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Clinical Nursing Judgement 1

Clinical Nursing Judgement
Sarah Patrick
Youngstown State University
March 19th, 2018
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Throughout our healthcare world, millions of patients are treated and cared for every

single day. Whether it be in hospitals, out patient’s centers, or nursing homes, there are sick

people who rely on healthcare workers to care for them. When you think about the saying “It

takes a village”, the health care world really does. The amount of people that collaborate and

work together to treat a patient is truly a “village”. Physicians, nurses, pharmacists, respiratory

therapists, x-ray techs, the list is truly endless. While many of these workers collaborate to help

the sick, not all are present with daily care. One healthcare worker that is though, is nurses.

Nurses care for patients for 12 hour shifts throughout the day. Therefore, they see the

progression of status with their patients and are expected to be knowledgeable and trustworthy to

notify doctors of any changes. With nurses having this responsibility, comes a lot of skills on

their part. While having nursing skills to perform procedures is one thing, another is also clinical

nursing judgement. According to the National League of Nursing, “Clinical judgment refers to

ways nurses come to understand the problems, issues, or concerns of clients/patients, to attend to

salient information, and to respond in concerned and involved ways”. (Nln.org, 2018). Clinical

judgement is what nurses use every single day to provide the appropriate needs for their patients.

As a student nurse, soon to be RN, clinical nursing judgement is something that I am

learning every single day. During my preceptorship in the PICU, I had a patient where clinical

nursing judgement was all on me. My patient was a female, in her mid-80’s, who presented with

SOB and was diagnosed with pneumonia. During my noon rounds, she was sitting in the chair,

very nauseous, and asked if I could get her lunch. I noticed she seemed working hard to breathe,

so I fixed her nasal cannula tubing hoping that would improve the oxygen she was receiving. As

I was setting up her lunch tray, I could tell her respiratory rate was increasing. My first thought

was, “what is her pulse ox?”. On my floor, the pulse ox machines are out at the nurse’s station,
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but something told me not to leave this patient to go get one. My first decision was to put the call

light on and hope someone could bring it to me. Within a few seconds, my nurse brought me a

monitor. Assessing her pulse ox, she was at 90 with 3 L via NC. As I noticed her respiratory rate

increasing, I thought back to critical care during our respiratory chapter. My thought was, “What

happens to someone who is breathing so rapidly?”. The first thing that popped into my mind was

ABG’s. During this time, my nurse and I called the doctor and explained what our patient was

experiencing. Luckily, the doctor was right on the floor and came to assess our patient with us.

While waiting for the doctor to arrive however, my nurse asked me what I expected my patient’s

ABG’s to be. I immediately thought, “she had a high respiratory rate and she was

hyperventilating, therefore they would be interpreted as respiratory alkalosis”. We got stat

ABG’S on our patient and was also ordered a stat EKG, and stat Labs. While getting our ABG’S

and placing leads on for the EKG, I noticed she was still breathing rapid and seemed like she was

very uncomfortable. My nurse was speaking to the doctor, and I blurted out “We need to check

her temperature, she keeps complaining of chills”. My nurse, who was allowing me to take the

lead, went to go get a thermometer and sure enough, she had a temperature of 103. While the

EKG showed what we already knew about our patient (stable A-fib), I knew something still

wasn’t right. By this point, more nurses, doctors, and staff came in the room and RRT was called

on my patient. It was determined that she was becoming septic. She only had just started being

treated for severe bacterial pneumonia, which she was experiencing symptoms of, for weeks.

This was the first time I ever had a patient in a situation as serious as this one where I was trying

to critically think what to do next. After many interventions were made and my patient was

stable, my nurse and I discussed making judgement calls. She told me to never feel ashamed if I

must call an RRT on a patient and to not second guess my gut feeling. At this moment, in my
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senior year of nursing school, I felt like I used clinical nursing judgement appropriately and

helped make appropriate intervention happen as my patient was declining.

Looking at the importance of clinical nursing judgement, it is used in practice every

single day. According to the British Medical Journal, or BMJ, “Nursing practice demands that

practitioners display sound judgement and decision-making skills as critical thinking and clinical

decision making is an essential component of nursing practice”. (The BMJ, 2018). The British

Medical Journal also goes on to explain how the importance of clinical nursing judgement plays

a role in patient outcomes. As a nurse, being effective with assessments, paying attention to

details, and talking and interacting with your patients are all important for improving their

outcome upon discharge. According to Nurse Journal, “Clinical skills in nursing are obviously

important, but critical thinking is at the core of being a good nurse”. (https://nursejournal.org/,

2018). When I think to myself what kind of nurse I want to be, “good” is at the top of my list. I

want my patients to know they are in good hands, and that I am capable of being their advocate,

teacher, care giver, and decision maker all in one. When I started nursing school, I was asked to

take a Kaplan test that examined my critical thinking skills. I was asked prioritization questions

and many other questions that made me really think about what I would do in various situations.

Three years later, I took another critical thinking test, just like the one I had taken three years

prior. I was amazed at myself with how much more I felt I understood the questions, my

confidence in answers, and how I perceived the situation. Clinical nursing judgement was

instilled in us young student nurses the day we started nursing school. It has grown with me over

the years and has truly shown me how important my role is as a nurse, even though I am still just

a student.
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In conclusion, clinical nursing judgment grows along with the nurse. It is an important

part of the nursing process and allows us nurses to make decisions in the best interest of our

patients. As my example above showed, my experience with clinical nursing judgement was just

the beginning of my critical thinking skills. As I grow as an RN, and experience many different

patient situations, I will start the transition from a novice nurse to a skilled experienced nurse.
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References

https://nursejournal.org/, 2. (2018). The Value of Critical Thinking in Nursing +

Examples. [online] Nursejournal.org. Available at: https://nursejournal.org/community/the-

value-of-critical-thinking-in-nursing/ [Accessed 18 Mar. 2018].

Nln.org. (2018). [online] Available at: http://www.nln.org/docs/default-source/default-

document-library/nursing-judgment-final.pdf?sfvrsn=0 [Accessed 18 Mar. 2018].

The BMJ. (2018). Nurses are critical thinkers. [online] Available at:

http://www.bmj.com/content/356/bmj.j1548/rr-0 [Accessed 18 Mar. 2018].