Clinical Nursing Judgment 1

Clinical Nursing Judgment

Jeremy Ray

Youngstown State University Department of Nursing

NURS 4850

Dr. Randi Heasley

February 12, 2024

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Clinical nursing judgment is an important aspect of nursing practice. Regardless of if they

are a new graduate nurse or a veteran nurse every nurse possesses some level of clinical nursing

judgment, and in a lot of situations this judgment can be the difference between the life or death

of a patient. For this reason, nursing judgment is one of if not the single most important aspect of

the nursing practice. Clinical nursing judgment is defined as the process by which nurses make

decisions based on nursing knowledge (evidence, theories, ways/patterns of knowing), other

disciplinary knowledge, critical thinking, and clinical reasoning (AACA 2024). This skill is

typically not very “sharpened” when you graduate and are working as a new nurse on the floor.

In fact, I would suggest that a majority of new nurses struggle with this concept for the first year

of their career. The problem is that in school, whether it be an ADN program or a BSN program,

you do not get enough experience as a nurse on the floor. I know that may sound ridiculous to

anyone who has gone through the nursing program, however, while we do get time “on the floor”

as students we do not get the full workload or responsibilities of a nurse until we pass the

NCLEX and start our careers. This results in little to no development of our clinical nursing

judgment, and really all we have to fall back on is the book definition or case scenarios we went

over while in class. For most people, this does not help that much. This is because, as many of us

have learned throughout our journey through the program and careers at the local hospital, you

don’t really know how to do something until you are presented with a situation in which you

have to use it. It is for this reason that new graduate nurses tend to struggle with clinical nursing

judgment. In an online journal done on NurseEducator.com the authors sum up this struggle by

stating the following “New graduate nurses commonly lack confidence, an essential antecedent

to the practice of clinical reasoning and judgment. In the absence of confidence, new graduates

may exhibit reduced ability to manage novel or complex clinical situations” (Delle et al., 2022).
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In order to solve this issue nursing programs worldwide should gradually increase the

workload and responsibility of the students. As you start out in your first clinical, you should of

course only have one patient to take care of. However, as you progress through the program you

should get more and more patients and responsibility until you are at the full workload of a

normal RN. This would certainly improve the clinical nursing judgment of new graduate nurses

and help them adjust more to the nursing environment. However, the only way to truly improve

nursing judgment is to work in the field and get experience with all different types of patients.

Every nurse also has a different way of dealing with things, and it is the different experiences

and unique knowledge of the nursing field that determines how a nurse will begin their

assessment (Jessee, 2021). You will do things wrong at times and not know the answer, but

every nurse regardless of their amount of experience has gone through this and there are many

that are there to help you along the way.

In my own personal experience clinical nursing judgment has been a struggle for me. As

mentioned before, being a new nurse you really do not have much experience with nursing

judgment. Luckily, I have a job as a student nurse extern at the local hospital and have almost 2

years of experience in this job. This has helped me sharpen my clinical nurse judgment skills by

following around nurses and taking on certain responsibilities that a normal nurse would have. I

still struggle, however, because clinical judgment is a very hard concept for me. Being able to

decide which patient to visit when you have 5-6 of them is very difficult. Especially when the

patients cannot be judged by the ABCs of nursing. When you have 5-6 patients who have all

similar conditions it really comes down to if you have seen it before and how you have treated it

before. I base it off of whether or not the patient is actively deteriorating or not, then I decide

which conditions would result in the worst outcome for the patient if they are not treated
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immediately. Whoever is at the greatest risk of death or impairment is generally the one I see

first if I cannot use the ABCs. Doing this has indeed helped me and made things just a little bit

easier for me when it comes to prioritizing care. In one instance, I used this tool to determine

whether to see a patient coming back from a heart catheter or a patient who had gone through

open heart surgery 2 days prior. I prioritized the heart catheter patient because he may have not

been actively deteriorating but he was more unstable than the open heart patient who had been

stable all day. In fact, the patient I chose to visit first had bleeding at the site and numbness in the

finger as well as a cyanotic hand. This was a good decision by me and using this tool to aid in

my clinical nursing judgment helped me prevent a patient from having further complications. In

another instance I had a patient who needed to use the restroom immediately, on the way to get

this patient to the bathroom the patient in the room down the hall went into cardiac arrest. This

was a fairly easy decision to make because the cardiac arrest patient was actively dying but I

immediately stopped what I was doing and ran to start giving compressions.

In conclusion, clinical nursing judgment is definitely one of if not the most important

skill that a nurse possesses. In many situations that you may be presented with in your career as

an RN, clinical nursing judgment will be the factor that determines life or death of a patient. You

must try your best to sharpen this skill and use it to the best of your ability when you are working

on the floor, but it truly can only be improved by experience and accumulation of further

knowledge of the nursing practice.

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References

Home. AACN. (n.d.). https://www.aacnnursing.org/essentials/tool-kit/domains-concepts/clinical-

judgement#:~:text=As%20one%20of%20the%20key,critical%20thinking%2C%20and

%20clinical%20reasoning.

Delle, J. M., Cross, L., Weaver, A., & Jessee, M. A. (2022). Evolving the assessment of clinical

judgment: An individual ... : Nurse educator. LWW.

https://journals.lww.com/nurseeducatoronline/Fulltext/2023/03000/Evolving_the_Assess

ment_of_Clinical_Judgment__An.6.aspx

Jessee, M. A. (2021, October 27). An update on clinical judgment in nursing and implications

for education, practice, and regulation. Journal of Nursing Regulation.

https://www.sciencedirect.com/science/article/pii/S2155825621001162?via%3Dihub