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Clinical Nursing Judgment

Daziana Velasquez

Youngstown State University

March 19th, 2018


There are a lot of expectations when becoming a new nurse. Nurses who are educated and

trained well will have great hands on skill’s and with experience they will develop great nursing

judgment to make the best decisions for their patients. Nursing judgment involves problem

solving, decision making, and critical thinking. Critical thinking is being able to interpret a

patient’s needs, concerns, and health problems. Patients are the number one priority of a nurse’s

job. Families want a nurse who will be the best for their loved ones. I have been searching for the

precise answer for what really makes a great nurse, not just an average nurse and this is what I

found: “Nursing is a practice based discipline and one of the basic objectives of nursing

education is to achieve clinical judgment. Clinical judgment is essential for decision making and

is considered an inseparable part of a high quality nursing care. Therefore, nursing students are

expected to have relative skills and clinical judgment capability at the time of graduation”

(Pouralizadeh, Khankeh, Ebadi, & Dalvandi, 2017, p. 1). Based on that information, what really

separates an average nurse from a great nurse is quick critical thinking. Healthcare companies

want new nurses to have excellent clinical decision-making skills and good judgment. Therefore,

critical thinking is what makes a good nurse into a great nurse.

As a nursing student, I started from the bottom just like everyone does in the beginning.

Without experience there would be no learning. I however am very grateful for how much I have

learned in the past few years. In the medical field there is always room for growth, so I know that

every day I will acquire new knowledge. For the past three years I have had the opportunity to

learn from other nurses, whether it was in a hospital setting, at an off-site location, or in a

person’s home with an in home health care nurse. That is where I was able to listen, pay attention

and try and pick up on how other nurses used their critical thinking skills.

I would love to share an experience that I will never forget when I realized I was picking

up and learning how to use my clinical judgment. A year before this happened, my grandpa

became very ill. He ended up passing away from congestive heart failure. He had an in home

health care nurse who would come to check on him three times a week. Sue knew that I was a

nursing student and would try and explain what was going on with my grandpa because she

knew how much I wanted to learn and take care of him. One day she was checking his vitals and

doing an assessment, she said that his lung sounds did not sound good and wanted to get a chest

x-ray and send them to the doctor. Sue had me take a listen to his lung sounds and asked me

what I had heard, as a new student I had no clue, she told me to listen closely because I wouldn’t

forget the sound if I heard it again. She said, “what you are hearing are crackles” that is what is

heard sometimes when auscultating the lungs in a patient who has congestive heart failure. Little

did I know that night would be the last time I ever spoke to him again. As a student I didn’t see

all the other signs and symptoms that were building up leading to him going into heart failure

and the nurse didn’t like what she had heard but by the time the doctors saw the chest x-ray the

next day it was too late. Of course over the next few years during my nursing program I had

learned all the signs and symptoms and what to expect when a patient has congestive heart

failure. Learning from a book is a lot different than actually being hands on with a patient. So the

experience I would like to share, is when I was working with an in home health care nurse. We

went to the patients house a couple of times and the one week I was with her, she asked me if I

noticed anything different about him from our last visit. I tried thinking back to the last time we

saw him, he kept having this increased need to urinate at night and we started seeing edema in

his ankles and feet. She asked me “what did we keep doing at each visit?” I had to think back

some more and then I realized a huge thing we kept doing was weighing our patient. This time

when we weighed our patient, he gained a lot more weight than our last two previous visits, due

to the fluid retention. The guy we had been seeing stated that he was feeling a lot more fatigued

and weak since we had seen him. The nurse then asked me another question, she said “is there

anything else that you think we should do?” as a new nurse I was definitely intimidated because I

knew she wanted me to know the answer, but as a nursing student I had learned so much from

the books and still had so much more to see and learn that I was not sure of the correct answer.

