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Clinical Nursing Judgment Scholarly Paper

Elizabeth K. Roux

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Dr. Kim Ballone, Mrs. Wendy Thomas

March 2nd, 2020

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CLINICAL NURSING JUDGMENT

Definition of Clinical Nursing Judgment

Clinical judgment is a problem-solving activity, beginning with assessment and nursing

diagnosis, proceeding with planning and implementing nursing interventions and culminating in

the evaluation of the effectiveness of the interventions. (Victor, 2017, p. 237.) Nursing judgment

is a skill that every nurse has to use in his or her daily practice to make decisions effectively for

the patient’s best interest. “Knowledge development in clinical practice requires experiential

teaching and learning through facilitated, situated cognition with reflection.” (Kavanagh,

Szweda, 2017, p. 57.) Clinical nursing judgment is not something that can be taught in a

classroom. Through clinical experience, students gain the hands-on skills needed to make sound

judgments for the healing advancement of patients in a health care facility. Becoming a nurse is

much more than learning skills, medications, and procedures. The hands on experiences with

real patients are how students learn the process of nursing judgment in the clinical setting.

Importance of Clinical Nursing Judgment

Clinical nursing judgment is important in making decisions based on patient care and

safety. “There is a need for nursing education globally to assist nursing students in developing

the skills of critical thinking, clinical reasoning, and clinical judgment. Developing these skills

will require that nursing students develop the ability to: (a) analyze collected data (critical

thiking), (b) apply reasoning to the data obtained (clinical reasoning), and (c) appropriately act

based on the specific situation (clinical judgment).” (Sommers, 2019, p. 91.) Having good

clinical nursing judgment is so important because nurses need to know how to react when

something doesn’t go according to the care plan. Taking care of a patient is more than passing
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medications and charting, it is assessing the patient and learning what is their baseline, so when

deviations occur, the RN can recognize it and act accordingly.

Nursing judgment is severely lacking in new graduate nurses today. According to a study

done in 2017 by Joan M. Kavanagh and Christine Szweda at the Cleveland Clinic, new data

suggest that we are losing ground in the quest for entry-level competency. Graduates often are

underprepared to operate in the complex field of professional practice where increased patient

acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing

programs, have exacerbated a crisis in competency. New graduate baccalaureate nurses are

expected to have a high level of clinical competency, but they are underprepared due to the lack

of experience during the rigorous four or five year programs. The clinical portion of the

curriculum often takes a backseat to the demands of the course work required. Clinical situations

are extremely unpredictable. Student experiences differ greatly, depending on many factors

including facilities, patient assignment, and knowledge of the clinical instructor and or the RN

who was assigned.

Novice nurses and nurses with poor clinical judgment skills make more errors that

negatively impact patient outcomes, and the quality of patient care. Today’s nurses are expected

to have highly honed clinical judgment, yet most newly qualified nurses are ill-prepared for their

work. “They have not been clinically or educationally fully prepared for the demand for health

care and the greater accountability” that increased over time. (vanGraan, 2016, p. 281.)

Collaborative dialogue between students, educators and clinical mentors during patient

interaction is a tool to develop a nursing student’s ability to think critically, reflect, link concepts,

become self-directed and life-long learners. (vanGraan, 2016, p.280.)

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Personal Experience

Clinical nursing judgment is something I am still learning to use as a senior nursing

student, and in my role as a nurse’s aide at a local hospital. A few weeks ago at work, I was

taking 4:00 PM vitals on all of the patients who were wearing telemetry monitors. I went into the

room of an older female patient, and took her blood pressure on the Dinamap. The patient was

talking to me and her friend as the cuff was inflating. The machine beeped, and her pressure read

189/92. I asked the patient if her blood pressures normally run that high, and she replied that no

they didn’t, but she had been under a lot of stress lately. I told her that I was going to take it

again with the Dinamap and see if the pressure changed. The blood pressure was still upwards of

180/90, with the rest of her vital signs being normal. I told her I would be going to let her nurse

know, and I would probably be back in to take it with a manual cuff and stethoscope. The RN

was notified, and she gave me instructions to take it manually and to come back and tell her if it

was still high. The blood pressure was taken manually, and it was around the same as the first

two, still over 180/90. I reported this to the RN, and she said that the patient had a medication

ordered PRN for high blood pressures, and she would administer that dose immediately.

Using clinical nursing judgment, I was able to identify that this patient’s blood pressures

were out of normal range for a small, white female, with no other risk factors. I also made sure to

ask the patient what her baseline pressures normally read. I didn’t trust the first pressure reading,

so I took it again, and then a third time manually just to make sure that it wasn’t a false reading,

or technological error. I made sure to let the RN know that her patient was having abnormal

blood pressure readings three times in a row, and the RN used her clinical nursing judgment to

administer a PRN medication that would bring her pressures down to baseline.
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References

Kavanagh, J. M., & Szweda, C. (2017). A Crisis in Competency. Nursing Education

Perspectives, 38(2), 57–62.

Sommers, C. L. (2018). Measurement of critical thinking, clinical reasoning, and clinical

judgment in culturally diverse nursing students – A literature review. Nurse Education in

Practice, 30, 91–100.

Van Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses understanding of

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280–293.

Victor, J., Ruppert, W., & Ballasy, S. (2017). Examining the Relationships Between Clinical

Judgment, Simulation Performance, and Clinical Performance. Nurse Educator, 42(5),

236–239.