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Clinical Nursing Judgement

Michaela Watkins

Department of Nursing, Youngstown State University

NURS 4852 Senior Capstone Seminar

Dr. Kim Ballone and Ms. Randi Heasley

February 27, 2023

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Clinical Nursing Judgement

Clinical judgement is considered to be an essential skill for all nurses to have. In nursing,

the concept of clinical judgement is defined as the process by which nurses make decisions based

upon knowledge of evidence, theories, critical thinking, and clinical reasoning, which is then

used to understand and decipher information in patient care. There is a direct relation between a

nurse’s clinical judgement and decision making to patient outcomes (Clinical judgement concept,

2023). The concept of clinical judgement within nursing has evolved over the years and the

importance of it continues to grow. As health care becomes more and more complex, nurses are

being recognized more as key decision makers and demanding higher cognitive and clinical

skills than ever before. Nurses are also obtaining higher levels of responsibility and

accountability in highly complex and demanding clinical situations. (Flenady et al., 2022).

Nurses make numerous decisions within just one shift. Acute care nurses face a decision or

judgement every 10 minutes, critical care nurses every 30 seconds, and public health nurses

make up to 10 judgements with each patient they are in contact with (Thompson et al., 2019).

Clinical judgement is so important because the decisions made by nurses in practice directly

influence patient outcomes.

There are several factors that nurses consider when making a clinical judgement or

decision. The first is to identify patient care needs by gathering information from assessments,

listening to patients and their families, and evaluating clinical findings. With this, nurses are able

to narrow down possible clinical problems the patient may experience to help identify their

needs. This has a big connection to the important of obtaining a patient head to toe assessment.

By getting a baseline assessment at the beginning of the shift, the nurse is able to quickly realize

when something may be beginning to go wrong or start to improve. Identifying potential risks
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and establishing relationships with patients and their families can also assist nurses in identifying

the needs of their patients (Anton et al., 2021).

Another important factor for nurses to consider when making a clinical judgment is

workload management. Nurses need to be able to prioritize and cluster their care based on the

needs of their patients. Prioritization allows nurses to retain all critical information which can

enhance the effectiveness of the decision-making process. Prioritizing patients is very important

because a nurse must know what patient needs urgent care and what patient can be seen last. This

ties into clustering care, which helps improve time management. Clustering care also gives

nurses the opportunity to spend more time with their patients, which helps build rapport (Anton

et al., 2021). Lastly, seeking to learn can aid nurses in making proper clinical judgement. It’s

pivotal that nurses learn from patient experiences. This can be done through reflection of events

and errors during care interventions, case reviews, medical researching, and debriefing with

other health care team members (Anton et al., 2021). Identifying patient care needs, managing

workload, and seeking to learn are important factors in assisting nurses in making clinical

judgements and decisions.

As a nursing student, I’ve used clinical judgement in several situations during my clinical

experience. Over the years, my nursing judgement has improved, and it will continue to as I

begin my practice as a registered nurse in the future. A situation where I used clinical nursing

judgement happened during my preceptorship a few weeks. This patient came onto the med-surg

unit from the emergency department (ED) where he presented with hypoglycemia and a blood

sugar of 19. After interventions in the ED, his blood sugar fluctuated between the high 300s and

low 400s. I did my shift assessment of the patient and determined that he was alert and oriented

times 4 but had weaknesses in all extremities. After reassessing the patient later, he was only
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responsive to touch and was now disoriented. I checked his blood sugar with the glucometer, and

it resulted that it was >500. I checked it again, but it still read the same. STAT blood work was

done and ABG’s were ordered. After the blood work came back, his blood glucose level was 568

and his ABG’s were within normal limits. Insulin was ordered from the provider, so I

administered it to the patient. His status began to improve, and he became alert and oriented

again. Around 1800 when vitals were being obtained, the nurses aid reported that his heart was

over 160 and the patient was diaphoretic. An EKG was completed, and it resulted that he was in

supraventricular tachycardia. The patient was then transferred to an intermediate unit, so he

could be on a cardiac monitor.

This patient required clinical nursing judgement numerous times throughout this shift.

After reassessing the patient, I immediately knew something was wrong as it did not match his

baseline. That prompted me to obtain a blood sugar, and when it resulted as >500, the STAT

blood work was needed. When he was in supraventricular tachycardia, my preceptor and I knew

that he needed to be monitored more intensely, thus the transfer to an intermediate unit was

initiated. If I didn’t take action following my reassessment, then this situation would have

resulted in a negative patient outcome.

Overall, clinical nursing judgement is extremely important and a crucial skill for all

nurses to have. Nurses have more responsibility in a highly changing and complex health care

systems than ever before. The decisions that nurse’s make directly affect the patients and their

outcomes.
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References

Anton, N., Hornbeck, T., Modlin, S., Haque, M., Crites, M., & Yu, D. (2021, July 21).

Identifying factors that nurses consider in the decision-making process related to patient

care. Digital Health.

Clinical judgement concept. American Association of Colleges of Nursing: The Voice of

Academic Nursing. (2023).

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgement in nursing- An

evolutionary concept analysis. Journal of Clinical Nursing, 1-13.

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2019, May 4). Clinical decision

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

Nursing Studies.
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4852 Capstone
Scholarly Paper Rubric

Scholarly Capstone Paper

 A component of the capstone course, worth 20% of the final grade
 An in-depth exploration on the topic “Clinical Nursing Judgment”
 3 page paper
 APA format
 Minimum of 3 references citing recent Nursing Journals
 Define the concept, identify the importance of clinical nursing judgment, and then discuss
a personal experience where you used “clinical nursing judgment” in a specific situation.

Requirements: Possible Points Achieved

Points
1. organization and clarity of topic present 20 _________
2. content quality 20 _________
3. reflection of topic 20 _________
4. APA format and correct grammar 20 _________
5. Cited References 20 _________

Final Grade
_________/100
points

_________/20%

4852 capstone paper rubric 2023 Heasley/Ballone