CLINICAL NURSING JUDGEMENT 1

Exploration of Clinical Nursing Judgement

Ariana L. Ormiston

Youngstown State University

NURS 4850: Nursing Capstone

Dr. Randi L. Heasley, DNP, RN, CNE

March 01, 2024

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Exploration of Clinical Nursing Judgement.

Defining the Concept

Clinical judgement came about around the first World War when nursing had begun to

develop rapidly as injured soldiers needed care. This led to nurses having to develop skills such

as problem solving and judgement to care for these patients efficiently. Though, what they were

doing was not yet defined. “Clinical judgement is arrived at through clinical reasoning and is not

only based on clinical knowledge, but other factors such as nurses' personal values and

familiarity with the patient’. It is professional consideration and understanding of a problem or

need, concluding in a judgement of what to do next, as appropriate to each individual

circumstance” (Connor, J. al, 2023, p. 3331). This was a brilliant definition of what exactly

clinical judgement is. Clinical judgement then needs to be applied.

Imagine a nurse on a medical surgical unit. This nurse has four patients each with

different needs and diagnoses. This nurse will then have to prioritize their care for all four

patients in a way that gives these patients safe, efficient, and quality care. The nurse needs to be

able to recognize which patient is most important to see first. This is not to say that the other

patients are not as important, but are less likely to experience an adverse event. This would have

been the same during the first world war as the nurses would need to attend to the most critical

first as they would benefit greatly from it.

The world of nursing and health care is ever evolving and so is clinical judgement.

“Inconsistent clinical decision-making is of concern as nurses assume higher levels of

responsibility and accountability for patient care in healthcare environments that are increasingly

demanding and complex” (V.J. Clemett. al., 2020, p.1). The demand and complexity of nursing is

one of the reasons it is important for novice nurses to be tested on this concept.
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The Importance

Clinical judgement is important as it is crucial for safe, efficient, and quality patient care.

No matter what field of nursing or health care profession a person may be, clinical judgement is

going to be used. This skill is taught throughout a healthcare professional's time in college to

obtain a degree. The National Council Licensure Examination, or NCLEX, recently changed

their test format. This is because they realized that current testing items were not effective and

that it is important for clinical judgement to be tested and that preparation must begin in school

(Sherrill, K., 2020). It is important for novice nurses to understand the concept of clinical

judgement and apply it.

In nursing school exams, quizzes, and assignments are created for students to be tested on

their understanding of the nursing process and clinical judgement. This is because after years of

research it has been found that two common reasons a novice nurse may have disciplinary action

against their license includes the failure to notice and the failure to act (Sherrill, K., 2020). This

led to the push for a new licensure exam and content to be added in school curriculum. “It is

important that the nursing educators are able to determine whether a student nurse has met the

standards of proficiency for registration, including their competency to make safe clinical

decisions” (Sherrill, K., 2020, p.1). It is hoped that after they obtain their degree and pass their

licensure exam they will be better prepared to avoid disciplinary action and provide quality care.

Applying these concepts taught about clinical judgement at the bedside and learning how

to interpret important clinical data is crucial in helping determine the best responses for patients.

Clinical judgement is a principal part of evaluating and deciding the best plan of care for

patients. Leading to better patient outcomes.

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Personal Experience

A personal experience where I used “clinical nursing judgement” in a specific situation is

when I was pulled as an aide from an intermediate unit to a non-telemetry unit as a sitter for a

patient coming up from the emergency room. This patient was about mid 80 years old, not very

unresponsive, not moving around, and looked malnourished. I immediately noticed that this

patient should not have been admitted to a non-telemetry unit. I asked for a dinamap to get vitals

on them. Their vitals were not the best and they were still unresponsive to voice and sternal rubs.

They would occasionally move their arms, but in my head I wondered what the reason was that

they placed this patient on a non-telemetry unit and did not choose a telemetry unit for them as

the patient was clearly not stable and did not look to be in the best condition.

I told the nurse on the unit that I did not feel safe without the dinamap on as I had a bad

feeling this patient was not going to do well. I kept a pulse oximetry on their finger to monitor

their heart rate and oxygen saturation. After about ten minutes of sitting with this patient they

started seizing so I got them on their side and pushed the staff assist in the room and called down

the hall for help. They ended up calling a rapid response team and they decided to move them to

a new floor. I followed them to the intermediate floor where they would be watched on telemetry.

At some point before being admitted to a non-telemetry unit I feel the emergency room

or admitting floor should have questioned the unit the patient received a bed for and advocated

for them to be on a telemetry unit for their safety. I understand that the emergency room is busy

and gets swamped sometimes so they do the best they can. They ended up doing well on the

telemetry unit and eventually became more responsive and talking within the days following.

Clinical judgement is important. If I had not used my judgement skills and anticipated the

decline I probably would not have been much help.

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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023). Clinical judgement in nursing – An

evolutionary concept analysis. Journal of Clinical Nursing, 32, 3328–3340.

https://doi.org/10.1111/jocn.16469

V.J. Clemett and M. Raleigh. (2021). The validity and reliability of clinical judgement and

decision-making skills assessment in nursing: A systematic literature review. Nurse

Education Today, 102, 0260-6917. https://doi.org/10.1016/j.nedt.2021.104885

Sherrill, K. (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