1

Clinical Nursing Judgement

Joseph W. Kusior

Centofanti School of Nursing, Youngstown State University

4852 Senior Capstone

Dr. Kim Ballone & Dr. Randi Heasley

March 13, 2023

2

Clinical nursing judgement is defined as being the culmination of education, experience,

and insight that allows nurses to execute the best action possible on behalf of patients (Victor, J.

2017, p.266). In the field of nursing, clinical judgement is a very critical component to taking

care of patients, whether that is direct or indirect. This concept can be the defining line of life or

death for an individual patient, or it can affect every patient a nurse may encounter if they are not

able to properly form their clinical nursing judgement. In any type of care setting, poor clinical

judgement can be the cause of death, loss of a limb or the deterioration of a patient if the nurse is

not skillful of mindful of the situation at hand. Clinical judgement begins in the classroom, and

can be a useful skill for anyone, not just nurses even though clinical judgement is a crucial tool

in the field of nursing.

While in the classroom, clinical judgement is often taught as simulations, educating

students where to look, what to look for, how and when to intervene as well as knowing the

proper interventions for the patient. While beginning in the classroom, clinical judgement will

progress through the clinical setting where patient care becomes hands on for students, the most

critical time for the development of clinical nursing judgement. Students must learn to adapt to

changes, slowly at first then further progressing into more critical situations. Students, as well as

seasoned nurses should also be aware of cues, whether they are subjective or objective data to

guide their basic care and the target areas for each patient. This judgement should be expanded

for student nurses and Registered nurses in all care settings. “While about 60% of registered nurses

(RNs) work in hospitals,5this exploration of nursing judgment also applies to nurses who work in non–

acute care settings such as long-term facilities, schools, home health, hospice care, and other locations

(Victor, J. 2017, p.266-267). All locations of healthcare will require a degree of clinical judgement, each

needing to know what level of critical thinking to be ready for when the situation arises.
3

Opportunities to expand knowledge of clinical judgement can come from employment, personal

experience, preceptorship, nurse extern positions, nurse intern positions, the classroom, textbooks, and

simulation education. Each setting for knowledge gain can put a student or an RN in a position to learn

critical thinking skills that they need to properly provide care to their patients, or in an emergency,

another RN’s patient. An important task for nurses is to be able to care for patients both autonomously

and efficiently all while problem-solving using judgement and intellect. “Health care is becoming more

complex, and nurses are recognized as key decision-makers, progressively required to provide safe and

effective nursing care in multi-layered healthcare environments that demand higher cognitive and

clinical skills… (Connor et al., 2022). With the nurse being a key decision maker in all healthcare settings,

effective assessment and critical thinking is being incorporated into settings where complex patients do

not exist, just basic quick care. Most importantly, where nursing clinical judgement is most critical are

ICU units, emergency units and LTAC where patients have the most opportunity to decline rapidly.

Beginning with the nursing process, nursing judgement in the clinic setting is based upon a

broadly used and important tool that is a building block to all care a nurse or any healthcare worker will

provide. “Clinical judgment is an essential element of a nurse's decision‐making process that affects

patient safety… nurse educators should understand the process of clinical judgment and allow students

to develop their clinical judgment by thinking like a nurse during a real situation in the clinic (Uppor et

al., 2022). Stated previously about clinical judgement beginning in the classroom, it is important for the

educators to also have a solid and functional judgement of their own to be able to contribute to the new

generation of nurses evolving nursing process. The nursing process is as follows: assessment, diagnosis,

planning, implementation, and evaluation. Assessment is the largest factor to a critical decision, as

before a decision is made to a patients plan of care, there must be evidence of assessment to document

changes or progression. Assessments should be the nurses first action when engaging with a patient, as

it can be directly linked to a clinical judgement, adjusting the care based on the needs of the patient.
4

On a personal experience, clinical nursing judgement has crossed my own path when faced with

patients that require critical care. On the job site that currently employs me, this unit is known as an

LTAC floor, also known as long term acute care. This type of floor receives patients that need hospital

care extending beyond the normal limits a regular hospital floor would allow. Relying on the patient’s

insurance to provide financial cover for them, they are accepted and triaged into different categories

based off their acuity, or how medically severe their condition is. The long-term acute floor also consists

of RNs, CNAs, certified respiratory therapists, physical therapists, a dietician, and on-call physicians that

round roughly at 5:30 AM. Most difficult things relating to patients and a decline in health seem to

happen mostly in the morning, which follows my experience of use with clinical judgement.

After a round from the pulmonologist, CNAs were required to do their rounding where we had

found a patient short of breath, tachycardic and in a restless state. This patient suffered from a major

heart attack at the age of 43 and received open heart surgery two weeks prior. The reason for admission

was for anti-biotic treatment and they were to be discharged when completed. Upon the assessment,

the nursing judgement skills that were acquired from school allowed myself to begin to look at the

scenario at hand and react promptly. With the signs and symptoms already present, diaphoresis was

noticed as well as poor recovery from the administration of 100% oxygen through the ventilator. A

pulmonary embolism was suspected, where the bed was then placed in a high fowler position,

instructions to the patient to remain still and to not panic despite the feeling of panic due to dyspnea. I

had used my clinical nursing judgement to apply the 100% oxygen as needed, raise the head of the bed,

instruct the patient to remain calm while I had called overhead for staff assist. Upon staying with said

patient, their lips began to turn blue, eyes rolling in their head and asystole on the bed side monitor. The

PE had broken loose and was in the patient circulation. Dropping the bed to a flat position, I called a

code blue while then staff began to rush into the room where we began CPR, but after 45 minutes were
5

unsuccessfully able to revive the patient. The pulmonologist had mentioned that we had done

everything correctly, and that my good assessment and call for help was a great step to make, and good

assessment skills will get student nurses a head start with becoming an RN.
6

References

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

evolutionary concept analysis. Journal of Clinical Nursing. https://doi-

org.eps.cc.ysu.edu/10.1111/jocn.16469

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

Victor, J. (2017). Improving clinical nursing judgment in prelicensure students. Journal of

Nursing Education,  56(12), 733-736. doi: https://doi.org/10.3928/01484834-20171120-

05