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Clinical Nursing Judgment

Nicole Cage

Centofanti School of Nursing, Youngstown State University

NURS 4850: Senior Capstone Seminar

Dr. Randi Heasley

March 1, 2024
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Clinical Nursing Judgment

I have only just begun to appreciate the true concept and definition of clinical nursing

judgment. As a novice student nurse, I have been focusing on the task at hand and have struggled

to put the whole picture together to fulfill the requirements of clinical nursing judgment. Now, as

a senior, I can better appreciate and see how necessary good clinical judgment is and how to

work towards meeting the standard of adequate clinical judgment as a nurse. Some components

of good clinical judgment are strong assessment skills, quantifying and collecting available

patient data, critical thinking, and keeping up with the evolving healthcare system. A working

and current definition of clinical judgment in nursing has been established by a nurse, Justine

Connor, and her colleagues by way of concept analysis to come up with a contemporary

definition for clinical judgment. The result of their analysis and the definition they came up with

is “Clinical Judgment is a reflective and reasoning process that draws upon all available data, is

informed by an extensive knowledge base, and results in the formation of a clinical conclusion”

(Connor, 2022, p.1). With this definition, we can begin to analyze and understand why clinical

nursing judgment is so vital and how we can continue to evolve this definition as the nurse’s

roles and clinical responsibilities increase and change. This definition is meant to be malleable

and workable to adjust to and with the evolving roles and responsibilities in the field of nursing.

The definition of clinical nursing judgment highlights the importance of using a

reflective process that draws upon available data. Throughout my time in school, I have learned

about a pioneer nurse, Florence Nightingale, and how she applied reflective knowledge and data

to implement the best and most effective interventions to promote healing and progress within

her patients. Our definition mentions the need for data, and Florence noticed the lack of record

keeping, and thus, lack of data present to make decisions about patient care. Florence started
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keeping diligent records for her patients. Not only did her efforts document the care each patient

was getting, but she also documented what interventions and medications were working for a

patient leading to a desired outcome. Through her record-keeping, she was able to determine

what worked and what didn’t work resulting in data used to make clinical judgments (Matthews

et al., 2020). This is how Florence was able to advocate for her patients to receive quality food,

air to breathe, and sanitary environments. She recorded and documented what happened when

simple standards such as infection control and poor nutrition were present and were a detriment

to her patient's healing. She was met with disdain and push-back from high-ranking military

officers who viewed her efforts as “too much indulgence” for soldiers (Matthews et al., 2020,

para. 7). Despite this, Florence persevered with her data collection and treatment of soldiers. This

is one of the most essential concepts I have learned in nursing school: What can I do for this

patient to improve their condition and promote healing? Florence was able to realize the

importance and need for data that could be used in reasoning and clinical practice, as our

definition suggests.

Another important part of clinical nursing judgment is having extensive knowledge to

pull from to make sound clinical judgments. This is something I struggle with as a student nurse

and something I anticipate I will continue to struggle with as a new graduate nurse. An article

published in the American Nurse Journal discusses the evolution a novice nurse may go through

to acquire a true clinical nursing judgment. The article titled “New Nurses and Clinical

Judgment,” explains how new nurses commonly experience “an academic-practice gap in which

they have difficulty transferring knowledge and theory to the clinical setting” (Grube, 2023, para.

1). I agree with and have personally experienced the notion that new nurses often have a task-

oriented mindset and are unable to use information gathered and reasoning skills to reach a
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conclusion within a reasonable amount of time for patient care. Student nurses rely heavily on

rules and guidelines to dictate patient care experiences (Grube, 2023). This shortcoming of

clinical nursing judgment in new nurses and nursing students is why clinical experience and

quality precepting are vital. Experience is the main underlying variable of good clinical nursing

judgment. An experienced nurse, who is already armed with the skills, knowledge, and critical

thinking can better teach and lead the student nurse or new nurse to acquire clinical judgment. It

is easy and expected for a new nurse to become overwhelmed by the inherent shortcomings in

knowledge and experience, but being paired with and mentored by an experienced nurse can help

a new nurse work through this period and gain skills to encourage “clinical reasoning and

judgment using an evidence-based approach” (Grube, 2023, para. 7).

Despite being a student nurse, I have been able to demonstrate clinical nursing judgment

in specific situations. One situation occurred during an off-site mental health clinical rotation. I

was at an outpatient facility that offered individuals a place to detox from drugs and/or alcohol

and was open to clients 24 hours a day. A middle-aged female presented for detox and was

brought in by her mother and daughter. I was sitting with the intake employee during the initial

interview and took notes as the patient disclosed her health history. This patient was chronically

homeless and had a history of mental illness and substance abuse. During the interview, it was

clear the patient had no interest in mental health treatment of any kind. The patient

overwhelmingly agreed to all physical health appointment opportunities such as a primary care

appointment, chiropractic care, and suboxone. The patient became visibly distressed when

psychiatric or mental health treatment was offered, and the patient quickly rejected any offer

relating to psychiatric care. Her body language became closed off and her attitude became

distrusting when psychiatric care was mentioned. There was some confusion with the intake
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paperwork, so the employee conducting the interview suggested the patient get a change of

clothes and a snack and the employee would be back in 15 minutes to have the patient sign the

paperwork for her detox stay at the facility. When the employee returned with the paperwork

ready to be signed, the patient refused to sign. She was not budging and became agitated over the

employee's request that she sign the paperwork we just went over. The situation started to get

tense and I suddenly realized why the patient wouldn’t sign. The first document to be signed

simply stated that the opportunity for physical health and mental health treatment was provided

to the patient and would continue to be provided to the patient while in detox at this facility. The

patient refused to sign it because she thought it meant she was agreeing to mental health

treatment. I vocalized this concern in front of the employee and patient and asked the patient if

the reason she wasn’t willing to sign the form was because it suggested mental health treatment.

The patient agreed to this being the reason for her refusal, and the employee was able to further

educate the patient that this form did not mean she was signing up for mental health treatment

but instead was acknowledging that it was offered to her and available to her if she wanted it. I

demonstrated nursing clinical judgment in this situation by using previous knowledge,

experience, and data gathering to reach a clinical conclusion. In my previous job, I worked

closely with the homeless population, and many struggled with mental illness. I was able to draw

upon my previous experience and recognize the body language and attitude shift by the patient to

put together an accurate clinical conclusion.

In conclusion, we can see how vital clinical nursing judgment is to the field of nursing

and the individual nurse and their delivery of care. Collecting and analyzing data, experience,

and critical thinking are only a few components of clinical nursing judgment. I am eager to be a

part of the evolution of nursing and aim to use the topics discussed to contribute to the field. I
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am humbled and excited to be a part of this field and to participate in life-long learning aimed at

providing the best patient care possible.

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References

Connor, J. (2022, July 25). Clinical judgement in nursing – an evolutionary concept analysis.

Wiley online Library. https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.16469

Grube, T. (2023, September 13). New nurses and clinical judgment. American Nurse Journal.

https://www.myamericannurse.com/new-nurses-and-clinical-judgment/

Matthews, J., Whitehead, P., Ward, C., Kyner, M., & Crowder, T. (2020, May 31). Florence

Nightingale: Visionary for the Role of Clinical Nurse Specialist. OJIN.

https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/

OJIN/TableofContents/Vol-25-2020/No2-May-2020/Nightingale-Visionary-for-Clinical-

Nurse-Specialist.html