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Clinical Nursing Judgment

Conor T. Crogan

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Professor Ballone & Professor Heasley

March 13th, 2023

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Clinical Nursing Judgment

For this paper we will be discussing the true definition of what clinical nursing judgement

is and personal experiences where judgment was made in a clinical nursing scenario. First and

foremost, according to Embler’s (2021) article on Wolters Kluwer, clinical nursing judgment is

defined as,

“Accumulation of knowledge and skills over time, which contributes to the

nurse’s ability to analyze and synthesize the patient presentation, objective, and

subjective data, and then provide evidence-based nursing interventions to improve patient

outcomes; clinical decision making. Clinical judgment also contributes to the nurse’s

ability to respond to changes in patient presentations with sound clinical decision-making

and patient advocacy” (Embler, 2021.)

The point of this article is stating that experience over time will help grow and strengthen a

nurse’s clinical judgment. It will help sharpen the senses in an intense scenario where error is

minimal, and time is not on your side. Knowledge by itself can get you so far, so the experience

overtime combined with knowledge will help exceed one’s personal clinical judgment.

Clinical nursing judgement is also very important, and Rischer’s (2021) article will show

another definition of clinical nursing judgement and how important it is to build working in a

healthcare setting. A big part of this article is that Rischer stated that “critical thinking + clinical

reasoning = clinical nursing judgement” (Rischer, 2021). To understand what this means we

have to break down the three components. The first part is critical thinking, this is “Critical

thinking requires the nurse to think clearly, precisely, and accurately and act on what they know

and understand and are able to apply to the bedside...” (Rischer, 2021). Next is clinical

reasoning which is the process by which nurses observe patients’ status, process the information,
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come to an understanding of the patient problem, plan, and implement interventions, evaluate

outcomes, with reflection and learning from the process. Applying these two in a patient’s

scenario will create more sufficient clinical nursing judgement according to Rischer’s article.

Clinical judgment is an essential skill that nurses are required to absorb to distinguish proper

nursing interventions when coordinating patient care. It is a skill that allows nurses to take

control of patients that are deteriorating at an increased rate. That being said, according to

Margot Phaneuf (2008), “Using clinical judgement allows the nurse to identify, associate and

interpret the signs or symptoms of a given condition…” (Phaneuf, Pg. 2, 2008). Thus, describing

that the proper use of clinical judgment in a health care setting will enable the nurse to see what

the problem is through signs and symptoms. Then associate potential conditions that could be

causing these reactions. Therefore, the nurse will be able to take action in ways they believe is

best to treat the underlying problem taking place for the patient in need of help.

As personal experience where I was able to use clinical nursing judgement was when I

was precepting at St. Elizabeth’s Hospital in Youngstown Ohio, on the Surgical Intensive Care

Unit. My patient was diagnosed with acute respiratory distress syndrome along with severe brain

trauma. This was my first week at this clinical site as the shift prior we were floated to another

unit. That being said going into this shift I was nervous and to be ready to take initiative but at

the same time ask questions when needed. My patient had an OG tube and was on the ventilator

setting of A/C mode VC+. Since my patient had ARDS and severe brain trauma, I knew that

respiratory problems are always a possibility. So, I would do hourly checks to monitor the

patient’s respiration with the ventilator and monitor the SPO2. During one check I realized that

the patients Spo2 dropped from 98% to 90% and the ventilator started beeping. Seeing that I first

checked to if there was any cyanosis around the mouth or at the fingertips or toes. Once I noticed
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there was nothing there, I checked the pulse oximeter. That was one and the Spo2 was still low.

Moving forward, I wanted to check the tubing of the vent but did not want to do that without my

nurse. So, I called my nurse into help me with my patient. My nurse applied suction through the

OG tube to get all the secretions out that could have been blocking the airway and wasn’t getting

enough oxygenation. Once the suction was applied the ventilator stopped beeping and the Spo2

went back up to 98%. This happened again later on that shift where the Spo2 dropped, and I

applied suction and the patients SPo2 went back up to 98%. Since I was able to experience this

during my precept, in the future, I will be able to have clinical judgement on my own when I see

this happen again. I feel like my initial thought process and critical thinking was good to see how

severe the hypoxia was by checking for cyanosis. Once I realized that wasn’t the case, I wanted

to see if the pulse ox was properly on. I realized through clinical reasoning that there was

something I wasn’t sure about hence I referred to my nurse for help. She showed me how she

approached it and how to have proper dexterity with suction the patient.

Overall, clinical nursing judgment is acquired over time and is a very important and

useful skill in the field of healthcare. Even though clinical nursing judgement is not easy to teach

or learn, a new employee or student can begin to develop the skills through class, practice in

skills training and even in the hospital on the job. Over time these experiences will build up

comfortability and a firm foundation of clinical nursing judgment which will develop positive

patient and family outcomes in the clinical setting. This shows how important clinical judgement

is in the day to day life of a nurse. Although I have not perfected and fully developed my own

clinical judgement skills, I have noticed progress through preceptorship, clinicals and work

experience in the hospitals. I know that I will accelerate just as much if not more once I am able
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to be in a comfortable setting with knowledgeable staff where I am familiar with my

surroundings day to day and develop a solid foundation of clinical judgement.

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References

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical decision-making

and patient advocacy. Wolters Kluwer. Retrieved February 24, 2022, from

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

Phaneuf, M. (2008, December 17). Clinical judgement - an essential tool in the nursing profession.

Clinical Judgement – An Essential Tool in the Nursing Profession. Retrieved March 12, 2023,

from http://www.prendresoin.org/wp-content/uploads/2013/01/Clinical-Judgement-.pdf

Rischer, K. (2021, June 22). Defining clinical judgment and why it's so important. KeithRN. Retrieved

February 24, 2022, from https://www.keithrn.com/2021/06/defining-clinical-judgment-and-why-

its-so-important/