CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement

Mariah Nuzzi

Youngstown State University

Nursing 4852: Senior Capstone

Dr. Kim Ballone and Mrs. Wendy Thomas

March 9th, 2021

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Clinical Nursing Judgement

“It is essential to ensure that new nurses are competent in many skills, especially critical

thinking, which is identified as essential to meet current nursing practice demands” (Bittner et

al., 20201). As student nurses we learn so many basic skills early on; however, one thing that

can’t be taught through a book or lecture is how to utilize clinical nursing judgement. That

comes with years of nursing experience and practice, and there is never a clear right or wrong

answer on what could be done. Clinical judgement refers to ways nurses come to understand the

problems, issues, or concerns, of clients or patients to attend to important information, and to

respond in a concerned and involved ways. Nurses implement clinical judgement in complex

care situations by working with interprofessional teams to ensure health care quality and safety.

Critical components include changes in patient status, uncertainty about the most appropriate

course of action, accounting for context, and the nurse’s practical experience. Therefore, one can

see clinical judgement is a very controversial topic in the field of nursing.

Thought Process to Make a Clinical Judgement

As I mentioned before, there is no one clear course of action for clinical judgement;

however, there are steps on how you can best asses the situation. First, the nurse needs to pay

attention to the patient’s condition or what they are experiencing. Then, the nurse must gather the

information regarding the problem, utilize their reasoning abilities to interpret the facts and apply

critical thinking to confirm or exclude certain hypotheses. Finally, the nurse resorts to logical

deduction to identify the problem. Following these steps can help direct your thoughts on how to

use clinical nursing judgement (Martin et al., 2020). According to Cazzell and Anderson, there

appears to be an overlap in critical thinking and clinical judgement and that deduction is needed

for both concepts. When nurse educators teach or encourage deductive skills, critical thinking
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and clinical judgement may be improved, enhanced, or developed. Simulation may be a strategy

to facilitate deductive skills (2016).

Clinical Judgement in Nursing Leads to

There are many reasons clinical nursing judgement could be utilized, and they can lead to

the identification and logical interpretation of symptoms; the planning of care to alleviate or

prevent complications or relapses; the nurse is doing what the patient would do for themselves if

they had the required strength and knowledge; helping the patient satisfy their physical,

psychological, and spiritual needs at the same time; and assisting the patient is passing away with

dignity, if necessary. (Martin et al., 2020). All of the things listed above are of significant

importance in the nursing career, which is why clinical nursing judgement is crucial to have.

Utilizing Clinical Nursing Judgement as a Student Nurse

My experience of utilizing clinical nursing judgement in clinical as a student nurse was

devastating, but important. I am doing my preceptorship at Akron Children’s NICU and we were

caring for a twenty-seven-week-old neonate who was very small and fragile. We admitted the

patient from labor and delivery, and he only weighed 1340 grams. The mother had an abruptio

placentae and they intubated the neonate immediately after birth. However, once he came to the

NICU his breathing patterns and SpO2 was stable, so they extubated and put him on a bubble

CPAP of six. Initially they put a UAC in, but later on his toes started to turn a purple color and if

we weren’t assessing him every hour, he could have lost his toes due to lack of circulation. We

immediately notified the nurse practitioner, and they removed the UAC and put in the UVC

which does not pose the same risk for neonate’s toes. Furthermore, my preceptor and I utilized

clinical nursing judgement to notify the nurse practitioner, because if not, our neonate could have

lost his toes. We continued to perform our assessments as normal and made sure that capillary
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refill was less than two seconds on his lower extremities. Later in our shift we noticed the

neonate’s temperature was very high and he was becoming tachycardic. So, we turned down the

temperature in the incubator, but then the neonate’s temperature dropped significantly, and he

was still tachycardic. Therefore, we knew something was not right with this neonate. We notified

the nurse partitioner, she told us to get a CBC, and the hemoglobin was very low. She wrote an

order to transfuse blood to the neonate and recheck labs after. However, even after giving

multiple units of blood, the lab results came back with a hemoglobin of four. At this point, my

preceptor knew this was not going to be a good outcome and there wasn’t much else we could

do. The neonate ended up dying on the next shift due to becoming septic and it was due to E. coli

in the bloodstream. We were probably going to lose this infant either way, there wasn’t anything

that could have prevented it. However, I feel that my preceptor and I constantly assessing the

neonate, and acting quickly by using clinical nursing judgement, it gave this infant the best

chance possible. This was a very hectic shift, but I learned showed much on how important it is

to utilize clinical nursing judgement.

Conclusion

Educators in nursing programs have developed a number of strategies to integrate and

measure critical thinking in the curriculum. Many of these strategies focus on immersing

students into real practice experiences to prepare them to enter the nursing workforce (Bittner et

al., 20201). Therefore, one can see that clinical nursing judgement can’t necessarily be taught

through a lecture or book, and it is learned through real practice experiences. I shared my

experience at the NICU, and I learned just a portion on how to utilize clinical nursing judgement.

As I continue to precept and become a new graduate nurse, I will learn more with time and
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experience. Clinical nursing judgement is something all nurses need to utilize because it is such

an important part to quality and safety of care.

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References

Bittner, Nancy, Phoenix PhD, CNS, Campbell, Elizabeth, MSN, RN, Gunning, Thomas & MSN,

RN. (2021). Impact of a Dedicated Education Unit Experience on Critical Thinking

Development in Nursing Students. Nurse Educator, Advance on-line publication.

https://doi.org/10.1097/NNE.0000000000000966

Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical Judgment

During Simulation with Senior Nursing Students. Nursing Education Perspectives

(National League for Nursing), 37(2), 83–90.

https://doi-org.eps.cc.ysu.edu/10.5480/15-1553

Martin, B., Greenawalt, J. A., Palmer, E., & Edwards, T. (2020). Teaching Circle to Improve

Nursing Clinical Judgment in an Undergraduate Nursing Program. Journal of Nursing

Education, 59(4), 218–221.

https://doi-org.eps.cc.ysu.edu/10.3928/01484834-20200323-08
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