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Reflection on Clinical Nursing Judgment

Summer Neely

Nursing Program, Youngstown State University

4852: Senior Capstone

Dr. Kim Ballone & Mrs. Wendy Thomas

March 2nd, 2020

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When I hear the words “clinical nursing judgment” I think of a nurse taking initiative and

making a decision regarding a patient’s care with that patient’s best interests in mind. This

judgment is guided by instinct, hours of education, possibly years of experience, and maybe even

a little bit of a gut feeling. This decision the nurse makes does not have to be necessarily a big

one, but regardless of what the action is, it can have the most significant impact on the patient,

and that is what matters. To further build on this idea, when a nurse uses clinical nursing

judgment, he or she may not only be doing so for the safety and well being of their own patient,

but for other patients and even staff as well.

Being able to use satisfactory clinical nursing judgment is what separates an excellent

nurse from a mediocre nurse. Every nurse can and will learn to insert an IV, to draw blood, and

pass medications, but the best nurse goes well beyond that and does so in part by incorporating

their own clinical nursing judgment. With that being said, this all boils down to one’s critical

thinking skills, in a way. One must be able to look beyond what is written plainly in front of

them and delve deeper into the whole picture, and the thing about critical thinking is, at least in

my opinion, it cannot be taught. A person has to develop critical thinking skills and build this

ability within themselves.

So far, I have discussed clinical nursing judgment as being comprised of the nurse’s

ability to take initiative and use their critical thinking skills. There is one more component to this

judgment that I think is equally as significant as these two previously discussed, and that is

responsibility. It is part of the nurse’s role to take responsibility for all of their actions but even

more so than that it is up to the nurse to take full responsibility over their patient, regardless of

others’ actions or lack thereof. It does not matter if the nurse delegated a task out to another

person or if a prescriber ordered an incorrect dosage, as the nurse it is their responsibility to use
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their clinical nursing judgment to determine whether or not every intervention being done for the

client is correct and in their best interest.

Now, the extreme importance of clinical nursing judgment cannot be exaggerated. It is

not enough for a nurse to go to work, look at their patients’ orders for their shift and follow a

pre-made worklist that’s in the computer charting. Just when one thinks they understand the

sheer importance of clinical nursing judgment, they hopefully realize that it’s even more

important than that! Human being lives are in nurses’ hands… this is a job not to be taken

lightly. And, besides all of that, even if a nurse wanted to go to work and perform their job at a

bare minimum and simply only complete the tasks on their worklist, even that would be difficult.

Having to care for other humans along with all their innate imperfections and perhaps

bipolar ways of thinking compared to our own without any judgment is a daunting challenge

within itself, and it is one we may never be able to overcome but one we must learn to almost

adapt to. A nurse must stand firmly in his or her own beliefs and stand strong with their own

morals. As nurses, we are called to care for all. Patients come from every single walk of life, and

without judgment or persecutory behavior, they have the right to receive the best care possible,

and in the end the decisions they choose to make are in their hands, not ours. Hui-Wen Sato

MPH, MSN, RN, CCRN (2017) writes, “we are stretched in how we think the world works, and

in how we think it should work” (p. 6). With that being said, nurses must exercise their own

professional nursing judgment not only to deliver the best care and outcomes to their patients,

but in order to protect and care for ourselves mentally and spiritually, as well. This is what Sato

refers to as “the inner stretch of nursing.”

I found an article from the American Journal of Nursing and the following is an excerpt

from it that I absolutely love and resonate with, “As nurses we are well positioned to listen for
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and validate our patients’ truths. When we allow their voices to be heard in a safe,

nonjudgmental context, we can be catalysts on their path to healing” (Lewis-O’Connor, 2019, p.

8).

With all this discussion of clinical nursing judgment, an important fact for us novice

nurses to keep in mind is that it does not come to anyone overnight. Nursing judgment

accumulates and grows stronger with experience and time, just as anyone’s judgment on

anything grows over time in general, just with life’s day-to-day happenings! Another article I

found pertaining to nursing judgment is titled “Ten Good Things About Being an Older Nurse”

and number eight reads, “We are more likely to trust our own judgment. If something feels

wrong, it probably is. Seasoned nurses are not afraid to say, ‘Hold on, let me think about this for

a minute’” (Facente, 2019, p. 9). To me, that statement makes me think of the word confidence.

No one is born with an astounding sense of confidence, it is buried within a person and it is up to

them to cultivate that confidence and grow it for and within themselves, and this takes time. Over

time, as a nurse gains more experience and therefore confidence, his or her nursing judgment

will also then grow. It can make all the difference for a nurse to say, “stop, something isn’t right

here” or “is this treatment or lack thereof appropriate for my client?” but these things take time,

confidence, and nursing judgment.

Nurses exercise their nursing judgment every single day. Recently, in my preceptorship, I

had a patient who was admitted to our floor with a hip fracture after a fall. The patient has a

diagnosis of dementia and becomes very confused, so confused at times that she poses a risk to

herself for she does not understand her own limits or safety. She did not have a sitter and was

alone in her room. Frequently, we were in the patient’s room because she would try getting out

of bed and her bed alarm would go off. The nurse prior to us on night term did not order a sitter
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because this patient could not be discharged back to her long-term care facility until she had

gone at least 24 hours without a sitter… in my opinion, this was a negligent action on the part of

the prior nurse. The patient’s basic safety needs were not being met! It did not matter if the

intention was to keep her from having a sitter so she could be discharged sooner, if without that

sitter she suffered another fall and consequently acquired yet another injury or fracture and an

even longer hospital stay! Due to this, my preceptor and I filled out the form within the patient’s

chart requesting for a sitter for this patient, and at the end of this form, there is even a box to

check off that states we believe the sitter is needed for this client based on our “clinical nursing

judgment.”

To summarize this paper, I would like to conclude with the following from an article I

read on the Journal of Research in Nursing’s website, “The judgements made by nurses in the

clinical area will determine the nursing care received by patients. Clinical judgement is,

therefore, a critical aspect of professional practice” (Martin, 1999, p. 1). The judgment a nurse

exercises during his or her shift should never be underestimated in the power it can have on a

patient and the outcomes of their care. As nurses, we must always act as our patients’ advocates

and exercise our best clinical judgment to deliver the best care to every single patient.
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References

Facente, A. (2019). Ten Good Things About Being an Older Nurse. American Journal of

Nursing, 119(11), 60. 10.1097/01.NAJ.0000605384.29818.a1

Lewis-O’Connor, A. (2019). Truth, Voice, and Resiliency. American Journal of Nursing, 119(2),

11. 10.1097/01.NAJ.0000553188.35696.de

Martin, P. J. (1999). Influences on clinical judgment in mental health nursing. Journal of

Research in Nursing, 4(4), 273-281. https://doi.org/10.1177%2F136140969900400405

Sato, H.W. (2017). The Inner Stretch of Nursing. American Journal of Nursing, 117(10), 51-52.

10.1097/01.NAJ.0000525874.43984.a3