CLINICAL JUDGEMENT 1

Nursing Clinical Judgement

Michael R. Martin

Centofanti School of Nursing, Youngstown State University

NURS 4852, Senior Capstone Seminar

Dr. Kim Ballone, Ms. Randi Heasley

March 13, 2023

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Clinical Nursing Judgement

The concept of clinical nursing judgement can be defined as the process by which nurses

and nursing students make decisions based upon nursing knowledge, critical thinking, and

clinical reasoning to understand and interpret information in the delivery of patient care. It is

what guides a nurse to make decisions in relation to theories, evidence, and patterns of

knowledge that prompt them to think critically and reason clinically. Sound nursing clinical

judgement is at the core of competent and safe client care (Dickison, Philip et al., 2019). Nursing

clinical judgement is a key quality that nurses gain a better understanding of with the more

experience they have. Making clinical decisions based on clinical judgement is correlated

directly to quality patient care outcomes, so it is important as senior nursing students to gain a

good understanding of what it means to have sound nursing clinical judgement as we prepare to

graduate and pass our NCLEX to work as RNs independently.

As a nursing student, our knowledge of the nursing profession is not quite developed

enough to have excellent or overly proficient clinical judgement. While we do attend many hours

of clinical rotations throughout the semesters of nursing school, the knowledge we obtain in

school does not always correlate with how things are actually done in the real world. Although,

most of time our clinical faculty will guide us in the right direction to help us differentiate and

understand what the proper way is to perform different tasks and how it is going to best benefit

our patients. Therefore, it isn’t particularly easy to take everything we learn in lectures and apply

it to real life scenarios. However, this is time we start to form clinical judgement, and although

we might not always have a good understanding of the topic matter, we make good judgement

calls without realizing that these experiences are culminating sound nursing clinical judgement

within us. We don’t always recognize it, but our experiences during clinical coupled with the
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nursing knowledge gained in lecture and guidance from our instructors is the base upon which

we start to develop nursing clinical judgement.

Critical thinking is also a key aspect of nursing clinical judgement. This is something we

have all learned to do throughout nursing school. The biggest difference between us as students

and the seasoned nurses that we work alongside with is the pace at which critical decisions are

made. As nursing students, the vast majority of us are able to think through a patient scenario and

apply critical thinking to our thought process when deciding the best way to go about a specific

circumstance. A seasoned veteran nurse however, has made that same decision a couple dozen

times already and knows exactly what to do, how to do it, and when to do it. They are able to use

their extensive nursing knowledge and critical thinking skills instilled within them to apply their

nursing clinical judgement and make fast-paced, high-quality decisions. Therefore, the more

experiences and circumstances a nurse has and is put under during their career, the better their

nursing clinical judgement becomes and the safer, more quality their care becomes for their

patients.

Clinical reasoning is the last component of clinical nursing judgement I will discuss.

According to Lisa Gonzales, “Clinical reasoning is a skill that requires time, practice, and

cognizance to develop” (2018). I believe we as nursing students struggle most with this aspect

because we do not always see how our patient progresses. Rather, we provide intervention for 8

hours out of the day and go home, not to see our patient until the following week, if at all.

Furthermore, we are not always able to see how our care has benefited our patients long-term

and so we sometimes lack in our ability to understand the reasons behind why we do what we do.

Instead, we rely on what we are taught in lectures to drive our reasoning skills instead of

observation of quality outcomes related to the interventions we provide our patients.

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Importance of Clinical Nursing Judgement

To reiterate, sound clinical nursing judgement is something that a nurse will develop and

get better at implementing over time through experience. It is a key component of providing safe,

effective, and quality patient-centered care. Clinical nursing judgement is important in that it

helps us as nurses to understand how they can respond to various changes in our patient’s

condition and also ensures that we can make sound clinical decisions in conjunction with patient

advocacy. It is a vital part of becoming an RN because our number one priority is always patient

safety. Good clinical judgement allows us as nurses to weigh our options and select appropriate

interventions, initiate nursing interventions that adequately address the needs of our patients, and

evaluate patient outcomes to improve the approaches we take to the manage the problem our

patients are experiencing. Once a nurse has built a strong base of clinical nursing judgement,

they are able to interpret relevant clinical data to determine the best response and intervention for

the patient to ensure the highest quality and safest care possible. Personal experiences play a key

role in providing the right skillsets for clinical nursing judgment. The following are my personal

experiences as a nursing student where I had to engage in and utilize my clinical nursing

judgment with the amount of knowledge and skills that I had.

Scenarios

One scenario that has stuck with me since the beginning of nursing school was during the

first semester of clinical rotation. My group was assigned to a basic med-surg unit at St.

Elizabeth’s hospital in Boardman. About halfway through the semester, my clinical instructor

had asked me to interview my patient about his interests/hobbies, emotions, financial situation,

as well as how he was going to pay for his stay at the hospital. While I understand these are

viable questions as a part of a psychosocial assessment, my patient was a terminally-ill cancer

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patient. He was suffering from end-stage colon cancer and was going to be put in a hospice

facility. Palliative care was consulted as part of his care team at the time. Yet, my instructor

insisted that I complete a psychosocial assessment on him. Given my patients’ state of well-

being, he was physically unable to answer any question I had. I was going to have to discuss

these topics with his significant who was in the room, his wife. Using my clinical nursing

judgement, I decided to not conduct this interview as I felt it was inappropriate. His significant

other was already visibly upset, and I did not see this as an appropriate conversation/assessment

to engage in at this time. This was not easy to discuss with my instructor as it was as it was my

first round of clinical rotations as a nursing student, and I was nervous to upset my instructor

who was persistent that I conduct the assessment. In hindsight, I am proud of myself for using

my better judgement and advocating for my patient, rather than following through with what my

clinical instructor insisted I do. It was brought to my attention the following semester that this

specific instructor was fired due to multiple student complaints about her being brought to the

attention of administrative faculty.

Another scenario that I recall happened last semester during our critical care rotation

through the SICU and CVICU. My patient was ordered digoxin to treat his diagnosis of atrial

fibrillation. Upon my initial assessment, I noticed that his heart rate was trending in the low 60’s.

When it was time to pass him his prescribed digoxin, I once again assessed his pulse. My

assessment revealed his heart rate to be around 56-59 beats per minute. Using my nursing

clinical judgement, I decided not to administer him this medication due the way I know digoxin

works on the heart to slow down heart rate. I then notified his physician and documented in the

EMR that he did not meet the parameters for administration of this medications since his pulse

was below the normal range of 60-100 beats per minute.

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Conclusion

In conclusion, while clinical nursing judgement is a crucial part of providing safe and

quality patient care, it is not something that we as nursing students are going to be proficient in

until we gain independent experience working as an RN. To have this clinical judgement, we

must possess high quality nursing knowledge, critical thinking, and clinical reasoning to

understand and interpret information in the delivery of patient care. These are aspects that we as

new graduate nurses will improve upon over time with the more experience we gain, one patient

and one experience at a time.

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References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State

Boards of Nursing Clinical Judgment Model Into Nursing Educational

Frameworks. Journal of Nursing Education, 58(2), 72-78.

https://doi.org/10.3928/01484834-20190122-03

Gonzalez, L. (2018). Teaching Clinical Reasoning Piece by Piece: A Clinical Reasoning

Concept-Based Learning Method. Journal of Nursing Education, 57(12), 727-735.

https://doi.org/10.3928/01484834-20181119-05

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

undergraduate nursing students. Nurs Forum. 2022; 57: 932- 937. doi:10.1111/nuf.12757