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Clinical Nursing Judgment

Sterling J. Roberts

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Professor Ballone & Professor Heasley

March 13th, 2023

Clinical Nursing Judgment

Clinical nurse judgment is a skill that all nurses must have in order to provide quality patient care.

It is defined by the National League of Nursing as, “ways nurses come to understand the problems,

issues, or concerns of clients/patients, to attend to salient information, and to respond in

concerned and involved ways” (Benner, 2010). As nurses, we employ our clinical judgment

continually throughout our shift by observing and identifying any changes in the patient’s

condition, ensuring their safety, advocating for their needs, and prioritizing their care. Our

judgment is vital in assessing and evaluating the patient’s condition and deciding on the

necessary interventions while keeping in mind the importance of the outcomes. The clinical

judgment process is an integral part of nursing, and it goes hand in hand with the nursing

process.

The ability to make sound clinical judgments is crucial for nurses to provide safe and

effective care, and it requires a combination of knowledge, experience, and critical thinking

skills. It is one of the most important qualities to have as a nurse in their practice. But clinical

judgment is a difficult concept to teach in the classroom. Lectures and reading do not do this

concept justice. Instead, clinical judgment is best developed through hands-on experiences and

mentorship from experienced nurses in the field. Some of these experiences include a hands-on

head to toe assessment, inserting a foley catheter or a IV catheter, interacting with patients and

many more concepts in practice. Through simulations, clinical and preceptorships with active

nurses, the student nurse is able to develop their skill in the real world. These opportunities allow

students to work alongside nurses or instructors to learn how to prioritize care, monitor patients,

make critical decisions, review orders, and interpret lab results. “The development of clinical

judgment itself is not a clear linear process, and although years of experience in nursing appear

to support the sound development of clinical judgment skills in a nurse, almost all the literature
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around this concept addresses that it is imperative the skill must be introduced in foundational

studies of a nursing students course of study” (Connor 2022). This allows for students to observe

how other nurses preform in the field allowing them to improve their skill based of how a nurse

works. Since critical judgment and skills come with years of experience and time, it’s important

for students to begin these opportunities early so by the time they get hired as an RN they already

have a background and real-world application of nursing skills. After obtaining a position on a

floor, a nurse is oriented for several weeks allowing them to practice these newly learned skills.

This is different than clinicals because it allows the nurse to be fully responsible for patients

while using judgment and proper nursing care. “Practice-ready graduates require focus on

bridging the gap between academia and practice in these key areas and a supportive work

environment. Helping to ease NGNs’ frustration and assist toward confidence should be the goal

of academic and orientation programs” (Monagle 2018). A lot of nurses are “practice ready” but

have no core experience so this is why bridging the gap of nursing school and nursing practice is

very important. Especially in today's world, most specialty areas are willing to sign new grads

with no prior experience as stated by Monagle. “The growing demands of the acute care setting,

including complex patients and staffing challenges…”(Monagle 2018). This is because of the

demand for nurses so therefore a lot of the time specialty units will take what they can get. Of

course, these nurses need an extensive orientation to get them onto the level of the unit but with

specialty clinicals and preceptorships, this should put those nurses ahead. Nurses who are

properly able to develop their clinical judgment skills ultimately become more successful nurses

with better outcomes for their patients.

I have had several experiences where I have had to use clinical nursing judgment but,

there is a specific experience that was crucial in testing my skills. During a 12-hour ICU
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precepting shift, I was assigned a patient that had a fall which caused a fractured arm along with

a spinal injury of the neck (C3-C4). This patient had many problems, but our main concerns were

his respiratory status and neuro status. In the beginning of the shift, I closely monitored the

patient as he was sleeping. When he started to wake up was when things took a turn. His oxygen

saturation began to drop, and I noticed he had a wet cough. The patient was in pain and trying to

take deep breaths but was unable to do so. I then called the nurse to assist me to perform

nasotracheal suctioning to remove the secretions that the patient was unable to cough up. Despite

feeling nervous and overwhelmed at first, I quickly realized that this experience would be a

defining moment in my nursing preceptorship. After the suctioning, the patient’s oxygen

saturation went back up to 96%. Throughout the day I noticed his O2 dropping so I kept using

my clinical judgment and was able to suction the patient on my own to help clear the patient’s

airway. I was aware that my patient was a risk for aspiration along with a compromised airway

due to his neck injury. When my attempts were not enough to help clear his secretions, I knew it

was time to ask my nurse for help. I believe that now seeing how to handle this situation in the

field I can now apply it in future patients when I’m a nurse by myself.

Overall, clinical nursing judgment is an acquired skill that is learned over time. Although

clinical judgment is a hard topic to teach in lecture/class, a new grad nurse or student can learn

these skills through clinical and quality preceptorships. Over time with practice, the novice nurse

is able to use clinical nurse judgment to provide quality patient care and better outcomes.

Furthermore, the incorporation of evidence-based practice and ongoing education can further

enhance the development of clinical nurse judgment and ultimately lead to improved nursing

care. Although I personally have not fully developed my clinical judgment skills, I feel as if I’m

improving every day with clinicals and my preceptorship in the CVICU.

References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgment in nursing –

an evolutionary concept analysis. Journal of Clinical Nursing.

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

Monagle, J. L., & Lasater, K. (2018). New graduate nurse experiences in clinical judgment:

What academic and practice educators need to know. Nursing Education Perspectives,

39(4). https://doi.org/10.1097/01.nep.0000000000000361

 Benner, Patricia E. Educating Nurses: a Call for Radical Transformation. Jossey-Bass,

2010.