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Clinical Nursing Judgment

Abigail R. Langmeyer

Centofanti School of Nursing, Youngstown State University

NURS 4850: Nursing Capstone

Dr. Randi Heasley

March 1, 2024
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Clinical Nursing Judgment

To promote and ensure patient safety, nurses must incorporate clinical judgment skills

into the scope of nursing practice. Clinical judgment is a cognitive process (Uppor et al., 2023)

that emerges from the aspects of critical thinking and evidence-based practice. Failure to use

clinical nursing judgment can result in a patient’s health status deteriorating, therefore

jeopardizing patient safety and putting their lives at risk. Students need to begin to develop the

importance and application of clinical nursing judgment. Before nursing students graduate and

enter the nursing profession, universities and professional nursing instructors must educate and

teach students to develop safe and effective clinical judgment. In a nursing journal, Uppor et al.

(2023) state, “Stimulation-based learning has become a vital pedagogy used widely to develop

students’ clinical judgment” (p. 445). Such learning will help students enhance their skills and

promote patient safety. As a future registered nurse, I need to continue learning and growing

upon my clinical judgment and critical thinking skills. It’s important to realize how common it is

to see new graduate nurses struggle with developing judgment skills. New graduate nurses often

rely on technology and end up missing cues and important details regarding a patient’s status

(Kinyon et al., 2021).

During my time as a senior nursing student, there was a moment in my nurse

preceptorship where I applied my clinical judgment skills along with my assigned preceptor. A

few weeks ago, I was caring for a patient who came in with an altered mental status and had a

history of multiple comorbidities such as diabetes mellitus, hypertension, and congestive heart

failure. Towards the end of the shift, my preceptor and I were getting ready to administer the

patient’s evening medications; however, our patient suddenly became severely short of breath

and their blood pressure was surpassing 180/120. Shortly after we assessed these observations,
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we immediately followed the ABCs of nursing and raised the head of the bed into an upright

position and increased the liters of oxygen on the nasal cannula from 2 to 4 L. This corrected the

patient’s shortness of breath, but now it became crucial to correct any circulation problems

causing the increased blood pressure.

With understanding the patient’s past medical history, I realized their maintenance fluids

of lactated ringers were still running at a rate of 100 mls/hr. When I brought this observation up

to the nurse, we both decided to immediately stop the running fluids. That was most likely a

main contributor to the cause of the patient’s shortness of breath and elevated high blood

pressure. After we turned off the fluids, the nurse made an immediate call to the attending

physician. The physician ordered IV propranolol to correct this blood pressure reading. Soon

after, the physician took a visit to assess the patient and told us the next plan of action. His orders

were to discontinue the lactated ringers and to update the patient’s status after administering the

IV propranolol. After 30 minutes, we notified the physician that the patient is in stable condition

and their blood pressure and other vitals were back to baseline.

While learning to become a nurse, it is crucial to assess and understand the patient’s

baseline status. Without using clinical judgment skills, we would have failed to recognize

specific cues and critical data (Kinyon et al., 2021) relating to the patient’s current condition.

When the patient became stable, I was able to reflect on my clinical judgment skills. It’s

important to evaluate yourself each day on the unit. Self-reflection is a valuable tool (Maffucci et

al., 2023) that can be used to develop and improve clinical judgment skills in the nursing

profession.

After this situation, I evaluated myself and realized what my strengths and weaknesses

were and what I should improve on. My strengths include understanding patient cues, medical
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history, and current baseline. For instance, I noticed how the IV fluids were still running and

alerted the nurse immediately. On the other hand, some of my weaknesses include relying on my

preceptor’s command. For example, I was waiting for my preceptor’s approval to let me know if

shutting off the fluids was the best call of action. After each shift at the hospital, my preceptor

and I reflect on our days, speaking on what we learned and what we can improve on. Self-

reflection and active learning (Maffucci et al., 2023) are tied to positive clinical judgment skills.

Due to this, it is vital that student nurses and experienced nurses should take time to discuss

different experiences throughout their days.

To incorporate a strong understanding of clinical judgment skills, nurses must have a

positive and determined attitude. I attempted to complete each shift in its entirely with a positive

attitude. Having a poor attitude can limit your personal growth and inhibit clinical nursing

judgment skills. Another important aspect that helped me with my clinical judgment skills during

this situation was having adequate situational awareness. I was able to be alert for any changes in

the patient’s condition and doctor orders. For example, I immediately noticed the shortness of

breath my patient was experiencing and the new order of IV propranolol. Without having strong

situational awareness, nurses will fail to recognize the signs of clinical deterioration (Alqarrain et

al., 2024). Different approaches to nursing practice will enhance clinical judgment skills and

improve patient outcomes and safety.

I need to continue to grow and enhance my clinical nursing judgment skills. Utilizing the

nursing processes, incorporating critical thinking, being aware of your situation, and having a

positive attitude can all improve the development of clinical judgment skills. I believe I

developed and improved upon my clinical nursing judgment skills by implementing these

attributes into my training.

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References

Alqarrain, Y. , Roudsari, A. , Courtney, K. & Tanaka, J. (2024). Improving Situation Awareness

to Advance Patient Outcomes. CIN: Computers, Informatics, Nursing, Publish Ahead of

Print , doi: 10.1097/CIN.0000000000001112.

Kinyon, K., D’Alton, S., Poston, K., & Navarrete, S. (2021, August 2). Improving physical

assessment and clinical judgment skills without increasing content in a prelicensure

Nursing Health Assessment course. MDPI. https://www.mdpi.com/2039-4403/11/3/57

Maffucci, J., Vanderzwan, K., & Burt, L. (2023). Evaluating a shared reflective practice to

develop nursing student clinical judgment. Nurse Educator.

https://doi.org/10.1097/nne.0000000000001570

Uppor, W., Klunklin, A., Viseskul, N., Skulphan, S., & Turale, S. (2023). Designing simulation

scenarios to enhance nursing students’ clinical judgment: a Qualitative study. Pacific Rim

International Journal of Nursing Research, 27(3), 445–456.

https://doi.org/10.60099/prijnr.2023.262001