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The Importance of Clinical Nursing Judgment In Practice

Ashley L. Ventimiglia

Department of Nursing, Youngstown State University

NRS 4852: Senior Capstone

Dr. Ballone, Mrs. Heasley

January 30, 2023

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The Importance of Clinical Nursing Judgment In Practice

Clinical Nursing Judgment is something that is used in practice by health care

professionals every day. Many experienced clinicians may use this skill subconsciously, but for

those new to practice, this is a skill that takes much practice to perfect. Banning reviewed three

clinical decision-making models and defined clinical decision-making as “a process that nurses

undertake on a daily basis when they make judgments about the care that they provide to patients

and management issues (Menetti, 2018; Banning, 2007). The concept of clinical judgment

involves the ability of the provider (for the purposes of this paper, the nurse) to make decisions

regarding patient needs, treatments and problems; and how to take action. “Nurses are expected

to notice cues and changes in patient conditions, regardless of how subtle they may be, to be

proactive in the prevention of further harm and swift in the detection of deterioration in a

patient's condition (Manetti, 2019). These concepts start in the very early stages in nursing

school and continue to progress through the entirety of one's career. To be exceptional at making

decisions in the clinical setting, you must not only understand the pathophysiology of the

patient's condition, treatment options and implications for these treatments, but you must also

possess the necessary skills to involve the patient and family in their care and to assist in their

coping. Sound clinical judgment demands an adaptable and salient capability to identify relevant

characteristics of an open-ended, possibly unclear clinical situation, decipher the significance,

and respond safely and appropriately (Manetti, 2019; Tanner, 2006). To add to this, a nurse on a

typical unit may have a four to five patient assignment that they must simultaneously prioritize.

As a new graduate nurse, this skill must be developed quickly and effectively to provide

adequate patient care, and the instinct to “just know” what to do may be a difficult and daunting

concept to grasp.
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Those who have never experienced a patient in the hospital setting may find it hard to

understand why clinical nursing judgment is so important, but upon entry to this setting, they

would likely understand fairly quickly. Nursing clinical judgment, in many cases, may be the

difference between life and death for a patient. To the patient receiving care, the nurse may be

one of the only people that they see throughout the day. Although there are a variety of

professionals involved in the patient’s care, the nurse is oftentimes the primary individual at the

patient’s bedside. As a result of this, the nurse must be prepared to handle any emergencies,

complications, concerns and emotional responses that the patient may experience and that of

their families in the appropriate way.

Personally, I feel that it is hard to pick just one example of clinical judgment to discuss in

this paper. I believe that clinical judgment is used in every aspect of nursing from deciphering

normal and abnormal labs to a head to toe assessment. Every time the nurse gives medication or

performs an intervention on a patient, they are using their clinical judgment. Some nursing

judgment calls have more of an impact on others but that does not make them any more

important in creating positive patient outcomes.

A specific instance where I used clinical nursing judgment was in my critical care

clinical. I was placed in the ICU at Trumbull Regional Medical Center for the fall semester. As

we progressed throughout the clinical, I felt that I gained more comfort and experience in being

able to identify complications that may be developing in patients and to respond to emergency

situations. One morning, the provider for my patient notified me that they were ready to be

extubated and asked me if I would like to perform the task. Of course, as an eager student, I

agreed. Through the education I had acquired on extubation in my complex care class, I knew

that prior to extubation, the patient must go through a breathing trial to ensure that they will be
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able to breathe adequately on their own following the procedure. I also learned that it is a good

idea to ensure that the patient is alert and oriented, and is able to lift their head off of the pillow,

indicating they can follow commands and that they have strength in their neck muscles to

maintain their own airway. Although this patient passed their spontaneous breathing trial, they

seemed lethargic during my assessment and were slow to respond to my commands. Personally, I

expressed these concerns to the provider following my nursing judgment call that they were not

ready to be extubated. Unfortunately, the provider instructed me to proceed with the extubation

anyway.

Now that I knew that the patient was having a hard time following commands, I assumed

that they may have a difficult extubation, so I ensured that I took extra precautions to make sure

no complications arose. I noticed that there was no supplies in the room in the instance that the

extubation did not go to plan, so I made sure that I had the necessary supplies in case there was a

negative turn of events. These items included an ambu bag, suction, a form of supplemental

oxygen (I suggested both a CPAP and a nasal cannula to be in the room just in case, to which the

respiratory therapist agreed), a 10cc syringe to remove the air from the cuff, and if worse came to

worst, a reintubation kit. As I proceeded to extubate, my intuition was correct, and the patient's

stats began to drop. The respiratory therapist immediately wanted to put CPAP on, but the

patient had a lot of mucus still in their mouth and throat. Using quick clinical nursing judgment, I

feared that if they put the CPAP on before the mucus was cleared, she may aspirate and develop

pneumonia and ultimately may be at risk for reintubation. If this were to occur, the patient’s

mortality rate would be increased astronomically. I insisted that they let me suction the mucus

before they placed the CPAP. Following the suctioning and placement of the CPAP, the patient's

stats improved.
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In conclusion, clinical nursing judgment is vital in positive patient outcomes and is used

constantly in the hospital setting. Although providing sound clinical judgment flawlessly is a

near impossible task due to inexperience and the extensive responsibilities placed on nurses in

the field, it is an essential skill and should be stressed in the education of new graduate nurses. I

feel that my patient may not be alive if I did not use my clinical judgment skills to ensure that the

patient had the best outcome possible.

References
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Banning, M. (2007, March 1). A review of clinical decision making: models and current

research. Journal of Clinical Nursing; Wiley-Blackwell. https://doi.org/10.1111/j.1365-

2702.2006.01791.x

Connor, J. M., Flenady, T., Massey, D., & Dwyer, T. (2022, July 25). Clinical judgement

in nursing – An evolutionary concept analysis. Journal of Clinical Nursing; Wiley-

Blackwell. https://doi.org/10.1111/jocn.16469

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102–110. https://doi.org/10.1111/nuf.12303

Tanner, C. (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