Running head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Ashley Dibble

Youngstown State University

CLINICAL NURSING JUDGMENT 2

Abstract

Clinical nursing judgement is developed overtime through clinical experience. Having strong

fundamentals such as abstract and critical thinking skills are qualities many nurses acquire

throughout nursing school to ultimately help make decisions in the clinical setting. Nurse

educators have been the ones challenged to prepare future nurses with a solid foundation of

knowledge, skills, and a pattern of thinking to help problem solve that would translate effectively

into practice (Bowler, 2019). This tall order is what’s needed to build the foundation of critical

nursing judgment amongst future nurses. This paper will go into an in depth exploration on the

concept and importance of clinical nursing judgment. Then, I will discuss a personal experience

and situation where I had to use my best clinical nursing judgment.

CLINICAL NURSING JUDGMENT 3

Clinical Nursing Judgment

The concept of clinical judgment encompasses many components. It is the decision

making process that nurses go through to generate the safest and best solutions for the identified

concern. Nurses take subjective and objective data in a presenting situation to respond to the

concern in a timely, appropriate, and meaningful way. Clinical decision making is a necessary

competency for all nursing students. It is generated from a combination of education and

experience (Eisenmann, 2021). As nursing practice evolves rapidly in the ever changing health

care environment, “nurses are required to care for highly acute, complex patients with multiple

comorbidities while juggling an increasing number of work related cases (Eisenmann, 2021).

This means nurses must apply a vast amount of knowledge while providing patient care for

positive outcomes.

Critical thinking is a major component of being able to make clinical nursing judgment.

In nursing school, “clinical experiences are used to facilitate the application of knowledge and

development of nursing students’ critical thinking (Christy, 2018). Nurse educators play an

integral role in the development of a students critical thinking. Educators can role model their

own critical thinking in a clinical learning environment to prompt discussion, reflection, and

further understanding (Christy, 2018). This allows students can get an understanding of the

thought processes that nurses go through to achieve best clinical judgment. Then through

conversation of emphasizing a student’s strengths and previously learned skills the educator can

challenge a student to their critical thinking through a series of purposeful questions (Christy,

2018). This allows a student to start to connect their knowledge to situations in the clinical

setting and help develop their confidence.

CLINICAL NURSING JUDGMENT 4

Developing a strong sense of clinical nursing judgment is important because according to

“the 2014 National Council of State Boards of Nursing (NCSBN) practice analysis found current

nursing practice required licensed nurses to make increasingly more complex decisions”

(Eisenmann, 2021). Clinical nursing judgment is what allows nurses to apply clinical data to

think abstractly, prioritize tasks and see a more global picture in nursing care. It allows for

“higher level cognitive processing than simply drawing lines” (Eisenmann, 2021). Clinical

judgment development is necessary because it leads to appropriate nursing diagnoses, clinical

decision-making, and health promotion.

A nursing student’s lack of experience can make it difficult to make appropriate clinical

nursing judgment. According to the study, An Innovative Clinical Concept Map to Promote

Clinical Judgment in Nursing Students, the use of concept maps while in nursing school allows

students to show their learning and understanding of connections between clinical concepts.

Concept maps are used by nurse educators to assess a nursing student’s knowledge regarding

nursing care in a clinical or learning environment (Eisenmann, 2021). A concept map outlines

the information of a patient in a way where the nurse can analyze, interpret, and identify a patient

needs. The use of this tool in clinical experiences allows nursing students to learn and establish a

“pattern of potential clinical scenarios with each disease experience” (Eisenmann, 2021). Once

these patterns are paired with disease processes it within itself evolves a novice nurse’s clinical

judgment because the framework has already been thought about previously and can guide the

appropriate care and interventions. Although concept maps are a great tool, clinical experience is

still needed to provide authentic, high quality clinical learning opportunities for students

(Bowler, 2019). The experimental learning that takes place in the clinical setting is key in the

development of clinical nursing judgment.

CLINICAL NURSING JUDGMENT 5

As a nurse, you are constantly using your best clinical judgment. It is enhanced,

sharpened, and strengthened overtime through experiences in the clinical setting. There have

been multiple times where I have had to use my clinical nursing judgment. One experience was

while admitting and conducting a baseline assessment with my preceptor the patient was

unresponsive. He was stable on the monitor but would not respond to anyone including his son

who was in the room with us. We tried waking him with multiple attempts of sternal chest rubs

and shoulder taps while repeatedly saying his name. Still nothing, no movement, or signs of

consciousness. This was a very scary moment because we knew nothing about this patient other

than what was said during report from the floor he was previously on. After many unsuccessful

attempts of trying to wake this client up, we made an executive decision to call the Cardiac

Medical Emergency Team (CMET). Our nursing clinical judgment allowed us to recognize that

this was not normal and extra precautions were necessary at the time to make sure this patient

was safe even though the monitor was telling us he was stable. When CMET arrived, there was

many more people in the room assessing him and asking questions to his son because he was still

not responding to anyone. The team was working on getting another IV access site, drawing

ABGs and putting the defibrillator pads on him as cautionary measures. We had to be ready in

case a medical emergency was to develop. Once people started to poke and turn the patient, he

did start to make some sounds to let us know he was with us. Turns out he was just very groggy

and in a deep sleep, but as a nurse we have to take these sorts of precautions to make sure our

patients are not deteriorating. In this particular situation, my nurse and I gathered information on

this patient and made an appropriate decision to call a CMET to ensure the safety and well being

of our patient. We critically thought of ways to try and stimulate the client before initiating the
CLINICAL NURSING JUDGMENT 6

CMET and after many unsuccessful attempts we had to make the call. Ultimately, our clinical

nursing judgment lead us to the decisions we made.

Overall, clinical nursing judgment is a very important intuition that develops overtime

through experience. It is an important skill to devote time into developing because there is a high

standard of care in the healthcare environment. Creation of concept maps was one way nursing

students could enhance their clinical judgment. Nurses of tomorrow will be challenged to use

their skills, knowledge, critical thinking, professionalism, and technical proficiency to make

accurate judgments in the clinical setting.

CLINICAL NURSING JUDGMENT 7

References

Bowler, C. (2019). We must strengthen clinical nursing education! Reflections on Nursing

Leadership, 45(3), 167–172.

Christy, R., Profetto-McGrath, J., Myrick, F., & Strean, W. B. (2018). Balancing the seen and

unseen: Nurse educator as role model for critical thinking. Nurse Education in Practice, 31,

41-47. doi:http://dx.doi.org.eps.cc.ysu.edu/10.1016/j.nepr.2018.04.010

Eisenmann, N. (2021). An Innovative Clinical Concept Map to Promote Clinical Judgment in

Nursing Students. Journal of Nursing Education, 60(3), 143–149. https://doi-

org.eps.cc.ysu.edu/10.3928/01484834-20210222-04