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Clinical Nursing Judgement and the New Nurse

Emily Kurnot
Nursing Department, Youngstown State University
NURS 4852: Senior Capstone
Dr. Kim Ballone
March 15, 2021
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Clinical Nursing Judgment and the New Nurse

Healthcare has evolved drastically over the past few decades due to the advances in

technology. Patients are more accurately monitored and exponential amounts of new

interventions are being used to improve patient outcomes (Graan et al., 2016, p.1). Even with all

these improvements, registered nurses are still the individuals accountable for monitoring and

advocating for the patient’s best interest. The registered nurse must gather all assessment

findings and make a decision based on clinical nursing judgment. Clinical nursing judgment is a

concept that is critical for patient safety and good patient outcomes, yet it is one of the hardest

skills for a nurse to acquire and very difficult to define.

Clinical nursing judgment is a very broad term that encompasses everything from the

nursing process to critical thinking. According to Betts et al. (2019), “Clinical judgment is a

higher-order cognitive construct that represents medical knowledge, skill, decision making, and

critical thinking” (p.1). It is very important to understand all the different concepts that go into

clinical nursing judgment. The nurse must build and accumulate these different aspects in order

to have sound nursing judgment. Furthermore, Betts et al. (2019) went on more in depth to state,

“A combination of critical thinking and decision-making skills that is based on a solid foundation

of basic professional medical knowledge, in this this case with respect to nursing knowledge and

is critical to the general nursing process” (p. 1). These definitions of clinical nursing judgment

display how much experience and overall understanding of the health care system an individual

must have before acquiring this perplex skill.

The vast amounts of components that go into clinical nursing judgement are what make it

very hard for new graduate nurses to be component in this skill. It takes a solid foundation of

medical knowledge and skills which is just impossible to possess as a newly graduated registered
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nurse. According to Seidi et al. (2015), “… results show significant correlation between

residents’ skillfulness and their ability to make accurate clinical judgments” (p.12). Due to the

enormous amounts of skills that are encompassed in a nurse’s scope of practice, there is just no

way a freshly graduated nurse will be competent in all skills. Therefore, this will hinder their

ability to make sound clinical nursing judgments. New graduate nurses have also never been put

into a situation where they had to make a medical decision on their own, unless they were

previously employed in the medical field. Nursing students are taught to verify all actions they

do with their clinical instructor prior to carrying out any intervention. Although this is needed to

ensure safety to the patients, it increases the difficulty nurses will have adapting to their role of

the decision maker for all their patient’s care upon graduation. Research has shown that nursing

faculty need to better facilitate nursing students’ ability to autonomously think in the clinical

setting to better prepare them to use clinical nursing judgement as a nurse (Graan et al., 2016, p.

289). According to the research conducted by Seidi et al. (2015), “They (new nurses) were

struggling for gaining professional autonomy, striving for integrating clinical judgment skills,

scrambling to make effective educational interventions and striving for professional and

interprofessional collaboration in clinical judgment” (pp.1-2).

Why is there such a focus on clinical nursing judgment? Clinical nursing judgment is

critical to ensure safe and effective care to all patients. It acts as a fundamental backbone that

guides nurses as they make decisions about how to respond to patients’ condition changes and

what interventions need to be made. According to Graan et al. (2016), “Clinical judgement has

been recognized as a vital skill that enables nurses to determine the appropriate nursing

interventions when planning patient care, especially the ability to manage rapidly deteriorating

patients” (p. 281). I really like how this study brought up rapidly deteriorating patients. It shows
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the emphasis that clinical nursing judgment has on quick decision-making skills that are critical

to have to ensure optimal outcomes for all patients.

To better understand the importance of this concept, I would like to describe a scenario in

which I had to use clinical nursing judgement. I work as a float student nurse extern. At the time,

I was working on a Covid unit in the hospital. I was gowned up in proper personal protective

equipment to discharge a patient. While walking down the hall, I noticed a different patient with

their BiPAP off and they were out of bed walking alone to the bathroom. This patient did not

speak English and the dialect of Lebanese wasn’t supported by our interpreter iPad. I

immediately knew something was wrong. I used my nursing judgment to prioritize assessing this

patient over my planned discharge. I ran into the room and looked at the floor which was covered

in blood. This patient was on heparin and had ripped their IV out. I grabbed the patient and

guided him to the toilet to prevent him from falling as he was closer to his toilet than the bed. I

opened the door and yelled out the hallway for help as I noticed the patient’s oxygen was now

84% but the BiPAP couldn’t be moved to the restroom and the nasal cannula cord wasn’t long

enough to reach either. While waiting for the other nurse to properly gown up, I applied pressure

to the site in which the IV was ripped out to stop the bleeding. Once the other nurse entered the

room, we decided it was best to each get under an arm and carry him back to bed so the BiPAP

could be reapplied because his oxygen was continuing to drop. Once we successfully got him

back into bed and his BiPAP reapplied, his vitals continued to drop so we decided a rapid

response team must be called. We continually obtained vitals as well as a blood sugar until

further help arrived. This scenario shows how important it is to use clinical nursing judgement

which embodies nursing skills, decision making, and critical thinking in order to have optimal

patient outcomes.
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Clinical nursing judgement is a crucial skill for all nurses to master. There are many

different components that make up this concept and they include decision making, critical

thinking, medical knowledge, and a foundation of skills. These aspects make it very difficult for

a new nurse to have sound clinical nursing judgment as well as the lack of autonomy nursing

students have prior to graduation. Clinical nursing judgment is vital to the nursing process and is

used when planning and managing care. It is a tool that is used to ensure optimal outcomes for

every patient that a nurse encounters. While clinical nursing judgment is difficult to define, the

impact it has on nursing practice is exponential.

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References
Betts, J., Muntean, W., Kim, D., Jorion, N., & Dickison, P. (2019). Building a Method for

Writing Clinical Judgment Items for Entry-Level Nursing Exams.

https://ncsbn.org/Building_a_Method_for_Writing_Clinical_Judgment_It.pdf

Seidi, J., Alhani, F., & Salsali, M. (2015, September 28). Nurses' clinical judgement

development: A qualitative research in Iran.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601210/

Van Graan, A., Williams, M., & Koen, M. (2016). Clinical judgement within the South African

clinical nursing environment: A concept analysis. http://www.scielo.org.za/scielo.php?

script=sci_arttext&pid=S2071-97362016000100011

Van Graan, A., Williams, M., & Koen, M. (2016, April 05). Professional nurses' understanding

of clinical judgement: A contextual inquiry.

https://core.ac.uk/download/pdf/82645364.pdf