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Clinical Nursing Judgment

Zachary J. Arbogast

Nursing Department, Youngstown State University

4852: Senior Capstone

Dr. Kim Ballone and Mrs. Wendy Thomas

March 15, 2021

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Clinical nursing judgment is a very important part of how a nurse flows throughout a

shift and adapts to an everchanging environment. It is essentially the backbone of nursing and in

my opinion a nurse would not be able to function without it. According to Hensel and Billings

(2020), “the National Council of State Boards of Nursing (NCSBN) defines clinical nursing

judgement as an observed outcome of critical thinking and decision making” (p.128). Nursing

judgement is used just as another barrier of safety for the patient. Hensel and Billings (2020)

states, “there is a growing concern that novice nurses, who pass the NCLEX-RN, do not actually

have the knowledge , skills, or cognitive abilities to practice safely” (p.130). I would have to

agree with this statement even though I am a novice nurse. A novice nurses clinical judgement

cannot strictly be tested by just taking exams. A novice nurse can better their nursing judgement

by gaining experience with clinical scenarios and real world practice.

Youngstown State Universities nursing program uses simulations, clinicals, and in class

case studies in order for nursing students such as myself, to build clinical nursing judgement

skills. This process I believe has allowed me to gain a decent base in nursing judgement

throughout the past four years. The NSCBN has developed a task model for nursing programs to

follow in order to better refine nursing student decision making. Hensel and Billings (2020)

states, “the NCSBN-CJM is an integrated model faculty can use that provides a concrete

structure for teaching students to think through clinical situations and develop sound clinical

judgement” (p.132). After reading through how this model curriculum is laid out, the

Youngstown State University nursing program has definitely followed the layout of this model,

which will allow myself and fellow nursing students to feel better prepared for safe real world

practice. My personal definition of clinical judgment and the actual definition are very similar to

one another. Clinical nursing judgment is probably the most important component in nursing.
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As I stated, the importance of nursing judgment is very essential, not only for the nurses

work day to flow better, but also for better quality patient outcomes. I myself, like probably most

other nursing students at this point in time, have a sense of self-doubt when it comes to certain

aspects of nursing judgment and patient care. In my own personal experience it has never been

hard for me to talk with patients, but it has been difficult for me to put the pieces together for the

physiology of a disease process that the said patient has. With all things, I feel the only thing that

can better help me with this issue would be nothing but experience that I will gain throughout my

career. The nursing professors at Youngstown State University have done a great job guiding me

through the process of learning the material in the class room and applying it at the clinical

setting. One nursing article I found discusses how classroom activities support the process of

mastering physiology.

Bingen et. al (2020) states, “Active learning could promote nursing students engagement,

knowledge acquisition, competence and confidence” (p.2907). I completely agree with this

statement made by this author. In my personal ways of learning, active learning has always been

a stronger way for me to completely absorb the material being taught. Bingen et. al (2020) also

states, “Research indicates that on campus activities are crucial to the success” (p.2907). For an

example, throughout the nursing program we have done things such as last day clinical scenarios,

which have allowed us as a clinical group of nursing students to put together our knowledge to

work towards the best possible patient outcome through active learning. I remember the first one

I had to do in professional nursing one was difficult, but once I got into the scenarios for senior

year they got much easier, as do most things with time. Fogg et. al (2020) states, “Findings

suggest that virtual simulation is beneficial to student learning and the development of clinical

judgment skills” (p.58).

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Over the past four years I have had many personal experiences that have allowed me to

develop my clinical nursing judgment. Each one of them has slowly molded me into the future

nurse I will soon become. Although I have had many, there is one in particular that stands out in

my memory. The personal experience that stands out to me the most, where I had to use clinical

nursing judgment took place during precepting this semester at Trumbull hospital in the

emergency department. The experience involved a patient that was suffering from having the

urge to urinate and being unable to successfully without the help from a Foley catheter. The

patient had been in the emergency department the previous day and had his indwelling Foley

taken out due to it causing him to much discomfort. The patient also has a history of benign

prostatic hyperplasia. The previous day it was stated the patient had a burning sensation and

some blood in his Foley bag. The patient was not incontinent, however, he stated that he just had

trouble getting the initial process of voiding started. The nurse and physician the previous day

decided it would be best to pull the Foley to relieve discomfort and encourage him to void on his

own. The emergency room physician the next day during my shift ordered an indwelling Foley

catheter for the patient to help aid in voiding due to him returning the next morning stating he

was just in too much pain to initiate the process.

Rather than just putting the same type of Foley in that would possibly just cause the same

issues he was previously already having, the precepting nurse and I used our clinical nursing

judgment, which allowed us to think to use a three-way lumen Foley catheter. The idea would be

that we would be able to attach and infuse a bag of saline, or irrigating solution that may help in

irrigating out any issue in the urethral canal. The emergency room physician also prescribed the

patient pain medications until he was able to go see a urologist to better aid in his care. This

decision of Foley catheter, I believe gave this patient the best possible outcome.
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References

Bingen Maria Hanne MSc; Steindal A. Simen RN, PhD; Krumsvik Johan Rune PhD; Tveit Bodil

RN, PhD; Study physiology within a flipped classroom: The importance of on-campus

activities for nursing students’ experiences of mastery; Journal of Clinical Nursing:

4/6 2020 – Volume 29 – Issue 3 – p 2907-2917

Fogg, Niki MS, RN; Kubin, Laura Phd, RN; Wilson Elaine Cecilia Phd, RN; Trinka Michele

MSN, RN; Using Virtual Simulation to Develop Clinical Judgment in Undergraduate

Nursing Students; Clinical Simulation in Nursing: 11/20 2020 – Volume 48 – p55-58

Hensel, Desiree PhD, RN, PNCS-BC, CNE, CHSE; Billings, Diane M. EdD, RN, FAAN, ANEF

Strategies to Teach the National Council of State Boards of Nursing Clinical Judgement

Model, Nurse Educator: 5/6 2020 – Volume 45 – Issue 3 – p 128-132