Being a registered nurse comes with much more than hands-on skills and the ability to

chart on patients’ conditions. Before becoming a registered nurse, understanding the rationales

for nursing actions is the key element of caring for a patient. For example, a registered nurse can

be told to turn patients every two hours by hospital policy, but what if he or she does not

understand the purpose of this action? What if the family of those patients asks why they are

being turned every two hours? The nurse is an educator and understanding the rationales for

nursing care is a part of clinical nursing judgement. Amy J. Costanzo MSN, RN-BC stated in her

journal, Just a Nurse, or a Bedside Leader?, “When you say “I am a nurse” you are claiming the

values of nursing and your contribution to assisting patients in achieving their best level of

health. To do so requires a clear vision of nursing as a profession and of nurses’ contribution to

the health care team.” (Costanzo, 2017). Clinical nursing judgement is the clear vision of nursing

and without it, a registered nurse cannot play his or her part in a patient’s dynamic care plan.

Clinical nursing judgement is constantly being used while caring for patients.

Understanding how and why a patient’s medications are being administered, having precise

assessment skills, acting as an uplifting voice for patients, and being a leader capable of

appropriately delegating tasks are all elements of being a registered nurse with clinical nursing

judgement. Health care providers prescribe medications to patients, but registered nurses have

the responsibility to administer medications. During medication administration, a great deal of

clinical nursing judgement is used. Performing three ways of verifying proper medication

administration is essential. Asking the patient to state his or her name and birth date and looking

at the patient’s arm band are ways of verifying correct medication administration. Performing

this verification is one of the many ways a registered nurse uses clinical nursing judgement.

Giving the right dose of the right medication to the right patient is a crucial responsibility.
Whether or not the registered nurse is aware of safe medication administration or not

demonstrates the presence or lack of clinical nursing judgement. A registered nurse must also

understand the action of medications that are being administered during his or her shift.

Understanding the action of a medication is extremely important during administration and

during the assessment of its therapeutic use. For example, administering furosemide (Lasix)

requires clinical nursing judgement by understanding the use of furosemide, understanding what

lab values to assess before administering furosemide, and what assessment findings to except to

prove that therapeutic use of furosemide is achieved. A registered nurse with good clinical

nursing judgement assesses the patient’s potassium level before administration because

furosemide is a potassium-depleting diuretic. He or she would also assess breath sounds,

respiratory rate, and blood pressure shortly after administering furosemide based on knowing

that this medication is rapid-acting and works to pull fluid from the vascular system. The

registered nurse would expect to hear clear breath sounds, to observe regular, relaxed breathing,

and a lower blood pressure. Keeping this thought process in mind during medication

administration with all medications and their different uses is crucial during patient care. Having

precise assessment skills also plays a vital role in clinical nursing judgement. An excellent

example of this is assessing a patient’s vital signs and observing his or her nonverbal

communication to make a judgement call on what the patient needs. If a registered nurse was to

walk into a ventilated patient’s room and notice that his or her Sp02 is in the 80%’s, heart rate is

greater than 110 beats per minute, and the patient appears restless, agitated, or nervous, the nurse

would use clinical nursing judgement by first checking tubing and connections, and if those are

all properly intact, then the nurse would know to suction the patient to eliminate thick secretions

that may be blocking the patient’s airway. After suctioning, the nurse would then take clinical
nursing judgement further by reassessing the patient’s Sp02, heart rate, and nonverbal

communication. If suctioning was successful, the nurse would except to see Sp02 greater than or

equal to 95%, heart rate 60-100 beats per minute, and calm or relieved nonverbal ques. A

registered nurse also uses clinical nursing judgement by being a patient advocate. Sometimes

family members become so scare of losing their loved one that they forget to stop and try to

figure out what the patient really wants. This is when the nurse must step in and be a strong,

uplifting voice for the patient and try to support and educate the family members during a

difficult, life-changing event in their lives. Susan B. Hassmiller PhD, RN, FAAN stated in her

journal, The Essence of Nursing Care, “Consumers have positive patient experiences when they

believe the health system is easy to access and navigate; their needs are being met; and,

importantly, they are being listened to and respected, and can contribute to decisions related to

their own care. Frontline nurses, as the health professionals who spend the most time with

patients and their families, are central to ensuring that the patient experience is a positive and

dignified one.” (Hassmiller, 2017). A registered nurse with good clinical nursing judgment

knows how to appropriately and professionally delegate tasks to LPNs and UAPs. The registered

nurse is responsible for his or her patient and properly delegating patient care as needed is a part

of this responsibility. Understanding skills along with limitations of LPNs and UAPs is crucial.

