Love it. A hands-free 2-damage attack that costs no resources!
When you're fighting with a limited-ammo weapon (Flamethrower sais hi!) or your name is Randall Cho then the ability to save a bullet and finish off a foe with a punch is very useful.
Anybody with a high fight stat can make routine good use of this thing (Mark Harrigan for example). Another clutch use is when youre playing an expensive build and want a cheap attack (Roland Banks decks routinely burn a lot of money) or if you have a conditional weapon (Machete).
You can use this to supplement a Vicious Blow as a means of accessing extra damage with unarmed attacks, or you can layer the two for a straight up 3 damage attack.
Also Yes I've realized I've confused Randall and Nathaniel, too late to stop now!