Running head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Alexa Pasquale

Youngstown State University

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Clinical nursing judgement 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) This is an

important skill for all nurses to develop in the beginning of their career and to utilize for years to

come. Clinical judgement is employed when nurses are setting priorities, planning outcomes,

reacting to an acute or critical situation, and simply using their intuition when performing patient

care. When looking at clinical nursing judgement, one must understand that several factors play a

role during the development of a new nurse’s clinical judgement. Basic knowledge of nursing

theory from lecture, professional ethics, human understanding, and patient relationships are

essential in the development of student nurses’ judgement. In addition to the basic knowledge

learned throughout nursing curriculum, there are additional factors within the education of new

nurses that may influence a student’s clinical judgement. Thoughtful behaviors, use of evidenced

based care, context of learning environment, and individual and professional characteristics of

clinical teachers can either improve or impede the development of clinical judgement in nursing

students (Pouralizadeh, 2017). Both the student nurse’s personal characteristics, as well as their

educational and clinical experiences help to shape their developing skill of clinical judgement.

Nursing judgment may be one of the most important qualities in any nurse. Although it is

of utmost importance, it can also be seen as the most difficult to learn. One can understand skills

and concrete concepts easily, but struggle with proper judgement. Clinical judgement cannot be

easily taught through a lecture or nursing course, rather educators should provide students with

the tools needed to foster the development of sound clinical judgement. Some nursing educators

believe that although clinical nursing judgement can only be shaped through experience, such
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ways of thinking can be seen in some students. (Pouralizadeh, 2017) As stated by many nursing

journals, the most effective way to teach clinical judgement is through simulation, clinical

experience, and the mentoring process. (Pouralizadeh, 2017) Watching other nurses act in the

field and practicing patient cases in simulation labs are two ways that students can begin to

develop judgement. A sound background in clinical judgement is important in the development

of both a student nurse and a professional. Educating new nurses and promoting the development

of sound clinical judgement is something both nurse administrators and educators strive for

(Manetti, 2018). The more practice one gets in using this skill the more apt they will be to apply

it when they become practicing registered nurses. A nurse with appropriate clinical nursing

judgement is set apart from those who do not possess the quality. These nurses will be more

successful with tasks such as prioritizing, reacting to acute situations, and attending to changes in

patient status. In the end, their care will be more efficient, and their patients will produce better

outcomes. As stated by Manetti, “it is commonly observed that new nurses need the support of

more experienced nurses to validate decisions made.” As a new nurse one should seek the help

of their colleagues in order to fine-tune the skill of clinical judgement. Overall, sound nursing

judgment leads to better patient outcomes, the goal of quality healthcare.

Throughout my student nursing career, I have been prepared to use the skill of clinical

nursing judgement. We have participated in many simulations in the campus nursing labs and

spent countless hours on hospital units practicing our skills and watching the staff. It wasn’t until

my preceptorship that I had a real opportunity to put what I had learned and practiced to use. I

am precepting on a Labor and Delivery floor, monitoring women in labor and assisting with both

vaginal and cesarean section deliveries. One of the most common, yet serious, complications we

see is fetal hypoxia, evidenced by late decelerations in the fetal heart rate. Late decelerations in
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fetal heart rate can cause fetal brain damage if not treated and reversed. During one of my shifts,

my nurse had gone to use the restroom, and asked a fellow nurse to watch her patients on the

monitors. As I sat at the nurses’ station, also watching the fetal monitors, I had noticed that one

of our patients was experiencing late decelerations on more than one contraction. I had learned

about this in class and knew that late decelerations were an ominous sign for fetal well-being. No

one was reacting to this finding, so I decided to do whatever I could as a student to help. It came

to mind that we learned that position change is the first thing we do to help the baby’s heart rate

recover effectively after contractions to restore adequate blood flow to the fetus. I walked into

the room and calmly told the patient that we needed to change her position to her left side and

assisted her in repositioning herself in bed and adjusted the ultrasound on her abdomen to detect

the fetal heart rate once again. When my nurse returned, she reviewed the tracing and noticed

that the patient had experienced some late decelerations, but that they subsided. I knew then that

I had used my clinical judgement appropriately to react to a change in patient status.

In conclusion, although students may not possess sound clinical judgement upon

graduation, they should feel that they have the tools needed to develop the skill throughout their

practice. Many educators understand that students may not be able to learn judgement in the

classroom but identify that some students display the ways of thinking needed to advance to

clinical nursing judgement. The most adequate ways for students to learn and practice the skill

are simulation, observation, and clinical experience. The importance of clinical judgement allows

a good nurse to become a great nurse who improves patient outcomes with her care. Being able

to identify when to intervene, prioritize patient care efficiently, and set patient goals are signs

that a nurse has developed sound clinical judgement throughout practice. I believe that although I

may not be able to say that I possess the full quality of clinical nursing judgement in myself, I
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know I have had adequate preparation, experiences, and opportunities to allow my judgement to

develop throughout my nursing education.

References

Critical thinking and clinical judgment: A practical approach. (2014). AJN, American journal

of nursing,104(1). doi:10.1097/00000446-200401000-00054

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing

forum, 54(1), 102-110. doi:10.1111/nuf.12303

Pouralizadeh, M. (2017). Factors influencing nursing students’ clinical judgment: A

qualitative directed content analysis in an Iranian context. Journal of clinical and

diagnostic research, 11(5), 1-4. doi:10.7860/jcdr/2017/25753.9822