She helped me out a little bit and told me to really think about what I just saw while assessing the

patient and then it hit me! I remembered that week my grandpa fell a few times, started gaining

weight out of nowhere, and was also having shortness of breath when laying down. That is when

I told the nurse I need to listen to his lung sounds. When I did, I heard the exact noise I heard

when listening to my grandpa’s lung sounds and those were crackles. When I told the nurse she

then did her assessment on him as well and heard the exact sound I did when auscultating his

lung sounds. The nurse I had been working with told me she was very proud and to look how far

I have come with using my clinical judgment skills. Two semesters ago, I was unsure what to do

besides listen to vitals and notice certain signs and symptoms. Now when I see certain signs and

symptoms I put them together and that helps me narrow it down to what I think the patient could

possibly be experiencing. I was very curious to see what would happen next, as a student and

seeing what happened to my grandpa in the past, the first thing I asked her was what do we do

now? She had his wife get him to the hospital where they would take care of him and treat him

before it got worse. That was my first best experience using critical thinking and I was so proud

when I realized I had put the pieces of my education together.

As we can tell, clinical nursing judgment is necessary. These skills are expected from us

by the time of graduation. Our professors, clinical faculty, and preceptors work very hard to help

us get to where we need to be. At the end of each semester our clinical faculty set up a

simulation lab for us at the school. This is where we show what we have learned and we build on

it every semester. The faculty go ahead and come up with a few scenarios, some life threatening

and some where we just need to use our head and put everything together to see what is actually

going on with the patient. I believe this has really helped with our critical thinking skills

tremendously. While doing some research, I found a study where other students felt the same

way. “21 group discussions indicated that students perceived that simulation enabled them to

strengthen their theoretical knowledge allowing them to understand what was happening with the

patient in order to make an appropriate judgement. They explained: ‘simulation mimicked what I

have been learning.’ ‘I applied the previous knowledge to analyze the data… it helped me to

understand the patient’s needs… recognize some abnormal signs and symptoms.’ ‘Practicing the

realistic scenarios helped us to interpret the patient’s concerns… and make sense of what we

learned…’ ‘We pull our knowledge and skills together for analyzing clinical problems while

making appropriate judgement’” (Yuan, Williams, & Yok Man, 2014, p 12).

In the beginning as I mentioned, we all start out from the bottom. We come a long way from

freshman year to senior year. As I found in one last article “Critical thinking is one of the most

important concepts involved in the field of education. Enabling students to think critically is not

only a primary purpose of higher education, but also facilitates the dynamics of academies and

universities and helps them survive, develop and promotes scientific societies” (Azizi-Fini,

Hajibagheri, & Hajbaghery, 2015, p 1). I am a very firm believer that we would not be entering

graduation in the next two months if we were not learning to develop and establish critical

thinking skills. I know that our professors did a wonderful job with making sure we graduate

with the knowledge that we need, not just to be an average nurse, but to be a great nurse.

Clinical judgment is not something we know in a semester or two. It is when we get near the

end and can start making sense of everything that we have learned over the past few years, we

can finally start putting the pieces together. It will feel natural and just click. This is not a skill

that we just have right off the bat, this takes experience, hard work, paying attention, and a lot of

guidance over the years. As we are told several times by other nurses, professors, faculty, and

doctors… “you will never stop learning” and I believe that just by the precepting hours I have

done at the hospital. Every day I go to the hospital, there is a new experience and new knowledge

to gain. My clinical judgment has come a long way since freshman year and I know that my

critical thinking skills will keep improving as long as I put in the effort and work hard to be the

best nurse that I can be.



Azizi-Fini, I., Hajibagheri, A., & Adib-Hajbaghery, M. (2015, March). Critical thinking skills

in nursing students: A comparison between freshmen and senior students. Retrieved


Seidi, J., Alhani, F., & Salsali, M. (2015, September). Nurses’ clinical judgment development:

A qualitative research in Iran. Retrieved from

Yuan, H. B., Williams, B. A., & Man, C. Y. (2014). Nursing students' clinical judgment in

high-fidelity simulation based learning: A quasi-experimental study. Retrieved from