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Clinical Nursing Judgement

Lucy McCarty

Senior Capstone 4852

Wendy M. Thomas, MSN, CNS, FNP

February 26, 2022

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Clinical Nursing Judgement

Clinical nursing judgment can be defined in a variety of ways. Benner et al. (1996)

defined clinical judgement as, “the ways in which nurses come to understand the problems,

issues, or concerns of clients/patients, to attend to salient information and to respond in

concerned and involved ways” (p. 2). Another source spoke about clinical judgment in nursing

by stating, “Clinical judgment is tremendously complex. It is required in clinical situations that

are, by definition, under- determined, ambiguous, and often fraught with value conflicts among

individuals with competing interests. Good clinical judgment requires a flexible and nuanced

ability to recognize salient aspects of an undefined clinical situation, interpret their meanings,

and respond appropriately. Good clinical judgments in nursing require 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” (Tanner p.205). My personal definition of clinical

nursing judgement is less involved. I believe clinical nursing judgement can be described as the

assessment of a patient’s condition which then, by deduction and critical thinking, can be treated

using current evidenced-based practices. Clinical nursing judgement not only requires a

knowledge of pathophysiology and the disease process, but also requires independent, quick

thinking on the part of the nurse and the healthcare team.

Clinical nursing judgement is extremely important. In order to have patients being treated

in a safe, effective manner clinical judgment is the cornerstone. The nurse must be able to

recognize subtle changes in their patients’ conditions and then use their judgements to respond in

the best possible way to ensure a positive patient outcome. Thompson et. al states, “Nurses’
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judgements and decisions have the potential to help healthcare systems allocate resources

efficiently, promote health gain and patient benefit and prevent harm,”. This only begins to

describe how important clinical nursing judgement is to the practice of nursing. A lapse in

judgement can truly be the difference in the life or death of another human being. Nursing

judgment is something that cannot be taught, but simply honed over time with experience, trial,

and error. Nursing school is simply the beginning of the road; the start of learning to put together

the pieces of the puzzle, form a clinical theory, and use judgment to implement the best treatment

possible.

In my nursing school career, I have used clinical nursing judgement on several occasions.

One instance that sticks in my mind is when I was on my clinical rotation in the medical

intensive care unit at St. Elizabeth’s in Youngstown. I was caring for a COVID-19 patient with

my cover nurse, who was diagnosed with bilateral pneumonia. Upon comparing her chest x-rays,

we could see that her lung fields were progressively worsening. She was on sedation and a

paralytic due to being intubated and was also placed in a prone position. As I was in the room,

alone, providing direct patient care I could see that she seemed to be agitated. The high-pressure

alarm on her ventilator was going off frequently. It was my clinical judgement that this patient’s

sedation may not have been at the dose that she was requiring. When I brought these assessment

findings to my nurse, she discovered that the patient’s sedation had been lowered during the past

shift. My nurse agreed with my judgment call and worked with the treatment team to have our

patient’s propofol increased back to a level that would assist with her anxiety and

ventilation/perfusion status. This was just one, most recent example of how I have been actively

working to improve my own clinical judgement skills from the assessment data and observations

that I have available to me. Clinical judgement is extremely important. It is not a skillset that can
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be developed overnight. It must continually be re-assessed and improved upon. Nursing clinical

judgement should be constantly changing and evolving. I believe the desire to continually

improve clinical judgement is the mark of a truly intelligent and dedicated nurse.
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References

Lasater, K. (2007). Clinical Judgment Development: Using Simulation to Create an Assessment

Rubric. Journal of Nursing Education, 46(11), 496–503. https://doi.org/10.3928/01484834-

20071101-04

Tanner, C. A. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in

Nursing. Journal of Nursing Education, 45(6), 204–211. https://doi.org/10.3928/01484834-

20060601-04

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision

making and judgement in nursing research and education. International Journal of Nursing

Studies, 50(12), 1720–1726. https://doi.org/10.1016/j.ijnurstu.2013.05.003