Running Head: Clinical Nursing Judgement Saves Lives 1

Clinical Nursing Judgements Saves Lives

Megan E. Fagert

Youngstown State University, Nursing

NURS 4852: Senior Capstone Seminar

Mrs. Thomas

2/28/22
Clinical Nursing Judgement Saves Lives 2

Clinical Nursing Judgements save lives

Clinical Nursing Judgement is one of the most important skills a nurse can possess. This

involves being competent in nursing skills, mindset, and knowledge to take care of their patient

to the best of their ability. According to Muntean (2011), “Sound clinical reasoning and clinical

decision-making is largely considered a “hallmark” of expert nursing” (p. 1). Nurses must have

the ability to use clinical judgment and critical thinking. Their judgement and decision making

often have life or death otucomes. Nurses hold many different responsibilities when it comes to

the patients they care for, whether it be advocating when they see something is off or being

competent in their care and skills in general. Clinical judgement accumulates overtime in nurses

so taking advice from more experienced nurses will benefit new grad nurses in the long run.

Graan (2016) claimed, “Higher cognitive skills are essential competencies for nurses joining the

technologically and increasingly complex health care environment to provide safe and effective

nursing care” (p. 280). It takes time to build of the skills and competencies needed for improved

patient care. When gaining these skills, nurses become better at analyzing situations and making

use of objective and subjective data while on the job. Clinical nursing judgment leads to

improved patient outcomes overall.

Clinical Nursing Judgement is critical in the medical profession. Victor-Chmil (2013)

claimed, “The term critical thinking, clinical reasoning and clinical judgement are intercalated

concepts. Each represents an important set of processes leading the nurse to sound, evidence-

based practice” (p. 1). All of these are correlated with each other and are important while

providing care. Nurses have many jobs during their shift and they’re responsible for a lot. This

can cause them to get overwhelmed. It’s important they are using their critical thinking skills and
Clinical Nursing Judgement Saves Lives 3

clinical nursing judgement always. Critical thinking will provide the way to clinical nursing

judgment. If there is no critical thinking, then clinical judgement may become weakened. With

clinical judgement becoming weakened, it leaves room for errors within the scope of practice.

This helps promote better health care to the patients. When using clinical judgement, the goal is

to evaluate the patient for the best treatment and care for their individual diagnosis. Application

of knowledge is important when it comes to clinical nursing judgement so as nurses advance in

the profession, they become more competent in this skill. Clinical judgement is a complex topic

because it covers so much of what a nurse is supposed to do on the daily. Tanner (2006) found,

“Good clinical judgments in nursing requires an understanding of not only the

pathophysiological and diagnostic aspects of a patient’s clinical presentation and disease, but

also the illness experience for both the patient and family and their physical, social, and

emotional strengths and coping resources” (p. 2). Nurses must be competent in their learning as

well as their jobs in general. There’s a lot of aspects that go into the topic of nursing judgment.

As a nurse, we must know about the different nursing diagnoses our patients have and how to

implement care with them. Clinical nursing judgement involves the nursing process steps of

assessment, planning, implementation, and evaluation.

A personal experience I had involving the use of my clinical nursing judgement was

during one of my first shifts precepting. My nurse and I were caring for four different patients

that day. I had to decide which patient to assess and get vitals on first based off my own

judgement and prioritizing skills. When we went around with the night shift nurse to get report,

we went through each room, and I observed each patient individually. One of my patients was

said to be going through withdrawal from alcohol and when we went into the room, he was

shaking and sweating excessively. I decided he was the first patient I would go in to assess. I
Clinical Nursing Judgement Saves Lives 4

went in there right away with the dynamap to get some vitals and do his head to toe. He stated

that he was freezing even though he had six blankets on him. The nurse said he was shaking and

most likely was in withdrawal. I noticed his breathing didn’t sound right as soon as I walked

into the room. I quickly hooked him up to the dynamap to get some vitals. His oxygen ended up

fluctuating between 60 and 65%. My patient was already on 9L of oxygen per minute. I put his

head of the bed up as far as it would go to see if it would improve his oxygen status. I also made

sure that pulse oximetry reading was accurate by using other fingers to check it as well. I called

my nurse in to inform her about the patient’s status and we tried to up his oxygen to see if it

would improve his oxygen saturation. He wasn’t improving with a couple interventions we did

involving trying to use a mask since I noticed he was breathing primarily through his mouth

rather than his nose. The nasal cannula wasn’t a good option for him at this moment because

even when we would tell him to breathe in through his nose it was wasn’t improving his oxygen

level. We called the Respiratory Therapist into the room, and she tried to get him on the Bipap

machine. He wasn’t improving so we ended calling the rapid response team. The RRT ended up

being over two hours long and we were able to stabilize him with the Bipap machine. We then

had to take him down to the ICU once he was stabilized.

I thought I showed excellent clinical nursing judgment by deciding to go assess him first.

I think it’s so important to get reported off in the patients’ rooms so you can observe the patients.

Observing the patients before going in to do my complete assessment gives me a good idea of

who I should see first. Depending on how many patients a nurse has will determine how much

time it would take to get into each patient’s room. If I wouldn’t have went to him first, then the

situation could’ve turn out very different. I think we would’ve wasted valuable time and the

patient’s status would’ve been much worse if I waited to see him. My patient was withdrawing
Clinical Nursing Judgement Saves Lives 5

from alcohol, but no one was too worried about him because they blamed his symptoms on him

being in withdrawal. He was shaking uncontrollably and said he was freezing with more than six

blankets on. His breathing didn’t sound good, so I jumped in quick to assess. I was proud that

day and felt my clinical nursing judgment was strong. I’m happy I was able to help that patient

and notice he was having an oxygen saturation issue because things could’ve been worse if I

hadn’t have seen him as my top priority that day of care.

Clinical nursing judgement is a huge skill and asset that all nurses should have and be

competent in. Overtime, a nurse’s judgement will improve due to experiences in the profession.

As a new graduate it will be important to take advice from nurses with experience. My clinical

nursing judgement that I chose to discuss is something that I’m proud of. All the clinical

experience the YSU Nursing program has given me has continued to build my clinical nursing

judgement. I look forward to my critical thinking and judgement improving overtime as I go on

to take a job as a nurse. The use of clinical judgement can mean life or death for a patient so it’s

crucial that it’s being used.

Clinical Nursing Judgement Saves Lives 6

References

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

clinical judgement: A contextual inquiry. Health Sa Gesondheid, 280.

https://doi.org/10.4102/hsag.v2li0.967.

Muntean, W. (2011). Nursing clinical decision making: A literature review - NCSBN. Retrieved

February 18, 2022, from

https://www.ncsbn.org/Nursing_Clinical_Decision_Making_A_Literature_Review.pdf

Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment in

nursing. The Journal of nursing education, 1-3. https://doi.org/10.3928/01484834-

20060601-04

Victor-Chmil, J. (2013). Critical thinking versus clinical reasoning versus clinical judgement.

Nurse educator, 38(1), 1. https://doi.org/10.1097/nne.0b013e318276dfbe.