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The Importance of Clinical Nursing Judgement

Emmalee Rich
Nursing Department, Youngstown State University
NURS4852: Senior Capstone Seminar
Professor Ballone & Professor Thomas
March 2, 2020
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Nurses are required to provide superb clinical judgement in order to enable the entire

healthcare team to generate optimal patient outcomes. Nurses are at the bedside throughout the

patient’s entire stay and formulate a relationship with the patient and the patient’s family. This

nurse-patient relationship gives the nurse insight into other correlating factors surrounding the

patient’s condition. The information gathered may be a vital source of information that other

medical members may not have discovered during their short-term assessments. This additional

information is critical when determining treatment plans. The nurse uses close observation skills,

along with critical thinking, to quickly make life-altering judgement calls. Registered nurses use

the ‘nursing process’ to guide their decision-making. This nursing process begins with a

thorough bodily assessment accompanied by general patient observation. This assessment

requires close analysis from the moment the nurse meets the patient. Not only does the nurse ask

subjective questions to the patient, but he/she is also perceiving the patient’s behaviors and using

clinical background to come to a nursing diagnosis. This nursing diagnosis step is the next part

of the nursing process. Once the nurse has made his/her observations, taken vital signs, and

completed a thorough bodily assessment, the nurse formulates a nursing diagnosis related to the

patient’s condition. The nurse collectively distributes this data to the rest of the healthcare team.

The healthcare team discusses these findings and develops a plan of care comprised of nursing

interventions. Once the nurse has completed the assessment, formulated a nursing diagnosis,

implemented the nursing interventions, he/she evaluates the outcomes.

The observations, clinical data, and judgment collected by the nurse directly correlate

with patient outcomes. Therefore, patients’ lives are undoubtedly affected, positively or

negatively, depending on the accuracy of the clinical nursing judgement. The medical team,

consisting of a physician, resident(s), respiratory therapists, and more, value the nursing clinical
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judgment in high regard. These medical team members ask the nurse what he/she had observed

during the assessment. They rely on the nurse’s clinical judgement skills to account for all

entities of the disease process. “The term ‘clinical judgement’ is synonymous with critical

thinking, decision making and clinical reasoning” (Hallin et al., 2016, p. 2). People across the

country are living longer due to treatments for many diseases that did not previously exist.

Chronic illnesses are being treated and have led to an increased lifespan. According to the

journal: Professional Nurses’ Understanding of Clinical Judgement: A Contextual Inquiry, the

demand for accurate critical thinking and nursing judgement has only increased as chronic

illnesses increase. The journal states: “As a rapidly advancing profession, nursing demands

higher cognitive skills from nurses. As the acuity of hospitalized patients and the prevalence of

chronic illnesses increase, the length of hospital stay shortens” (Graan et al., 2016, p. 281). This

demand for accurate clinical judgement is vital when planning patient care and optimizing

positive outcomes.

Every nurse uses clinical judgement on a daily basis. Nursing students have been exposed

and trained to formulate this essential thought process. It is essential for nursing students to learn

critical thinking skills and appropriate nursing judgement from the beginning of their learning

experiences. In a journal from the University of Johannesburg, the authors described the

importance of clinical educators collaborating with the professional medical team to find

opportunity for such nursing judgement. This experience from the beginning may lead to

increased accuracy during the student’s professional nursing career. According to the journal:

Clinical Reasoning of Nursing Students on Clinical Placement: Clinical Educators’ Perception,

clinical judgment is taught throughout the three years of nursing school. In the study conducted

in this journal, most clinical educators found a strong correlation between the level of clinical
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reasoning related to the clinical performance (Hunter & Arthur 2016). The demand of accurate

clinical judgment has been instituted in nursing programs across the country due to the direct

correlation to patient outcomes. This conclusion of this journal states: “...clinical reasoning is the

cornerstone of health professional practice” (Hunter & Arthur, 2016, p. 78).

In my personal experience, I have used clinical nursing judgment to identify a problem

and move through the nursing process. During my preceptorship, I was able to use my clinical

experience to identify a problem with a patient. The patient was an 82-year-old male admitted for

extreme fatigue accompanied by hypotension. He was currently in remission for Non-Hodgkin’s

Lymphoma and was receiving prophylactic chemotherapy treatment once a month at an

outpatient facility. He was soon admitted to the ICU and placed on a Levophed IV drip. His

blood pressures became stable and his fatigued decreased. My precepting nurse and I completed

bloodwork on the patient and took admission vital signs. I took the patient’s temperature

throughout the day. During one of my assessments, I noticed the patient’s skin was getting

warmer. The temperature of the patient was trending upwards from the time he was admitted to

the unit. Along with the increase in temperature, the heart rate increased to 112/minute and the

respiratory rate increased to 22/minute. His breath sounds were clear and unlabored. My nurse

and I immediately notified the physician who ordered acetaminophen. An act as simple as

checking a temperature and acknowledging trends affects the overall outcome of the patient.

These quick observations made by my nurse and me enabled the patient to be treated

rapidly, which is essential for any decompensating scenario. Without our quick intervention and

clinical judgment, the patient’s outcomes would not have been as optimal. Rapid nursing

intervention is vital in all patient scenarios.

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In summary, nurses’ observations, critical thinking, and ongoing assessments are vital to

patient care. Nurses are a critical part of the medical team that provide ongoing data to assist

doctors and other medical professionals in making relevant decisions to patient care. Clinical

nursing judgement is respected by the medical team.

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References
Graan, A.C., Williams, M.J., & Koen, M.P. (2016). Professional nurses understanding of clinical

judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293.

https://doi.org/10.1016/j.hsag.2016.04.001

Hallin, K., Haggstrom, M., Backstrom, B., & Kristiansen, L. P. (2015). Correlations between

clinical judgement and learning style preferences of nursing students in the simulation

room. Global journal of health science, 8(6), 1–13. https://doi.org/10.5539/gjhs.v8n6p1

Hunter, S., & Arthur, C. (2016). Clinical reasoning of nursing students on clinical placement:

Clinical educators’ perceptions. Nurse Education in Practice, 18, 73–79.

https://doi.org/10.1016/j.nepr.2016.03.002