Clinical Intuition in Nursing: Expertise and Epistemic Warrant

Abstract: Experienced nurses can recognize clinically significant changes before they can fully explain what they have noticed. This ability may support concern about deterioration without equally supporting an explanation of its cause. This article examines when acquired expertise warrants additional confidence in a particular clinical judgment. It develops a constructive analysis of the Heidegger–Dreyfus–Benner lineage using hypothetical clinical comparisons and an example involving delirium and bacteriuria. Heidegger’s account of concealment helps explain why a compelling interpretation may not reveal its own limitations. The clinical comparisons distinguish the grounds for an initial concern from its later confirmation. The bacteriuria example illustrates how improvement after treatment may reinforce a causal explanation without establishing that it was correct. Drawing on Benner’s account of experiential revision and research on intuitive expertise, the argument distinguishes opportunities for corrective learning from evidence that the clinician has learned to tell relevant cases apart. Calibration connects that learned ability to the setting in which it applies and the confidence it supports. Institutional feedback practices can help expose errors or leave interpretations unchallenged. The resulting account makes the authority of expertise specific to the judgment: additional confidence depends on what the clinician has learned to distinguish, whether that ability applies to the present case, and what current evidence supports or challenges.