There are better terms for it (such as “nursing intuition”), but I call it spidey sense because I just like to inject a little levity into my work day. Has it been researched? Has it been validated? I know it absolutely exists, and I am happy to have a decent dose of it. Spidey sense, however, develops with experience, so I can’t yet scale buildings or cast webs. You can’t get complacent with spidey sense because patients will always surprise you. People aren’t predictable, and bodies all work differently, so there will always be garden-path patients (another term of mine, stolen from Noam Chomsky [Wikipedia entry], meaning patients whose assessments and histories lead you down the wrong path completely).
What is spidey sense? Your patient just looks wrong. Or DOESN’T look wrong, but you have a gut feeling that something is about to go seriously wrong. Generally, and this is really the point of my post, you’ve got nothing to hang your hat on as far as an assessment finding or anything from the patient’s history, and that makes spidey sense problematic: IF you are working with a physician who trusts spidey sense (some do, from some nurses, and with varying degrees of acceptance), you don’t have much time to make your case, and “err…she just doesn’t look quite right to me” never sounds exactly right to me. I say it. I take the “advocate for my patients” part of my profession extremely seriously, and if the patient doesn’t look quite right and that’s all I’ve got, I use it. I feel a little silly, but I do. Sometimes spidey sense is wrong and the patient is fine, which is actually just peachy with me. I want all my patients to be fine and don’t mind looking a little stupid sometimes. (Nursing offers unparalleled opportunities to look stupid multiple times per shift, so I’m used to it by now, maybe.)
It takes some cajones to go with your gut as a newish nurse—especially if you’ve got nothing to go on and no track record. However, it takes guts to be a nurse to begin with, and the only way to get a track record is to run with things, so I advocate the pursuit of spidey sense. Most docs will at least agree with putting a line in a patient you think is about to go downhill, and for pure time savings in an emergency nothing, nothing, nothing beats ready IV access. If you don’t believe me, watch how quickly everyone’s interest is captured if a patient WITHOUT IV access suddenly goes into a life-threatening arrhythmia or pukes up a liter of blood or has a drastic change in level of consciousness. Have I put lines in patients who didn’t need them? Unfortunately yes. But patients also get a ton of radiological and lab tests that ultimately don’t show anything wrong either, and we still do those, so I lump unnecessary IVs in with that stuff.
Nurses, what do you have to say about spidey sense? Can it be taught? Honed?