Running head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Audra N. Picuri

Department of Nursing, Youngstown State University

Nurs 4852: Nursing Senior Capstone

Dr. Kim Ballone and Mrs.Wendy Thomas

February 28, 2022

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Nurses are responsible for making safe and quality judgments for each of their patients.

Safety is one of the most important elements for a nurse to recognize and remember when it

comes to caring for a patient. Nurses ensure that they are giving the highest level of care to each

individual patient by using clinical nursing judgment. “Clinical nursing judgment is the

accumulation of knowledge and skills that can contribute 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 that best suit the patient” (Embler,

2021). Having a strong foundation in nursing and applying clinical nursing judgment is

extremely important for a nurse and the interprofessional care team. Clinical nursing judgment is

individualized to the patient, their needs, their diagnosis, and their baseline. It is making a

decision that is cognitively and critically thought out based on supportive evidence. This

evidence can come from the patient’s values, whether that is religious, cultural, or social, the

nurse’s clinical expertise, and from external evidence surrounding the patient (Ginex, 2022). It is

important for a nurse to know what a patient’s baseline status is, as not all patients will act and

respond the same. It can take only seconds for an improper or poor decision to negatively impact

a patient, therefore it is important for all members of the interprofessional team to remember this

for every patient, every shift, every time.

As I transition from nursing student to registered nurse, I know that I will need to

continue to use nursing judgment in my everyday care for my patients. The National Center for

Biotechnology Information wrote a journal on the need for new graduate nurses to exercise

clinical nursing judgment more than ever as “the shortage of qualified nurses inevitability leads

to early and independent confrontation of new graduates with judgment and decision making”

(Pouralizadeh et al., 2017). Nurse educators have begun to implement this teaching so that when
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nursing students graduate, they recognize that the decisions they make are critical and could save

a patient’s life.

As a student, I have begun to use clinical nursing judgment throughout my clinical

experiences. One example of when I used clinical nursing judgment during nursing school was

during my Obstetrician/gynecologist and women’s health rotation. I had been working with a

multipara woman who was in labor with her fourth child. She came in with contractions early in

the morning and was dilated at 6cm. As she was in the active stage of labor, I checked on her

periodically. Within two hours of arrival, dilation increased to 8cm. At that point, I along with

the nurse also caring for her knew we needed to call the doctor. After about 30 minutes, the

doctor arrived, and she was still at 8cm. After waiting two hours for her to progress through the

transition phase, she dilated to 9cm, and we began to administer Pitocin and prep for the

epidural. Two hours after being given the epidural, she still had not progressed to 10cm and the

doctor left.

The last time I came into the room, was roughly 30 minutes after the doctor had left and 7

hours after she first arrived. I wanted to say goodbye to my patient as I was about to leave the

floor for the day. Upon going in, I noticed the fetal heart monitor looking very different than it

had the past few times I had checked. There were late decelerations with little variability in the

fetal heart rate, I immediately got the assistance of my cover nurse. This was a concern because

the late decelerations with little variability can mean “the contractions are harming the baby by

depriving them of oxygen” (Team, 2018). The cover nurse came in and checked the monitor and

encouraged the mother to reposition. During this time the patient began to get very

uncomfortable because her epidural was wearing off and the Pitocin had been discontinued.

Within the next five minutes the patient was having the urge to push and was in an immense
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amount of pain. The nurse was encouraging the patient not to as the doctor was not there yet and

the only ones in the room were the nurse and myself. After observing the patient and the nurse, I

knew that I needed to do something, despite the nurse telling the patient that they needed to just

wait for the doctor. I immediately ran out and got the midwife at the nursing station. I could tell

the patient would not be able to wait for the doctor and that the nurse needed assistance. The

midwife and three nurses rushed behind me to the patient’s room and delivered a beautiful baby

boy before the midwife could even put both gloves on.

While at the time I did not recognize this as clinical nursing judgment, I can confidently

say that I did in fact use clinical nursing judgment in that situation. I believe that if I would not

have checked on the patient before I left for the day, noticed the drastic changes in the fetal heart

monitor and told the nurse, the newborn may have had serious complications that may have gone

unnoticed for even longer and resulted in a decline in fetal heart rate. I also believe that if I

would not have gotten the midwife and just waited for the doctor, the cover nurse could have run

into major complications in both the mother and her child. A delay in a fetus coming out of the

birth canal and the late decelerations can result in asphyxia, or deprived oxygen, which can be

life threatening (Sissons, 2020). I like to think that I played a part in both the labor and delivery

being safe and the upmost care being given to the mother and her newborn at a critical time.

I know that I will continue to have to use clinical nursing judgment on a day-to-day basis.

It is important to remember to use this clinical nursing judgment even after school as “errors in

clinical nursing judgment and decision making are said to account for more than half of adverse

clinical events” (McCartney, 2017). I look forward to appropriately using clinical nursing

judgment and continuing my education to expand my clinical nursing judgment to give my

patients the safest and highest quality of care now and in the future.
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References

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

decision-making and patient advocacy. Back to top. Retrieved February 25, 2022, from

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-

judgement#:~:text=Clinical%20judgment%20is%20the%20accumulation,patient%20outco

mes%3B%20clinical%20decision%20making.

Ginex, P. K. (2022, February 11). Integrate evidence with clinical expertise and patient

preferences and values. ONS Voice. Retrieved February 25, 2022, from

https://voice.ons.org/news-and-views/integrate-evidence-with-clinical-expertise-and-

patient-preferences-and-values

McCartney, M. (2017, March 28). Margaret McCartney: Nurses must be allowed to exercise

professional judgment. The BMJ. Retrieved February 25, 2022, from

https://www.bmj.com/content/356/bmj.j1548

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017, May 11). Factors influencing

nursing students' clinical nursing jugment : A qualitative directed content analysis in an

Iranian context. Journal of clinical and diagnostic research: JCDR. Retrieved February 25,

2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483705/

Team, the H. E. (2018, January 10). Fetal monitoring: Abnormal heart tracings. Healthline.

Retrieved February 25, 2022, from

https://www.healthline.com/health/pregnancy/abnormal-fetal-heart-
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tracings#:~:text=In%20some%20cases%2C%20late%20decelerations,by%20depriving%2

0them%20of%20oxygen.