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Clinical Nursing Judgment: Confidence and Competence

Jessica Koches

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Dr. Randi Heasley

March 13, 2023

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Competence in a Clinical Setting

A patient's safety and condition depends on a nurse’s ability to recognize the possibility

of a quickly changing status of the patient and their condition. A nurse must be able to use proper

judgment and critical thinking in order to act appropriately to optimize patient outcomes. Nurses

must be able to critically analyze data while also appropriately implementing the correct care. It

is important that a nurse can recognize cues when working with any patient as the outcome of the

patient's status is never predictable. A nurse must also act in a timely manner due to time

sensitive situations. According to the Nurse Education Journal, studies show that new nurses

struggle to apply their recently acquired knowledge in the rapid-paced, ever changing clinical

setting (as cited in Kinyon, et al., 2021). Theoretical competence is important, however, new

graduate nurses lack practical proficiency. Concrete thinking is often used which causes the

nurse to miss cues of a deteriorating status. According to Kinyon, the implementation of clinical

judgment is made more difficult due to the ever-increasing amount of information nurses must

absorb (pg 600, 2021). Studies show that nursing knowledge doubles every six years (as cited in

Kinyon, et al., 2021). As important as it is to constantly learn and adapt, a nurse holds much of

the responsibility when it comes to patient status and care. If the information is constantly being

doubled, it is difficult for schools to teach future nurses clinical judgment on top of the growing

information. Clinical judgment is the ability for a nurse to recognize cues, analyze data, prioritize

their hypothesis, generate solutions, take action, and evaluate outcomes. Oftentimes, an

experienced nurse has the ability to complete these actions within a short amount of time. In

order to provide the best outcome for a patient, clinical judgment is required. Afterall, clinical

judgment could be the difference between life and death.

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Importance of Clinical Judgment in Nursing

The objective of nursing school is to teach students to be competent nurses with critical

thinking and decision making skills to promote safe, high quality patient care. Nursing school

often emphasizes the importance of clinical judgment however, focuses on students passing the

state board tests upon graduation. Although theoretical competence is very important, clinical

judgment may be the difference between life and death. The importance of clinical judgment is

transforming nursing education in order to close the practice-education gap (as cited in Kinyon,

et al., 2021). In a survey conducted by the National Council of State Boards of Nursing,

employers reported concern regarding new graduate nurses’ readiness to enter practice. Fewer

than 50 percent of employers reported “yes definitely” when asked if new graduates were ready

to provide safe and effective care (as cited in Kinyon, et al., 2021). Supporting the concern for

nursing preparedness, the World Health Organization stated that medication errors were the 14th

leading cause of death globally and the 3rd leading cause of death in the United States (as cited

in Kinyon, et al., 2021). Lack of clinical competency and readiness can significantly contribute

to preventable errors which are important to prevent when providing safe and effective patient

care. In order for a patient to receive safe, effective, and appropriate care, a nurse must be able to

judge the situation and patient appropriately. Although clinical rotations are the start of students

practicing clinical judgment, a preceptorship model allows students to learn how to incorporate

theory into practice. Preceptorship has existed in nursing education since long ago. Many

supported the use of the preceptorship model as an effective approach to facilitating students’

learning and acquisition of skills in clinical practice (Rosli, et al., 2022).

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Personal Clinical Judgment Experience

A senior preceptorship is a way for nursing schools to provide nursing students the

essential aspect of nursing. It helps students to transition into functional and competent nurses

under the supervision of a preceptor. Benefits from this experience may include building

professional roles, competence, confidence, and socialization in the nursing practice; as well as

developing and achieving personal goals, learning accountability and becoming more

familiarized with the organizational culture (Kim, et al., 2014). In other words, precepting is a

way for students to learn to deliver safe and quality care to their patients. Since beginning my

preceptorship, there have been many times I have witnessed clinical judgment used properly and

effectively. Although my preceptor is a newer nurse, she is very knowledgeable and is able to

adapt quickly to change. This is important as being a nurse on a labor and delivery floor,

anything can happen and change at any time. During one of my shifts with my preceptor, we

assisted with a vaginal delivery. For this delivery, she was showing me how to properly be a

baby nurse after the baby had been delivered. The delivery went well and the baby was out fairly

quickly. Although the delivery was smooth, the baby was blue and not crying. My nurse quickly

grabbed the baby and brought him to the warmer where she began to stimulate him using warm,

dry blankets. She then rolled up a small towel and placed it under the back of the baby’s neck

while simultaneously tilting his chin back. She listened to the lungs and prepared to suction the

baby. She had been using the bulb suction however, the baby needed to be deep suctioned. After

deep suctioning the baby, he began to cry and turn pink. This all happened very quickly as there

was other staff helping. It was amazing to see how quickly my preceptor was able to adapt to the

situation and respond in the correct way to provide the best outcome for the patient. While
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working on the baby, the mother was concerned, as any mother would be. My preceptor was able

to continue providing care to the newborn while also reassuring the mother.
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References