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Clinical Nursing Judgment

Kathryn M. Heavilin

Youngstown State University

NURS 4852: Senior Capstone

Kim Ballone & Wendy Thomas

February 16, 2022

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Clinical Nursing Judgment

Clinical judgment is defined as an accumulation of knowledge and skills over time,

which contributes to the nurse’s ability to analyze and synthesize the patient presentation,

objective and subjective data, and then provide evidence-based nursing interventions to improve

patient outcomes; clinical decision making. Clinical judgment also contributes to the nurse’s

ability to respond to changes in patient presentations with sound clinical decision-making and

patient advocacy (Embler, 2021). Nurses need clinical judgment in order to keep their patients as

safe as possible. This judgment comes from years of nursing school and experience in the

hospital setting. Clinical judgment is not just something you learn overnight, it is learned with

time and often learned from previous mistakes. Because of the experience, nurses who have been

working a long time will have some of the best clinical judgment.

Throughout nursing school, students learn how to do an in depth head-to-toe assessment.

Most of the time the students will learn what is normal for most patients. For example, students

learn that turgor should be assessed at the clavicle and should be elastic. From this, nursing

students will remember an elastic turgor is the normal finding; however, what happens when

turgor is not elastic? That is where clinical nursing judgment comes into play. Nursing students

who become new nurses have to realize that poor skin turgor can be caused by dehydration.

From there, the nurse will have to use their clinical judgment to determine what is causing the

patient to become dehydrated, and how to fix the underlying problem. A nurse cannot just assess

this problem, document it, and then move on. It is a nurse’s job to assess and fix problems the

patient may be experiencing all while using their clinical judgment.

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The main professional goal of nurses is to provide and improve human health.

Medication errors are among the most common health threatening mistakes that affect patient

care (Cheragi et al., 2013). Most of the medication errors are caused from using abbreviations

instead of the full names of drugs and similar names of drugs. This carelessness can result in

injury, and even death, to a patient. Nursing clinical judgment plays a huge part in medication

administration. It goes back to the basics; every nurse is taught to check a drug at least three

times prior to administering it to their patient. However, this is not the only thing nurses need to

check prior to giving a medication. For example, blood pressure medications need to be given

only after a BP is taken from the patient. Nurses need to take their time, and really think about

what will benefit their patient, and adequate medication administration is one of the most crucial

interventions a nurse can do for their patient. Although medication administration does not

technically require a lot of clinical judgment, it requires a nurse to assess the patient before and

after giving a medicine, and making sure the medicine will help the patient after they administer

it.

Patient handoff is another situation where nurses really use their clinical judgment. This

clinical judgment comes from the nurse giving the report, and also from the nurse receiving the

report. The process leading to a clinical judgment involves the integrated thinking about a patient

and begins when a nurse notices something about a patient's situation that demands attention

(Lavoie et al., 2020). The nurse who gives a patient handoff is in charge of telling the other nurse

the most important details about the patient. The judgment he or she uses helps determine what is

the most important intervention needed to be done by the next nurse. The nurse receiving the

report has to listen to everything he or she is being told and pick out the key parts they need to

work on first. For example; a nurse is told their patient has had crackles heard in both lungs. A
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nurse who uses their clinical judgment will think of multiple interventions they can do in order to

treat the problem; for instance, suctioning of the secretion build up can help eliminate fluid in the

lungs that is causing crackles.

A personal experience of mine using clinical judgment would have to be when I was in

the simulation lab. Simulation labs are crucial for nursing students. In real life, the nursing

instructor would cut off a student if he or she was doing something wrong that would put a

patient at risk. However, in a simulation lab, a student is able to make that mistake and see what

the consequences of their action would be. This helps a nursing student, and the students around,

learn from the mistake. One particular simulation lab I was a part of involved a pediatric patient

with a sickle cell crisis. My instructor told me the situation and gave me my orders then watched

me while I performed care. After I performed my care, I thought I was done.I told my instructor I

was done, and she read me a list of interventions and assessments I had forgotten to do. One

major thing I did not do was check the IV bag to see if it was the correct medication, and running

at the right rate. After I saw all my mistakes, I instantly felt stupid, and I have never made the

same mistakes since. Everytime I enter a real patient’s room I make it a point to check their IV

bags, pumps, and tubing all because of that one simulation lab.

In conclusion, clinical nursing judgment is a vital step in nursing. Each and every nurse

needs to take a step back from their patient and put together all the pieces of data to determine

the right steps into fixing a patient’s medical problem. Without clinical judgment, most patients

would not leave the hospital. Clinical judgment is not just learned, it is a process of acquiring

skills, training, and experience.

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References

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013, May). Types and

causes of medication errors from nurse's viewpoint. Iranian journal of nursing and

midwifery research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748543/

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical

decision-making and patient advocacy. Wolters Kluwer.

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement#:~:text=

Clinical%20judgment%20is%20the%20accumulation,patient%20outcomes%3B%20clini

cal%20decision%20making

Lavoie, P., Clarke, S., Clausen, C., Purden, M., Emed, J., Cosencova, L., & Frunchak, V. (2020,

June 21). Nursing handoffs and clinical judgments regarding patient risk of

deterioration: A mixed-methods study. Off-campus authentication for Library Resources.

https://onlinelibrary-wiley-com.eps.cc.ysu.edu/doi/pdfdirect/10.1111/jocn.15409