Malcolm Gladwell wrote about “rapid cognition,” or our innate sense of “knowing” in his 2005 book, Blink. If you haven’t read it, I highly recommend it; it is a fascinating read. Of it, Gladwell says:

You could also say that it’s a book about intuition, except that I don’t like that word. In fact it never appears in “Blink.” Intuition strikes me as a concept we use to describe emotional reactions, gut feelings–thoughts and impressions that don’t seem entirely rational. But I think that what goes on in that first two seconds is perfectly rational. It’s thinking–it’s just thinking that moves a little faster and operates a little more mysteriously than the kind of deliberate, conscious decision-making that we usually associate with “thinking.” In “Blink” I’m trying to understand those two seconds. What is going on inside our heads when we engage in rapid cognition? When are snap judgments good and when are they not? What kinds of things can we do to make our powers of rapid cognition better?

Within nursing, we call this concept “tacit knowledge.” It is not easily shared via lectures or books, but it comes with experience and knowing through repetitive, almost unaware situations and critical thinking. I explicitly learned about tacit knowledge (what an oxymoron!) in my undergraduate nursing studies. However, I actually learned tacit knowledge while working with patients alongside more experienced nurses.

I picked it up from colleagues like the night-shift LVN with 30 years of experience who walked back to the desk after assessing a certain patient she’d cared for over the last three days saying, “I’m going to keep my eye on Mr. Second-Door-on-the-Left. I can’t put my finger on it, but I’m going to watch him.” As the oh-so-terribly-young charge nurse, I’d walk in and assess him, too, especially because I knew he was scheduled for discharge some time the next day. Not seeing what my colleague saw nor anything in the chart to cause alarm, I brushed it off only to think, What the…???, as we called a code in the wee hours of the morning – in between patient rounds because my colleague increased her routine patient checks “just because.” Similar situations have happened to me numerous times, and I have learned to trust colleagues when they sense something going awry with a patient.

Tacit knowledge – it’s hard to explain when you know it as well as when you learn it. What a mysterious and fascinating concept and feeling. What are your experiences with tacit knowledge?