After reflecting on one of my shifts in the Labor and Delivery unit during my

preceptorship at UPMC Horizon, I remember a crucial time in my patient’s room when I had to

use clinical nursing judgement. Nurses strongly encourage skin-to-skin between the mother and

newborn immediately after birth. Skin-to-skin has amazing benefits including regulation of

temperature, heart rate, and respiratory rate of the newborn and promoting bonding between the

mother and newborn. My patient vaginally delivered her first child, a full-term baby girl, and
could not wait a minute longer to hold her in her arms. After quickly assessing the newborn’s

APGAR scores, obtaining vital signs, and suctioning the newborn’s mouth and nares with bulb

suction, the newborn was handed over to the mother for skin-to-skin. After about fifteen seconds

of the mother holding her newborn, I noticed the newborn’s color becoming dusky blue and her

extremities becoming limp. Although skin-to-skin is very beneficial, I knew this newborn needed

attention immediately. I told the mother that I needed to take the newborn back to the warmer for

further assessment, I told my preceptor about my observations during skin-to-skin, and I calmly

reached out to other nurses for help. We all moved quickly and quietly to avoid frightening the

parents who were still in the room. The newborn had a heart rate of 134 beats per minute, a

respiratory rate of 38 breaths per minute, and crackles in all lung fields during auscultation. The

newborn aspirated amniotic fluid during delivery and needed deeper suctioning. My preceptor

helped me set up for suction and together we suctioned the newborn’s airway. After suctioning

and some arousal with warm blankets, the newborn became pink in color and breath sounds were

clear. Once we agreed that the newborn was stabilized and doing much better, she was handed

back over to the mother and we explained how sometimes newborns aspirate on amniotic fluid

which can affect their breathing. We explained what suctioning was and why we needed to

suction the newborn. We made sure both the mother’s and father’s questions and concerns were

addressed, and the newborn remained stable.

Clinical nursing judgement is used by registered nurses every time they walk into a

patient’s room. Assessing vital signs, recognizing verbal and nonverbal ques, safe medication

administration, assessments and patient monitoring, patient and family teaching, patient

advocacy, providing physical care along with emotional support, and professional delegation are

all elements of clinical nursing judgment. Administering an injection, starting an IV, and
charting a patient’s vital signs are just a few skills that nurses perform every day, but nursing

knowledge is the most valuable tool a registered nurse can have. Being educated on patient care

and staying up-to-date with ways to improve patient care is what being a registered nurse is

about. Lois Corcoran BSN, PCCN made a statement in her journal, What a Nurse Really Wants,

that really spoke out to me. Her statement was, “Take the time to be present with them, hold their

hand, look into their eyes, and speak to them in a calm, respectful way that lets them know you

are here.” Nurses are the health care professionals who spend the most time in a patient’s room

and when a patient begins to slip from life to death, skills alone are not going to save that

patient’s life, but clinical nursing judgement will.

 Works Cited

Amy J. Costanzo MSN, RN-BC (March 2017). Just a Nurse, or a Bedside Leader?. Retrieved

from

https://journals.lww.com/ajnonline/Fulltext/2017/03000/Just_a_Nurse,_or_a_Bedside_Le

ader_.2.aspx

Lois Corcoran BSN, PCCN (May 2017). What a Nurse Really Wants. Retrieved from

https://journals.lww.com/ajnonline/Fulltext/2017/05000/What_a_Nurse_Really_Wants.2

9.aspx

Susan B. Hassmiller PhD, RN, FAAN (May 2017). The Essence of Nursing Care. Retrieved

from

https://journals.lww.com/ajnonline/Fulltext/2017/05000/The_Essence_of_Nursing_Care.

1.aspx