1

Clinical Nursing Judgment

Taylor Coy

Department of Nursing, Youngstown State University

NURS 4852 Senior Capstone

Dr. Ballone and Ms. Heasley

March 13, 2023

 2

Clinical Nursing Judgment

Defining Clinical Judgment and Its Importance

Clinical nursing judgment is a vital part of the Nursing career, it is how nurses make

decisions by using critical thinking and nursing knowledge. It is something that we as nurses

develop very early on in our schooling through our classes and clinicals and only gets stronger

with time and experience. Clinical nursing judgment is important because the nurse develops a

care plan for the patient based off their assessment of the patient and can adapt quickly to patient

changes using their clinical judgment skills. According to Guerrero (2019), “Clinical judgment

needs practice of observation skills, identification of appropriate data, and recognition of the

associations among the elements by judgment and rationalization because nurses take

responsibility and accountability with their judgment in their action and inaction and this will be

enacted using evidence-based practice, trainings, and learning” (p. 86).  Clinical nursing

judgment can be obtained through classroom knowledge and bedside nursing experience. Connor

et al. (2022) wrote, “Clinical judgment is a reflective and reasoning process that draws upon all

available data, is informed by an extensive knowledge base and results in the formation of a

clinical conclusion” (p. 1).  Clinical nursing judgment is something that we use all the time while

caring for our patients, even with small things that we may not realize we are utilizing our

nursing judgment. There are many times where things do not always go as planned, and not

every patient presents illness in the same way, so it is imperative that nurses are able to adapt

using their clinical nursing judgment. 

Personal Experience

For my preceptorship, I was placed in an intensive care unit, at Salem Regional Medical

Center. During this time, I was able to use my clinical nursing judgment skills in a variety of
 3

settings. A moment that sticks out to me is when I was assigned to a patient who had been on the

unit for a couple of weeks, after being admitted for hypothermia and hypoglycemia.  During her

admission, my preceptor and I were noticing that she was becoming increasingly short of breath

with very little activity and was requiring oxygen even though she was not wearing oxygen when

she was at home. The doctor placed an order to have a chest X-ray done.  This is where they saw

she was in fluid overload and needed a thoracentesis. The problem was that her platelet count

was extremely low at around 45 which is considered a critical value.  Due to this, the physician

did not want to do the thoracentesis until her platelet count came up. I knew that this was

because when the platelet count is low, the risk of bleeding increases.  However, her platelet

count was not going up in the days she was there. She was requiring more support each day and

had to spend most of the day on a BiPAP. The only time she was not using the BiPAP was to eat

and drink but even then, she was getting short of breath. The doctor decided that although the

platelet count was low, she needed the thoracentesis, and he went through with the procedure.

Before performing the thoracentesis, he stated “that the benefits outweigh the risks”.  It is

important to note that this patient had received hemodialysis that morning. In addition, we gave

the patient her scheduled medications that included BP (blood pressure) medication since her BP

usually ran on the high side. On top of that the thoracentesis was done after. 

About an hour after the Thoracentesis, I went into that patient's room to do the hourly

checks and I looked up at her vital machine, I saw her BP was critically low and showed her

MAP (mean arterial pressure) being 58. I knew that with a MAP of 58, the brain and the kidneys

are not receiving adequate perfusion. I knew from my critical care class that the goal is to keep

the MAP above 65. When I first saw her BP, my first reaction was to assess the BP cuff and

readjust it to make sure that it was on and working properly. After readjusting it, I retook the BP,
 4

and it was showing the same MAP. I then took a manual BP just in case the machine was not

reading properly and was getting the same BP. I informed my preceptor of the low MAP. He said

that he was not surprised as the patient just lost a substantial amount of fluid, between

hemodialysis (2500ml), the thoracentesis (1500ml) and she received BP medication on top of

that. To be on the safe side, we notified the physician to let him know about the situation. He was

also not surprised and stated that he was hesitant to give the patient a bolus of fluid since we just

removed a lot of fluid from her and did not want her to be in fluid overload again. He instructed

us to lay the patient as flat as she can be, and to keep rechecking the BP. We laid the patient flat

and rechecked her BP. Her MAP then went back up to greater than 65 within 10 minutes, we

then notified the doctor of the improved MAP. This experience gave me an opportunity to not

only use what I learned in school during my critical care class about how important it is that a

patient's MAP be greater than 65, but I also learned something new as well. I learned that a drop

in BP is not uncommon when a patient loses that much fluid. I will still always notify the

physician even if I suspect this is the reason, because it is vital to get that MAP back up.  It is

also better to be prepared and have the doctor know the situation just in case the MAP didn’t go

up. In that case, we would be trying to figure out the problem and severe damage could have

already been done.

Conclusion

Clinical nursing judgment is a vital aspect to nursing. As time goes on nurses are in

greater demand and the responsibilities of the nurse continue to increase.  Therefore, it is

important to equip nursing students and nurses in using clinical judgment in everyday patient

care. Nursing students must obtain a certain number of clinical hours while in nursing school

where they have the opportunity to gain real life experiences and start to use their knowledge to
 5

develop clinical judgment. While in nursing school, students are also assisted in learning clinical

nursing judgment by undergoing patient simulations while the nursing instructor observes and

assesses the nursing students’ ability to think critically and use clinical nursing judgment. The

instructor then debriefs at the end of the simulation to teach the students what they did well on,

and what they need to prove upon. This helps the students improve their clinical nursing

judgment in a controlled setting and not on a real patient. This way, when the time comes that it

is an actual patient, they will be better equipped to deal with the situation. Chmil et al. (2015)

explained, “During a simulation activity, prelicensure nursing students engage in an experiential

learning process with the goal of stimulating cognitive, metacognitive, psychomotor, and

affective domains. This experiential learning process incorporates the essential concepts of

nursing and the nursing process to facilitate the development of clinical nursing judgment and

the provision of competent evidence-based practice” (p. 228).

 Clinical nursing judgment is a critical aspect of the nursing profession that develops

from the time nurses are students to the time they are experienced in their career. The more

experience the nurse has, the greater clinical nursing judgment they will display.  Nursing is a

career where one can never truly know everything. Thus, many nurses with decades of

experience are still learning new things, especially since so many advances are being made in the

occupation. Therefore, it is important for the nurse to keep up to date with the best nursing

practices in order to continue to grow their clinical nursing judgment. 

 6

References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgment in nursing – An evolutionary

concept analysis. Journal of Clinical Nursing, 00, 1– 13.

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

Guerrero, J. G. (2019). Practice Rationale Care Model: The art and science of clinical reasoning,

decision making and judgment in the nursing process. Open Journal of Nursing, 09(02),

79–88. https://doi.org/10.4236/ojn.2019.92008

Chmil, J. V., Turk, M., Adamson, K., & Larew, C. (2015). Effects of an experiential learning simulation

design on Clinical Nursing Judgment Development. Nurse Educator, 40(5), 228–232.

https://doi.org/10.1097/nne.0000000000000159