Clinical Nurse Judgment

Clinical Nurse Judgment

Ashley Veneroso

Nursing Department, Youngstown State University

NURS 4852: Senior Capstone

Mrs. Thomas and Dr. Ballone

February 28, 2022

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Starting this next chapter of officially transitioning from a nursing student to a registered

nurse will require my clinical nursing judgment to be constantly utilized. So, what all does

clinical nurse judgment entail? Clinical nurse judgment can be described as the nurse’s ability to

analyze and synthesize the objective and subject data of a patient, and to correctly respond to

improve the patient’s outcomes (Embler, 2021). Utilizing the skill of clinical nurse judgment is

often critical in providing safe and effective care for patients. Being able to notice when a patient

has a change in status and quickly responded can be life or death for patients. As the nurse, you

are often the first person to notice a patient declining and the one who is first to respond to the

situation. Although working in the hospital you will have a team of people there to help, it is

your responsibility to first notice and utilize your judgment skills. This article states the overall

process of clinical judgment, “The process leading to clinical judgment involves the integrated

thinking about a patient and begins when a nurse notices something about a patient’s situation

that demands attention” (Lavone, 2019, p.3791). This process is necessary to provide care for

patients and needs to be utilized for every patient regardless of the situation.

Clinical nurse judgment has been a focus throughout nursing school because of how

much the skill will be needed in the field. Although acquiring clinical nurse judgment requires

experience and confidence. Being a nursing student, I have found that I am often able to analyze

the most obvious signs but fall short when it comes to analyzing the small judgment choices.

This article talks about why it is hard for new nurses to be able to use this skill, “The

phenomenon used is referred to as reality shock” (Maeland, 2021, p.291). This situation relates

to the gap between what is learned in the educational classes versus the reality of clinical

challenges. (Maeland, 2021) I could see how this is a challenge for utilizing clinical nurse

judgment as a new nurse. Often the reality of what you learn is a perfect world of how
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everything will happen but, it’s going to be completely the opposite when it comes to a real

clinical situation. Overall, my preceptorship has helped me keep obtaining my clinical nursing

judgment skills and I am working on them every shift.

In my time in nursing school, I found that clinical nurse judgment does not always have

to be about using it to identify patients’ status. Often, I have used clinical nurse judgment as a

prevention method that would help keep my patient safe and in a stable condition. An example of

when I utilize clinical nurse judgment a lot would be medication pass. I have been placed in

many situations with using judgment about medication pass. The first time would be knowing

when to withhold medications. I find this often the hardest as a new nurse, there often are no

orders when to hold medications unless there is something specific ordered by the doctor that

day. For example, we were administering metoprolol, and before administering it is important to

check the blood pressure and heart rate. Once checking the heart rate, we found it to be 55bmp

which would require us as the nurse to hold the medication. As a nurse, this can seem like a

simple task but being a new grad, it was a moment that I was the one who took initiative to make

sure we do not give the medication. This article, states that “Unsafe medication practices are the

leading causes of avoidable patient harm in the healthcare system across the world”

(Wondminenh, 2020, pg.1). This is a huge issue and happens more than it should in a hospital, it

can be extremely dangerous to the patient as well. Nurses often can get tired from working a

twelve-hour shift that these are the little things that can get overlooked. A study stated that “Out

of 203 nurses 68.7% reported committing medication administration errors in the previous 12

months” (Wondmineh, 2020, pg.1). This statistic has many factors that can contribute to why

these errors are occurring. Often factors that contribute are things such as lack of adequate

training, unavailability of a guideline for medication administration, inadequate work experience,

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interruption during medication administration, and working night shift These factors were all the

main contributing factors to the errors (Wondemich, 2020). I just want to point that out of those

factors many are what new nurses will face. Most new graduates will start on night shift, we all

have less experience throwing in an interruption while doing a medication pass, it is all a recipe

for how a new grad can make a medication error. It is crucial for new graduates to continue to

work on their clinical nurse judgment skills so that these types of errors do not occur.

Another example of a time I used my clinical nurse judgment skills would be a time

when knowing what my patient needed. I walked into my patient’s room to take them to the

bathroom, after getting them back into bad the patient reported that she started feeling very

nauseous and dizzy. My first initial response was to give my patient a basin, make sure she is not

lying flat in the bed, and turn her on her side. Knowing the patient, I had previously written

down all her medications due that day along with PRN medications that were ordered for her.

Immediately I knew to go get her PRN Zofran and get it to her as soon as I could. By completing

all of that by myself I found that my clinical nurse judgment was utilized.

These two situations where my clinical nurse judgment has been used may not have been

a time where it was life or death for the patient but still very important to keep the patient safe

and complete their needs. It has taught me the importance of knowing the type of medications

your patients are on and what guidelines are put in place for them as well. This allowed me to

keep my patient safe and not complete a medication error. I also learned throughout my

experience that completing my patient’s needs is also just as important. I kept my patient safe by

placing her in the correct position while leaving to grab medication to decrease her nausea. I

quickly responded to the situation and used my judgment on what type of medication would help

with this issue. Continuing to utilize my clinical nurse judgment skills will prepare me for when I
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am placed in a life-or-death situation with my patients. This skill is extremely important as a new

nurse to continue to grow and keep my patients safe to provide effective care.
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References

Imparting clinical judgment leading to sound clinical decision-making and patient advocacy.

Back to top. (n.d.). Retrieved February 23, 2022, from

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement

Lavoie, P., Clarke, S. P., Clausen, C., Purden, M., Emed, J., Cosencova, L., & Frunchak, V.

(2020). Nursing handoffs and clinical judgments regarding patient risk of deterioration: A

mixed-methods study. Journal of Clinical Nursing, 29(19–20), 3790–3801. https://doi-

org.eps.cc.ysu.edu/10.1111/jocn.15409

Maeland, M. K., Tingvatn, B. S., Rykkje, L., & Drageset, S. (2021). Nursing Education:

Students’ Narrative of Moral Distress in Clinical Practice. Nursing Reports, 11(2), 291-

300. https://doi-org.eps.cc.ysu.edu/10.3390/nursrep11020028

Wondmieneh, A., Alemu, W., Tadele, N., & Demis, A. (2020, January 13). Medication

administration errors and contributing factors among nurses: A cross sectional study in

tertiary hospitals, Addis Ababa, Ethiopia - BMC Nursing. BioMed Central. Retrieved

February 23, 2022, from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-020-

0397-0
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