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Clinical Nursing Judgement

Delaney Early
Centofanti School of Nursing
NURS 4852: Senior Capstone Summary
Dr. Kim Ballone & Ms. Randi Heasley
March 13, 2023
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Clinical Nursing Judgement

Clinical nursing judgement is one of the many staples in being a successful, well

decorated nurse. According to the National Council of State Boards of Nursing, the definition of

clinical judgement is the “observed outcome of critical thinking and decision making” (Schuster,

2020). Throughout my clinical experiences during my four years in the Youngstown State

Nursing program, I have learned that as important the knowledge we obtain is, it is even more

important how we apply that knowledge to our practice. As I proceeded through the program, I

came to realize that not only do you need to understand the content, but you must be able to

apply it to be successful. We have been provided with tools such as concept maps, databases,

research information, and most importantly, our brains, to make these necessary inferences for

our patients.

One of the most important points I wanted to discuss regarding critical thinking and

clinical judgement is the new NCLEX the class of 2023 will be taking. This new NCLEX I feel

is a perfect example regarding how we always need to be ready to use our critical thinking and

clinical judgement, especially in changing situations. Just like in the hospital when anything can

change with our patients, this new NCLEX is a great example of how we, as new nurses, will

need to be able to adapt and be ready for anything. In the fall of 2018, invitational educators met

at the National Council State Boards of Nursing to reflect on the research that was done on the

current NCLEX to determine if the exam properly measures clinical judgement. They arrived at

the consensus that the current testing content was not effective (Sherrill, 2020). The National

Council State Boards of Nursing supported a new approach known as The Clinical Judgement

Model. This new model would contain new content such as internal and environmental

conditions like environment, time constraints, task complexity, consequences, and risk. These are
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thought to be helpful in helping us make clinical nursing judgements regularly in our career.

(Sherrill, 2020).

With this new information from the National Council State Boards of Nursing, I think it

is even more pertinent now to make sure we are accustomed to clinical nursing judgement and

realize its importance. To use clinical judgement, we must also use critical thinking. A concept

developed by the American Philosophical Association is “critical thinking is the process of

purposeful, self-regulatory judgement. This process gives reasoned consideration to evidence

contexts, conceptualization, methods, and criteria” (Schuster, 2020). In order to use critical

thinking, I think it is important to use all of the resources available. A few examples of these

would be the patient’s chart, research articles, the doctor, Lexicomp, etc. Critical thinking is

what is used to arrive at a clinical judgement.

Using clinical judgement is especially important to incorporate in patients who are life

and death situations. “Knowing the patient was identified as an essential element for noticing

changes in a patient's condition and in guiding the subsequent nursing response.” (Dresser et al.,

2022). This quotation from a qualitative study about frontline nurses’ clinical judgement stuck

out to me because in order to make a clinical judgement, we need to understand our patient and

their circumstances. We cannot treat each patient the same way. We need to consider factors like

age, acuity, culture, religion, etc. These factors are what make our clinical judgements in the

healthcare setting. An example of this would be having a patient that is unable to receive blood

due to their religion or cultural beliefs. We now arrive at the question “So what do we do now?”.

This is where critical thinking and clinical judgement comes into play. An example of using

clinical judgement in this situation would be realizing that this patient may benefit from an

erythropoietin stimulating agent (ESA), or an iron supplement. These situations are why it is so
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important that as nurses it is important to make clinical judgements in order to benefit patient

outcomes.

I have had numerous experiences throughout my time in the hospital where I used clinical

judgement, but I had one that particularly stuck out to me. During my junior year, I had a patient

who was admitted with a COPD exacerbation. While I was at clinical, I noticed the patient was

having a tough time breathing with little secretions expelled and rhonchi auscultated. The nurse

attempted to suction the patient but was getting little to no secretions when suctioning. I noticed

that the patients had a discontinued order for a mucolytic medication. The nurse was unaware

that the patient had this discontinued order and I brought it up in the patient’s chart to her. The

nurse called the doctor and explained the situation and the doctor reordered the mucolytic.

Within the hour of taking the medication, the patient expelled copious amounts of secretions.

After noticing all the secretions collected with suctioning, I auscultated the patient and noticed a

significant decrease in the degree of rhonchi heard.

To arrive at the clinical judgement made using my critical thinking, I used the

information that I learned in the classroom, my own personal clinical experiences, and the data

gathered from patient assessment. The reason I knew the patient was probably suffering from

increased secretion buildup was because of the rhonchi auscultated, which I knew meant there

was some airway blockage due to secretions or fluid buildup. This is a common adventitious

lung sound auscultated with COPD patients. Because the patient had little secretions in the

suction chamber, I knew that there was more than likely some mucus that was lodged that

needed to be excreted. The role of a mucolytic is to break up and thin mucus to ease the

excretion of the mucus. I knew that giving this medication would decrease the patient’s lodged

secretions, leading to a more eased breathing pattern.

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To be successful as a nurse, it is a necessary skill to be able to use critical thinking

and make clinical nursing judgements. Not only will see more clinical nursing judgement

scenarios in the new NCLEX, but throughout our careers as nurses. As nurses, patients put their

lives in our hands. It is our job to be able to use our knowledge learned, know the patient’s

background, thoroughly assess the patient, and realize the acuity of the patient. All these factors

are what will help us as future nurses use our clinical judgment skills.
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References

Schuster, P. M. H. (2020). Concept mapping: A clinical judgement approach to patient care.

F.A. Davis Company. \

Sherrill, K. J. (2020). Clinical judgement and next generation NCLEX® – a positive direction for
nursing education! Teaching and Learning in Nursing, 15(1), 82–85.
https://doi.org/10.1016/j.teln.2019.08.009

Dresser, S., Teel, C., & Peltzer, J. (2022). Frontline nurses’ clinical judgment in recognizing,
understanding, and responding to patient deterioration: A qualitative study. SSRN
Electronic Journal. https://doi.org/10.2139/ssrn.4170633