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Clinical Nursing Judgment 1

Clinical Nursing Judgment

Everyday around the world, nurses use their knowledge that they

have gained through experience and years of practice to make the

best decision that they can. The more experience and knowledge a

nurse has at his or her disposal, the better the outcome will be.

Everything in nursing and in healthcare is about making the best

possible patient outcomes. Nurses work alongside a healthcare team to

take care of the patients. Sometimes nurses have to use their own

discretion to decide what is best for a patient. It is the nurses job and

should be their goal to acquire the knowledge necessary to have a

positive effect on the patient. Also it is the nurses job to make sure the

patient has the information they need to make informed decisions.

Clinical nursing judgment is used on every patient a nurse takes care

of during a shift.

Nurses must coordinate care with many healthcare team workers

and must also be on the page as the doctors. This may be difficult with

the different points of views between doctors and nurses. In an article

Harbison brings up the discussion of the difference between the

decision making between nurses and doctors. The author talks about

how doctors tend to use technical cues where as nurses use interactive

cues (2001). This is true in the sense that nurses primarily interact

directly with the patient and the doctor is able to separate themselves
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from the patient and look at only the information on the patient. The

doctor and the nurse must communicate effectively and collaborate to

allow for the treatment of the patient to be effective. It is important

that the goal for the patient is shared by everyone on the healthcare

team taking care of the patient. Everyone on the team must also use

the best of their knowledge to make decisions, especially nurses using

clinical nursing judgment.

It is very important that the healthcare team work together, but

it is equally important that the patient be active in their own care.

Often times the patient is forgotten about when it comes to articulating

possible methods of care. Florin discusses the importance of patients

being involved in their own care allowing them to have a sense of

control and also making informed decisions that alines with that

patients values. (2008). The patient must be given the knowledge

needed to be able to make an informed decision. The patients have the

right to make decisions regarding their healthcare and should be an

active participant based on the eagerness of the patient. The nurse

must use clinical judgment on when to incorporate the patient on

making care decisions. The nurse must assess the knowledge and

readiness of the patient to be involved in the decision making.

Experienced nurses sometimes make decisions that a new nurse

would not be able to. The experience level can separate one nurse

from another. According to Pearson, intuition is another decision


Clinical Nursing Judgment 3

making process used by expert nurses that have the past experience

that they can look back on and make an instant, knowledgeable

decision (2013). Intuition is a very powerful tool that is only available

when a nurse has seen something before and can act on it. There are

many different factors that go into clinical nursing judgment and

intuition is one of them. The nurse does not act on hard evidence,

intuition is a very useful tool and shows a sign of a well experienced

nurse.

As a student there are not many experiences that I can draw

back on and use intuition. There are times as a student that I have

been able to incorporate the patient in care. Also as a student I am

unable to take any new orders from the doctors but I have talked to

doctors over the phone about patient status and procedures that were

done on the patient. A specific time where I was able to use nursing

judgment was when a patient was experiencing back pain that was

severe. The patient was due for pain medicine but also had to go and

get an MRI done that day. I was able to call down to MRI and ask when

the patient would be going down for medication reasons. The patient

would have to wait for two hours until MRI and had IV pain medication

that would not last from then until the MRI was finished. So I was able

to work with the patient into using a heating pad so we could hold off

on the medication until the patient was going down for the MRI. The

patient was very satisfied with the heating pad and was able to be
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medicated just prior to MRI. The patient was able to get the MRI done

with minimal pain. Although that was just a couple hours out of the day

of taking care of the patient, I could tell that the patient was

appreciative of the care and attention that she had received. Clinical

nursing judgment can be used for pain management for a patient,

which seems simple but is important to the patient.

References

Harbison, J. (2001). Clinical decision making in nursing: theoretical


perspectives and their relevance to practice. Journal Of Advanced
Nursing, 35(1), 126-133.

Florin, J., Ehrenberg, A., & Ehnfors, M. (2008). Clinical decision-making:


predictors of patient participation in nursing care. Journal Of Clinical
Nursing, 17(21), 2935-2944. doi:10.1111/j.1365-2702.2008.02328.x

Pearson, H. (2013). Science and intuition: do both have a place in


clinical decision making?. British Journal Of Nursing, 22(4), 212-215.