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Nursing Judgement

Emily Shields

Youngstown State University

March 19th, 2018

Clinical Judgement


Throughout the course of nursing school we are loaded with an innumerable amount of

information, constantly probed by our instructors to think through patient scenarios critically.

However, to be a competent nurse it cannot stop there. Beyond critical thinking a nurse must

acquire nursing clinical judgement. According to Moluk Pouralizdah, “clinical judgement is

assessing the needs of the patients and deciding about the continuance or adjustment in taking

care of them in a cognitive and reasoning thinking process” (2017 pg. 1). It is a basic nursing

skill (Pouralizdah 2017). Nursing judgment includes the use of the nurses knowledge, intuition,

critical thinking, and critical reasoning to interpret the data and achieve the best evaluation of the

patients’ conditions (Pouralizdah 2017). It is important to note that clinical judgement and

critical thinking, although overlap in some ways, are defined differently but used tandemly. Mary

Cazzell argues in that, “critical thinking and clinical judgement are two separate concepts and

require separate, concise definitions to guide nurses and nurse educators” (2016 no pg.). Critical

thinking is tool used to make a final nursing judgement. Additionally, critical thinking also does

not happen alone. First, the nurse must gain a range of knowledge on the patients she is caring

for in order to even begin implementing critical thinking and nursing judgement. According to

Robert J. Evans, “skills in themselves do not contribute to the development of the profession but

that the knowledge base and clinical judgement has to be developed in tandem with the skill in

order for nurses to play a meaningful role within the healthcare system” (2006 pg. 156). Many

times throughout nursing school we have heard the phrase, “listen to your gut.” This does not

mean to throw out the text books and do whatever you “feel” is best. It does however press us to

be aware of our patients’ situations and remember that our intuition and “gut feelings” need to be

listened to. A nurse can make a huge impact on the outcome of a patient and using her clinical

judgement is what facilitates the opportunity to improve the status of her patient.


A nurse is a vital component to the management and success of the patients care. The

nurse many times will be the one spending the most amount of time with the patient,

implementing most of the doctors’ orders, assessing the patient, monitoring the patient, and

caring for the patient. Their input is crucial and their competency is necessary. To be clinically

competent it is required that the nurse have knowledge, skill and judgment inherent in the

practice of the profession (Evans 2006). Without it, the trust and desire needed to work together

is not possible (Evans 2006). This is why the development of nursing judgment is so important.

According to Moluk Pouralizdeh, “With the development of clinical judgement, the nursing care

quality will be promoted. Clinical judgement is a reliable tool to achieve professional

competence. It can lead to creating effective health care interventions and promotion of the

health in patients” (2017 pg. 3). So one reason why clinical judgement is so important is that it

promotes the quality of care for the patient (Pouralizdeh 2017).

There are many things that are involved in obtaining proper clinical judgement and

becoming clinically competent. One study reported that only twenty four percent of new nursing

graduates meet clinical judgement expectations (Pouralizdeh 2017). So what can nursing

educators do to accelerate the nursing students’ development of clinical judgement and prepare

them to be competent in their field? Mary Cazzell would suggest to make more use of simulation

as a strategy to facilitate deductive skills (2016 pg. 89). Along with this the literature mentions

multiple times about the importance of learning “therapeutic communication” and “proper

interaction with patient” while developing clinical judgement (Pouralizdeh 2017). According to

Pouralizdeh, “there is an emphasis on the importance of effective communication with nursing

staff and patients in the development of students’ clinical judgement” (2017 pg. 6). And of

course, clinical judgement is also grown in a nurse by gaining more experiences. The nurses

knowledge level, experience, and skill at integrating these factors determine their level of

judgement in the healthcare setting (Evans 2006 pg. 154). Gaining clinical judgement as a nurse

should be a focus in both nursing schools and hospitals for the improvement of patient care.


In conclusion we can define clinical judgement as an implementation of knowledge and

critical thinking to make a proper evaluation of the patient’s status and make a decision for their

care. Clinical judgement is vitally important for the nurse to have, to participate in the

management of care effectively, improve the quality of care, and become competent in their

profession. Nurses can gain clinical judgement in many ways. They can participate in different

simulations to promote awareness of certain scenarios. They can learn how to effectively

communicate with their patient and the healthcare team involved in the care. They can continue

to grow in their knowledge and understanding of certain disease processes by completed the

required continuing education hours. They also will need to gain experiences by practicing as a

nurse for an extended amount of time and then learn to integrate their knowledge and experience

to make appropriate judgements. Overall, defining what clinical judgment is, understanding why

it is so important and learning how to gain it is a very important thing for the newly graduating

nurse to know.


Cazzell, Mary, and Mindi Anderson. “The Impact of Critical Thinking on Clinical Judgement

During Simulation With Senior Nursing Students.” Nursing Education Perspectives:

April 2016 Volume 37 - Issue 2 - p 83–90 doi: 10.5480/15-1553

Evans, Robin J., and Glenn W. Donnelly. “A Model to Describe the Relationship Between

Knowledge, Skill, and Judgment in Nursing Practice.” Nursing Forum, vol. 41, no. 4,

2006, pp. 150–157., doi:10.1111/j.1744-6198.2006.00053.x.

Pouralizadeh, M., Khankeh, H. R., Ebadi, A., & Dalvandi, A. (2017). Concept Analysis of

Clinical Judgment in Nursing Students: A Hybrid Model. Iranian Red Crescent Medical

Journal, 19(5), 1-9. doi:10.5812/ircmj.45373