Something’s Not Right

Experienced nurses know this feeling well. Something is not right in the room before there is objective proof. Before the monitors alarm. Before anyone else fully sees it. 

It is not always dramatic and it is not always subtle. Sometimes the danger is quietly unfolding before anyone can fully explain it. Other times the severity is obvious, but the urgency of what needs to happen next is less clear. 

In Labor and Delivery, most patients are healthy, which can make true emergencies feel all the more jarring when they occur. Obstetric crises often evolve quickly and unpredictably. Sometimes the warning signs are subtle. Sometimes they are unmistakable. In either case, experienced nurses develop an internal sense for when something in the clinical picture no longer feels safe. 

What nurses often describe as intuition is rarely a mysterious feeling at all. It is pattern recognition built through repetition, exposure, and time at the bedside. Sometimes that recognition is about detecting subtle change early. Sometimes it is about recognizing when a situation can no longer safely remain unresolved. 

Sometimes one nurse speaking up early changes the entire outcome for a patient. 

As a Labor and Delivery nurse, I vividly remember a woman, pregnant with her first baby, who was transferred to our hospital from a small rural facility by AeroMed. The helicopter flight shortened her travel time from roughly three hours to one. Between the urgency of the transfer, the lab work sent ahead from the rural hospital, and her appearance when she arrived, I knew immediately how serious the situation was. 

She was dangerously thin. Her oily hair was tangled and matted. Her fingernails were bitten down and dirty. She arrived in filthy, ragged pajamas looking profoundly unwell. She was critically ill with a systemic infection that was ravaging her body. 

She was only twenty six weeks pregnant.

The fetal heart rate tracing was ominous from the moment she arrived. The baby was in significant distress and I believed there needed to be immediate consideration of a stat cesarean section. Meanwhile the critical care team remained at her bedside evaluating her, and from my perspective, carefully weighing a situation that allowed very little time. 

The patient had arrived alone by helicopter and her family had not yet made it to the hospital. She was not cognizant of what was happening around her. She could not maintain eye contact, participate in conversation, or even appear to hear the discussions taking place at her bedside. No additional labs were drawn after arrival because even the necessary surgical labs had already been sent from the transferring hospital and there simply was not time. She was too sick. 

At one point, and mind you this entire situation unfolded in less than an hour, I became so concerned with the trajectory of what I was seeing that I said to one of the surgeons at the bedside, fully aware the critical care team could hear me, “If we are not going to deliver her, why are we still monitoring this baby? The baby is actively dying and I feel we are ethically obligated to intervene. If we are not going to intervene, then we should remove the fetal monitor and focus solely on the mother.” 

I could not sit there silently watching that tracing deteriorate further without assertively and succinctly voicing what I believed was happening. 

My words helped clarify the urgency in the room, and shortly afterward the decision was made to proceed with a stat cesarean section. 

It was one of the fastest deliveries of my career. The baby was born alive, barely, and transferred immediately to the neonatal ICU. The mother survived surgery and was transferred directly to the surgical ICU. 

About an hour later, after some rest, coffee, and breakfast, luxuries our unit was able to allow that Sunday morning because it was not particularly busy, the OB team gathered for a debriefing. The critical care physicians remained with the patient, so it was only the Labor and Delivery surgical team present. 

I remember expressing gratitude that both patients were alive despite not knowing what would ultimately happen to either of them. One of the surgeons

then said to me, “Do you realize the reason we hesitated to do the cesarean section was because we were not sure she would survive surgery?” 

I was stunned. Honestly, I was angry. 

I responded, “Why was that never communicated to me as the nurse at the bedside? I understood she was critically ill, but I did not realize the team believed surgery itself might kill her. That changes everything. I don’t think it was fair to expect me to actively participate in the care of both patients without my understanding the full clinical picture.” 

The surgeon agreed with me. Then she said something I have never forgotten. “It was your advocacy and urgency that ultimately helped move the decision forward, because the baby would almost certainly have died had we waited much longer.” 

I have never forgotten this case, not because I detected subtle deterioration before anyone else recognized it. She arrived critically ill and everyone in the room understood that. What stayed with me was the reminder that experienced nurses develop a different kind of clinical judgment at the bedside. It is not a different quality of intuition, but a different depth of reference, built from years of seeing what illness and instability can look like in many forms. 

As nurses, experience teaches us to recognize when a situation is no longer safely sitting in uncertainty and how quickly outcomes can narrow while teams deliberate. But intuition is not the domain of experienced nurses alone. It shows up early in a nurse’s career as well, sometimes as a quiet sense of concern before the words exist to explain it. What changes with experience is not the presence of that signal, but the confidence, context, and speed with which it is acted on. 

Over time, what we call intuition becomes clearer: pattern recognition, urgency, advocacy, and experience colliding at once. 

This is why the feeling so many nurses describe as “something’s not right” deserves respect. It is a signal shaped by exposure, repetition, and time at the bedside, where recognition often arrives before explanation.