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Clinical nursing judgment scholarly paper

Kayla Rossetti

Centofanti school of nursing

Professor Heasley and Professor Ballone

March 9 2023
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One of the main attributes of being a nurse is having clinical nursing judgment. Clinical

judgement refers to the processes nurses use to make decisions based upon their knowledge. We

use evidence, critical thinking, reasoning and skill based theories to make such decisions. When I

hear the term “nursing judgment” I think in my head, “problem solving” and “ critical thinking”

as they are all related and can be used interchangeably. Clinical judgment is something that

comes along in nursing with time and experience. As we as the nurse accumulate information

and knowledge, it helps us analyze problems, synthesize objective and subjective data, and be

able to provide the correct care and outcome measurements needed.

The importance of clinical nursing judgment is to be able to provide safe and effective

care to our patients. We need to be able to recognize symptoms early and before they turn into

problems and know how to treat and correct the cause. Nursing judgment has a very wide range,

from things as simple as holding a medication or calling the doctor for questions, to things such

as determining to discontinue life support on a patient or calling a code off after 45 minutes of

trying.

I can think of a few examples in my personal clinical experience where myself or another

nurse has used clinical nursing judgment correctly and appropriately. We see patients everyday

who are blood glucose checks and have hyperglycemic treatment as needed. As the nurse we

know what times our blood sugars need checked and go in at appropriate times to do so. An

example of clinical nursing judgment in this aspect of blood glucose checks is, one day I had a

patient who when I checked the sugar is was 136. A blood sugar of 136 for us is a bit elevated,

but when I used my nursing judgment in the hospital setting, I went to the MAR on the patients

chart, looked at the Humalog sliding scale parameters and saw that anything less than 199 does

not require coverage. Now, I knew I needed to check the blood sugar before my patient ate their
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lunch, look at the parameters for the medication and knew to not give this medication. I then

charted on this patients MAR for Humalog, not given due to parameters of blood glucose not

met.

That is something that to us seems so simple to us that we don’t even realize, but we are

using our judgment to hold a medication to cause this patient not to have a hypoglycemic

response to a medication.

Another of the same type of issue arises with out patients who are on medications such as

Metoprolol, lisinopril and Norvasc. These medications are used to treat and manage high blood

pressure and therefore drop your blood pressure. As a nurse, looking at morning vitals at 730 am

and seeing a blood pressure reading of 95/72 and going in the room at 8 for a morning med pass

and checking the MAR and seeing metoprolol on their list, we should know this needs to not be

given. We should read metoprolol on the med list and know right away that this medication is

used to treat blood pressure and know we need to check the BP before administration. Then

when we see a reading such as 95/72 we know we will be holding this medication and not

administering as it would drop the blood pressure even more and this person could severely

decline.

Those are the examples of simple day to day use of nursing judgment and in my

experience, this is one I run across a lot. In my experience I can think of one more severe and

serious time I had to use my nursing judgment, during a RRT. A RRT is a rapid response team,

and this called for many reasons some being a change in patient status, new symptoms arising, if

oxygen status is dropping and we cannot get it up and just a general decline in status. The nurse

plays a big role during an RRT, including taking vitals, assessing status, medication

administration, observing and communicating with the doctors and charting on the patient.
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During the RRT, I hooked up the blood pressure cuff and was cycling vitals roughly

every 5 minutes or as the doctor said to. This patient in particular had an RRT called on them due

to a dropping blood pressure. When the doctors arrived this patient was sitting in the 60s over

40s. I immediately grabbed the dynomap and knew we needed it on when the doctor came up. I

had to be quick on my feet and think about what needed to be done in this situation and what

information the doctor would need and ask about. We need to be fully prepared for all situations

and be able to think critically quick and effectively. Some times we as nurses also have to

communicate to family members and be able to explain to them what is going on and what is

being done to correct the problems.

In conclusion, clinical nursing judgement is very important and is a needed attribute that

we must have. It is not only important to us and other members of the health care team but it is

important to the patients and family members of the patients as well. If we don’t know what is

going on and what the next steps need to be then we could make errors in our practice and

potentially cause harm. We must be able to asses, observe and act quickly and efficiently to

provide safe patient centered care.

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References

Uppor, W., Klunklin, A., Viseskul, N., & Skulphan, S. (2022). A concept analysis of clinical judgment in

undergraduate nursing students. Nursing Forum, 57(5), 932–937.

https://doi-org.eps.cc.ysu.edu/10.1111/nuf.12757

Urhan, E., Zuriguel, P. E., & Harmancı Seren, A. K. (2022). Critical thinking among clinical nurses and

related factors: A survey study in public hospitals. Journal of Clinical Nursing (John Wiley & Sons,

Inc.), 31(21/22), 3155–3164. https://doi-org.eps.cc.ysu.edu/10.1111/jocn.16141

Barry, A., Parvan, K., Tabrizi, F. J., Sarbakhsh, P., Safa, B., & Allahbakhshian, A. (2020). Critical thinking

in nursing students and its relationship with professional self-concept and relevant

factors. Research & Development in Medical Education, 9(1), 1–6. https://doi-

org.eps.cc.ysu.edu/10.34172/rdme.2020.007