Running head: CLINICAL JUDGEMENT 1

Clinical Judgement: A Vital Element of a Proficient Nurse

Timothy Erskine

Youngstown State University

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“Clinical judgement is the conclusion or enlightened opinion at which a nurse arrives

following a process of observation, reflection and analysis of observable or available information

or data” (Phaneuf M., 2008). For a nurse, many decisions are made within a short amount of time

and have a huge impact of how they are going to affect their patient, positively or negatively

(Tabak N., Bar-Tal Y., Cohen-Mansfield J., 1996). These decisions are made using nursing

clinical judgement which is shaped each and every day based on new experiences. In order to

achieve sound clinical judgement all nurses must be properly trained. Once this training base is

established, a nurse uses critical thinking, and the experience they have, in order to make life or

death decisions on nearly a daily basis (Phaneuf M., 2008).

Novice Nurse

Being a new nurse is very difficult and is only going to continue to be more difficult as

chronic illnesses increase, the length of stay shortens, and the patient-nurse ratios increase

(Graan A., Williams M., Koen M., 2016). Upon hire, nurses are expected to be highly competent

ready to work in the ever increasingly difficult heath care field, even though most do not even

meet the entry level clinical judgement (Graan A et. Al, 2016). It is shown, that most new nurses

provide care much like an analytical computer would, doing all the prescribed techniques and

using the nursing process verbatim, which is not the best way to provide sound clinical

judgement (Graan A et. Al, 2016). These new nurses tend to only tackle one intervention,

focusing on irrelevant information, while also using too much time and energy on

aforementioned task (Tabak N. et. Al, 1996). It is also shown that novice nurses are also usually

faster at making decisions, due to limited knowledge and not knowing/considering every

possible alternative or outcome that may happen from their intervention (Tabak N et. Al, 1996).
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Therefore, many new nurses will make uneducated decisions, quickly, without fully knowing the

consequences due to lack of experience and time within the nursing profession.

Expert Nurse

Through experience and a well-organized knowledge structure gained via massive amounts

of training, expert nurses are able to solve problems more quickly and efficiently than the novice

nurse (Tabak N et. Al, 1996). These experts have a more expansive knowledge base which is

much more organized and abstract than the novice. Thus, they are able to decide what they need

to do correctly and quickly (Tabak N et. Al, 1996). An expert nurse has one vital piece that is

impossible for the novice nurse to have, which is experience. Having a better knowledge of

almost all situations they encounter; the expert nurse is able to reach a decision much faster than

a newer nurse.

My Experience

Through each clinical, I can feel my own personal judgement building with every new

interaction, or every case that I see. Taking in all of this information and listening to the

experienced nurses is allowing me to gain a very expansive knowledge base, where I will use my

own critical thinking skills in order to really hone my clinical judgement ability. Although I am

gaining somewhat of my own identity, it is still extremely difficult for me to be confident in my

abilities, no matter what the task may be. I often find myself questioning my abilities on

interventions that I have performed with and instructor or nurse time and time again. Slowly but

surely, I am starting to build some sort of confidence, mostly because I have to. I have also

learned that just because someone has done something longer than you, does not make them

better. Every clinical I constantly have seen nurse chart things that simply weren’t true, simply

because they didn’t actually perform an assessment, or didn’t actually take the time to do
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something. Therefore, I have come to the realization that the only person who I can actually trust

with every fiber in my being, is myself. Although I am still a student nurse, I can feel myself

growing each and every day. For example, during my preceptorship at the Cleveland Clinic I

thought something different than that of my own preceptor. He has 33 years of experience in the

Neuro ICU, so he knows a thing or two. However, he has taught me to always chart my own

assessment, no matter what anyone says, including himself. When performing my Neuro exam, I

thought that I saw my patient had nystagmus, as a result of his stroke or procedure done. At first

glance, my nurse disagreed. However, after looking again he realized that I was actually right,

and he did have it. Although this seems like a small finding to some, I believe that it meant a lot.

Not only did I perform a good exam, but I used and was confident in my own abilities to exam

my patient. As a result, my preceptor now trusts me more and can also see that I am advancing

on with my abilities.

Conclusion

In summary, having a good grasp of one’s own personal clinical judgment is an essential

piece to one’s career as a nurse, no matter where you work, or how far along someone is within

their profession. Every single person is going to have their own clinical judgement which is

brought upon by personal experience. Throughout reading many research articles it is quite

obvious that the longer someone works within this setting, the more their judgment is tailored.

As of now, I have a pretty small knowledge base and must rely on things such as books, and

other nurses in order to make good, sound decisions for my patients. I always know that if I am

unsure or feeling not confident, that there is someone else I can ask.
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References

Graan, A. C., Williams, M. J., & Koen, M. P. (2016, August 08). Professional nurses' understanding

of clinical judgement: A contextual inquiry. Retrieved March 02, 2019, from

https://www.sciencedirect.com/science/article/pii/S1025984816300047

Phaneuf, M. (2008, December 17). Clinical Judgement – An Essential Tool in the Nursing

Profession. Retrieved March 02, 2019, from

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–

An_Essential_Tool_in_the_Nursing_Profession.pdf

Tabak, N., Bal-Tal, Y., & Cohen-Mansfield, J. (1996, October 1). Clinical Decision Making of

Experienced and Novice Nurses. Retrieved March 02, 2019, from

https://journals.sagepub.com/doi/pdf/10.1177/019394599601800505