up incorrect.

As a new ICU nurse, you may not have various scenarios to compare against because you haven’t been exposed to them…yet. Over time, you will start to unconsciously file patient scenarios, stories, and situations in the back of your brain. These files will assist in strengthening your inner voice in knowing something isn’t right before it is overtly showing¹. Your “feelings” become more of a “knowing”.

You have baseline clinical knowledge, but even this will deepen over time. You will refine your skills at recognizing the tiniest red flags that may have previously been unrecognizable. Or you can now fill in missing gaps based on small cues.

As you continue in your practice you will start to see moments when your inner voice was right. Those moments help you learn to trust your gut and stand in the power of your voice and knowledge as the nurse at the bedside.

Because your voice, knowledge, and thoughts matter.

What if you are wrong?

Although a nurse’s intuition has been repeatedly shown to be a vital indicator, it can be scary to vocalize that something is wrong when there isn’t tangible data supporting it³. Learning to use your voice as a new ICU nurse is another skill you have to practice. You are battling imposter syndrome, fear of what others may think, fear of being wrong, etc., all of which may make you not speak up.

But as the saying goes, better safe than sorry, especially when we are talking about people’s lives. Part of this will also involve accepting that you may be wrong, and you have to learn to be okay with that.

Talking to someone who you trust may help. This may be your former preceptor, a deskmate, or a charge nurse. If you need that added support until you feel more grounded in your own, that is okay! Building confidence as a new nurse in any setting takes time.

What if my gut is ignored by others?

Unfortunately, even if we pay attention to our intuition, others may question the legitimacy of it. I have been there, and it is frustrating. If there is one thing I try to teach, it is this: learn to speak the language they want to hear. Why do you feel the way you do? Chances are there are small red flags everywhere that lead to your overall feeling of “something isn’t right.”

Communicate those objective red flags. Offer suggestions on how to gain more information based on what you think may be happening. What I didn’t tell you about the patient above is that there were small clinical signs elevating my awareness that something wasn’t right. They were minute, but they mattered. I communicated this to the team and offered suggestions to obtain more information (new labs and a CXR).

Sometimes, you may have to partner with another nurse; it may take more than one of us to be heard (Listen….I am just being honest here! I have been that partner for many nurses).

Document your communication efforts. Watch your patient closely. Be the persistent nurse who continues to voice your concerns and, when needed, escalates them.

The bottom line:

A nurse’s intuition is a valuable tool in caring for critically ill patients. Learning to listen and trust yours will take time, especially if you are a new ICU nurse. It is always best to speak up when something doesn’t feel right, even if it means you may be wrong. Chances are your feelings have some clinical legitimacy, and this is what needs to be communicated to the appropriate individuals. Even if you are initially ignored, be persistent because you may be correct and help save that patient’s life.

Resources (and fun reading!):

1. Chung, J., Jung, H. Indicators of clinical deterioration in adult general ward patients from nurses’ perspectives: a mixed-methods systematic review. BMC Nurs 23, 861 (2024). https://doi.org/10.1186/s12912-024-02531-6
2. Hams SP. A gut feeling? Intuition and critical care nursing. Intensive Crit Care Nurs. 2000 Oct;16(5):310-8. doi: 10.1054/iccn.2000.1500. PMID: 11000605.
3. Romero-Brufau S, Gaines K, Nicolas CT, Johnson MG, Hickman J, Huddleston JM. The fifth vital sign? Nurse worry predicts inpatient deterioration within 24 hours. JAMIA Open. 2019 Aug 28;2(4):465-470. doi: 10.1093/jamiaopen/ooz033. PMID: 32025643; PMCID: PMC6994008.