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Analysis of Clinical Nursing Judgment

Michaela Huber

Nursing Department, Youngstown State University

NURS 4852 Senior Capstone

Ms. Thomas, Dr. Ballone

March 2, 2020
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Clinical Nursing judgment is an acquired skill in the field of nursing that improves patient

outcome and quality of life. It is used every day in numerous situations. Although this skill is

taught and reviewed in school; it truly comes with experience. Through data collection and

patient interaction, the nurse is able to develop appropriate clinical nursing judgment. To

obtain this level of judgement, a nurse must first understand the concept, value the importance

and practice it daily. With this skill, a nurse assists in detecting life altering signs and symptoms

and increasing the patient’s quality of life and success rate.

Clinical nursing judgement is the practice of a registered nurse making sound decisions

based off of subjective and objective data. This data is then applied to problem solving in a

clinical setting. Whether the situation requires a call to the doctor, withholding a medication or

continued close monitoring, the nurse is constantly making clinical decisions based on their

experience and professional judgement. The nurse decisions lie within the best interest of the

patient. Nurses throughout the day “must notice subtle cues and changes in a patient’s

condition to prevent complications and detect problems as soon as possible” (Manetti, 2018).

Nurses are required to have advanced critical thinking skills to assess a situation and possible

outcomes before making a decision that can affect a patient’s life. Making a judgement must

first begin with collection of data. Whether this is through the RN assessment or unlicensed

personal observations, “the ability to identify salient information in uncommon situations is

crucial” (Manetti 2018). The nurse must recognize unusual data that can be incorrect or

dangerous. This may require the professional to double check their data, or in an emergency,

make a quick judgement call. Dr. Manetti ( 2018) stresses 5 attributes used in making a

decision: Holistic assessment, critical thinking, practical wisdom, intuition, and reflection.
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Holistic assessment allows the nurse to collect data by evaluating the entire patient situation.

Critical thinking, practical wisdom, and intuition are valued skills that are acquired with clinical

experience. Lastly, reflection gives the nurse the opportunity to review her actions and decide

any further interventions to improve the situation. These attributes can assist a nurse in making

appropriate decisions that lead to the best outcome for the patient.

Clinical Nursing judgment is a “vital skill that enables a nurse to determine the

appropriate nursing interventions when planning patient care, especially the ability to manage

rapidly deteriorating patients” (Graan 2016). Nursing judgement can help improve the

treatment plan, and ultimately, the outcome of the patient’s condition. Whether the nurse is

monitoring a patient’s blood pressure or determining the necessity of a Rapid Response Team,

all nursing judgements can vastly affect a patient’s life. Nursing judgement establishes the need

for patient interventions. Regardless of the situation, it is pertinent the nurse takes the time to

assess the status properly. “Creative thinking and critical judgement is viewed as essential

skill”(Graan 2016) and needed throughout the clinical setting. These judgments allow the nurse

to evaluate the patient’s signs and symptoms in relevance with their history and quickly

determine the best action in a given situation. The nurse takes the responsibility of assessing

and evaluating to make further decisions. It is the nurse’s goal and duty to provide the high

level of care for the patient and provide appropriate clinical nursing judgement to make life

saving decisions.

A critical thinking situation recently occurred in my preceptorship. A new admission was

transported to the floor and I was delegated the task of taking her vital signs. The monitor read

her blood pressure as 210/90 so immediately I retrieved a manual blood pressure cuff. It was
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important to double check myself as well as double checking the machine. After using the

manual cuff and measuring the same blood pressure, I knew it was necessary to continue

investigating. “Clinical reasoning must arise from this engaged, concerned stance, always in

relation to a particular patient and situation” (Tanner 2016) which is done by the collection of

data. After collecting my data, I brought this to the attention of my preceptor since the next

steps were in her scope of practice. Subsequently to my data collection, the nurse’s clinical

response would be based off of the patient’s vital signs and symptoms at the time they were

taken. The nurse saw my data as valuable and reliable and made a nursing judgment call. After

reviewing the patient’s history, she called the doctor. This decision was formulated through

“generalized knowledge and rational process” (Tanner 2016). After contacting the doctor, a

beta blocker was prescribed to the patient. The nurse continues to use judgement to decide if

this medication is appropriate before administering. The nurse, patient, and I discussed the use

of this medication and all parties agreed it was in the best interest of the patient. Nursing

judgement is not “objective, detached and exercised with the patients concerns as a sidebar”

but includes the patient in the plan of care. Both my preceptor and I made appropriate clinical

nursing judgement in our scope of practice.

Clinical nursing judgement is a skill that comes with education and experience. Every

decision regarding a patient is vital to the patient’s outcome. Nurses treat every patient

uniquely and carefully, taking extra time in monitoring signs, symptoms and history, which

assist them in developing individualized interventions. All decisions are lifechanging and can

affect the course of the patient’s life. Clinical nursing judgment is a valuable skill used every day

in the nursing practice.

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References

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

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

10.1016/j.hsag.2016.04.001

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102–110. doi: 10.1111/nuf.12303

Tanner, C. A. (2016). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in

Nursing. Journal of Nursing Education, 45(6), 204–211. doi: 10.3928/01484834-

20060601-04