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An Exploration of Clinical Nursing Judgment

Mia A. Bruno

Centofanti School of Nursing; Youngstown State University

4852 Senior Capstone Seminar

Dr. Ballone and Mrs. Heasley

February 18, 2023

An Exploration of Clinical Nursing Judgment

When addressing the topic of clinical nursing judgment, it is imperative to understand

that this is a complex concept with many components. These components include clinical

reasoning, critical thinking, and clinical decision-making. Sound clinical judgment is said to be

the foundation of quality nursing care. (Manetti, 2019) Nurses are the eyes and ears of the

doctors in our healthcare system. They are expected to notice the most subtle of cues and

changes in the patient’s condition to then implement interventions to prevent further harm and

deterioration to that patient. Patient safety is reliant on the safe, accurate, and timely decisions of

educated nurses (Reay et al., 2016).

For this sound clinical judgment to develop, it takes knowledge, time, and experience to

acquire this skill. Clinical nursing judgment has a lot to do with nurses’ intuition and their

autonomy to problem-solve efficiently. As Dwyer et al. (2022) states: Clinical judgment 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.

No matter your unit or specialty, every patient is so different. You can have two patients

with the same diagnosis and even those patients can present with different symptoms and

respond to treatments differently. Along those lines, there's an important factor here known as

patient acuity. Patient acuity is the measure of a patient’s severity of illness and the stability of

physiological and psychological parameters. Therefore, a patient with a higher acuity will be

more complex and will in turn require more critical thinking to reach sound clinical judgment.

The demands of complex clinical practice settings mean nurses are multitasking more involved

tasks, have further increased their scope of practice, and make important judgments about the

care they provide (Manetti, 2019).

New technology and unsafe staffing ratios further complicate clinical nursing judgement,

making it an even more essential skill in modern healthcare. Noon (2014) suggests nurses now

practice in an environment where conventional nurse boundaries and responsibilities are

persistently challenged and employing clinical judgment for safe practice is essential. The

implementation of sound clinical nursing judgment is more important now than ever. The goal of

most nursing schools in our country is to prepare nursing students to take the NCLEX

examination. As much as this exam requires content knowledge, most of the questions revolve

around prioritization, delegation, and patient safety. All of these are key factors in improving

patient outcomes as I will explain with my own personal experiences below.

During my time in nursing school at Youngstown State University, I have been working

very hard to acquire the skill of nursing judgment and intuition. As we have limited time in

clinical settings, it is hard to identify the progression of this specific skill as we don’t have much

autonomy with our patients. I feel as though my own sense of clinical nursing judgment has been

slowly developing throughout the many challenging classes in this program. As I connect the

content learned in lecture with a real-life clinical experience, it seems as though I can critically

think and reflect on the situation, further developing my skills and cultivating a sense of

autonomy in my nursing practice.

Throughout the years, we have had many simulations in the lab with scenarios that are

linked to our lecture content for that class. In these simulations, we have a fully simulated patient

scenario where we are challenged to recollect all the information needed to take care of this

patient. I can recall one specific simulation lab scenario that I felt strengthened my clinical

nursing judgment. This simulation scenario was related to OB course content, and I was selected

to be the primary nurse. The scenario started off by reviewing the background information. The
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scenario then began with a patient who was 36 weeks’ gestation in active labor in Walmart.

Right away, we went up to her and asked her important assessment-style questions. After we

assessed the patient giving birth and our surrounding area, we realized that this baby was coming

now and there was no time to wait. After that realization, my first priorities were safety and the

risk of infection. I started to delegate tasks to people around me. I had someone call an

ambulance, I had others run to get supplies such as paper towels, blankets, towels, and water. I

also cleared the immediate area so as to not induce more stress onto the laboring woman. Since

this was an emergency, there wasn’t much time before she started pushing. As primary nurse, I

stepped in where a doctor would be, and delegated my fellow nurses to have blankets ready for

the baby. After only 5 minutes of pushing, the baby was born and EMS arrived at the scene. We

then paused the scenario and picked it back up in the hospital as the patient was transported

safely but was showing signs of postpartum hemorrhage. Again, as primary nurse I remembered

that we needed to give Pitocin, Hemabate or Methergine to stop the bleeding and stabilize mom,

so I delegated that task to the medication nurse. The patient was stabilized with our interventions

by the end of the simulation.

Overall, this was the first time that I had the ability to truly test my clinical nursing

judgment, and I was pleasantly surprised to feel confident in it. As primary nurse, I was able to

delegate tasks to the other nurses so we could stabilize our patient in a timely manner, to

recognize the risk of bleeding in a precipitous labor as well as the risk of infection due to an

emergency birth in a public place. I believe these simulations really do foster an environment to

build this essential skill and gave me the opportunity to exercise my clinical nursing judgment,

including the components of clinical reasoning, critical thinking, and clinical decision-making.
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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

Wright, J., & Scardaville, D. (2021). A nursing residency program: A window into clinical
judgment and clinical decision making. Nurse Education in Practice, 50, 102931.
https://doi.org/10.1016/j.nepr.2020.102931

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,
54(1), 102–110. https://doi.org/10.1111/nuf.12303