Clinical Nursing Judgment

Hayley Socha

Department of Nursing, Youngstown State University

4952 Senior Capstone

Wendy Thomas and Kim Ballone

February 28, 2022

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Clinical Nursing Judgment

Clinical judgment in simple terms is decision making. It is a vital part of evidence-based

care. Clinical judgment is when the nurse uses her knowledge to observe the patient and be able

to assess what the presenting situation is. A nurse with good clinical judgment identifies the

priority concern related to the patient’s condition, and then takes the assessment data and

formulates the best evidence-based solutions to provide the best outcome for their patient. As

stated by Kinyon et al. (2021), “To intervene quickly and prevent poor patient outcomes, nurses

must be able to recognize both the overt and subtle cues when performing a patient assessment.

If one lacks the ability to apply clinical judgment, there is an increased risk of missing the signs

of patient deterioration”(p.606). The problem is that clinical judgment does not come naturally, it

is something every nurse develops over time through continuous practice of skills and

assessments. The more experience and knowledge a nurse has, the greater their clinical judgment

and decision making will be.

How Clinical Judgment is Developed in Nursing Students

Some might be wondering how a nurse develops clinical judgment over time. Before a

nurse can have good clinical judgment, they must be able to critically think, and to critically

think foundational knowledge must be learned first. Nursing programs start by teaching

foundational knowledge as prerequisites for other courses. As stated by Makhene (2021),

“Foundational knowledge is made up of the facts, theories, principles, methods, skills,

terminology, and modes of reasoning that are essential to more advanced or independent learning

in an academic discipline” (p. 1). Foundational knowledge is required for the nurse to be able to

use critical thinking in the clinical setting.

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Once students are in the clinical setting, it is important that they be completing concept

maps, case studies, and patient teaching plans. These are important because they all involve

critical thinking. Concept maps, case studies, and teaching plans help the student nurse to realize

what should be done in certain situations. Clinical experiences allow student nurses to gain

experience with assessments, skills, and critical thinking which is why they are mandatory. As

new nurses gain more experience in the hospital setting, their ability to take all of the data they

have on their patient to formulate evidence-based nursing interventions and have the best patient

outcome will improve.

Importance of Clinical Nursing Judgment

Nurses are in a position where they are constantly having to make decisions based on

what they think will provide the best outcome for their patient. Sometimes, the nurse needs to

think very quickly. For example, a journal by Chang et al. (2019) talks about the fact that

electrocardiograms are one of the most important tools for diagnosing an MI. The journal goes

on to talk about how if the nursing staff does not make correct judgments in time regarding

dysrhythmias, it can lead to death of the patient. (p.p. 1225-1226). First off, if the patient is not

on a continuous monitor the nurse must have the ability to recognize physical symptoms

indicating that there is a problem going on. For example, if the patient is having pain in their

shoulder and palpitations, the nurse with good clinical judgment will be able to recognize that

these are signs of a heart attack and will obtain an ECG and act quickly. If a nurse has poor

clinical judgment in this particular situation, the patient could die of a heart attack.

Clinical judgment allows nurses to think quickly because they may have had similar

experiences in the past and gained more knowledge from those experiences. Even if the nurse did

not make the right decision in their prior experience, they are able to look back and think about
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what they could have done differently to have the best patient outcome. The goal as the nurse is

always to have the best patient outcome. Clinical judgment assists the nurse in doing so, which is

why it is so important. The functional status, safety, and satisfaction of the patient is at its best

when clinical judgment is at its best.

Personal Experience

As a senior nursing student, I am expected to know foundational knowledge and be able

to critically think in certain situations. There are many times when I have had to use clinical

judgment. One particular experience comes to mind when I think about clinical judgment. Upon

initial assessment, I noticed I was able to palpate my diabetic patient’s bladder. I instructed my

patient to try to void because I knew this was an abnormal finding. I notified the nurse and

documented the findings. Upon reassessment about an hour later, my patient had still not voided

and reported that he felt like he “couldn’t get it out”.

Using clinical judgment, I knew further assessment needed to be done with a bladder

scanner because my patient was having urinary retention. The bladder scan revealed 300 cc of

urine in the bladder. We called the doctor to get an order for a straight cath for this patient. I was

able to recognize the signs of urinary retention and respond accordingly to have the best patient

outcome for my diabetic patient who is already at risk for fluid overload.

Conclusion

To summarize, clinical nursing judgment is essential for the best patient outcomes.

Clinical judgment is not something that is just there. It is something that gets greater with time

and experience. Nurses start using clinical judgment once they have learned foundational

knowledge that allows them to critically think. Concept maps, teaching plans, and case studies

are vital in the learning process for nursing students to have that ability to recognize problems
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and interventions that can be done for their patient. The more a nurse is exposed to a certain

situation or diagnoses, the better the clinical judgment will be.

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References

Chang, C. Y., Kao, C. H., Hwang, G. J., & Lin, F. H. (2019). From experiencing to critical

thinking: a contextual game-based learning approach to improving nursing students’

performance in Electrocardiogram training. Educational Technology Research and

Development, 68(3), 1225–1245. https://doi.org/10.1007/s11423-019-09723-x

Kinyon, K., D’Alton, S., Poston, K., & Navarrete, S. (2021). Improving Physical Assessment

and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health

Assessment Course. Nursing Reports, 11(3), 600–607.

https://doi.org/10.3390/nursrep11030057

Makhene, A. (2022). Use of Foundational Knowledge as a Basis to Facilitate Critical Thinking:

Nurse Educators’ Perceptions. Nursing Research and Practice, 2022, 1–6.

https://doi.org/10.1155/2022/3736322