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Clinical Nursing Judgement

Sara R. Ciletti

Department of Nursing, Youngstown State University

NURS: 4852 Senior Capstone

Dr. Kim Ballone and Mrs. Wendy Thomas

March 28, 2022

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Clinical Nursing Judgement

Clinical nursing judgement is a concept taught to nurses early on in nursing school and is

a huge component to the practice of nursing. The decisions we make as nurses to help care for

our patients is what is known as our nursing judgement. Eisenmann (2021) explains, “Clinical

judgement is a logical process nurses move through to make decisions regarding a patient

situation” (p. 144). In nursing school, we are taught how to perform clinical skills and make

decisions by critically thinking. As nurses, we are the ones interacting with the patients every

day and reporting off to other team members about changes in a patient’s health status.

According to Kinyon et al, (2021), “Patients depend on a nurse’s ability to recognize and

respond quickly to changes in their condition” (p. 600). Nurses need to know the disease process,

signs and symptoms associated with them and medications used to prevent or treat such disease.

Clinical nursing judgement is important when treating patients. Poor clinical judgement

can lead to injury in the workplace. “Clinical judgement and decision making skills in solving

clinical problems is the most important factor in preventing such injuries” (Pouralizadeh et al.,

2017, p.1). It is important for nurses to learn adequate nursing skills early on in school to be able

to carry them over into practice. It is also important for nurses to be able to make appropriate and

safe decisions in the care of their patients. A lack in clinical judgement can lead to medication

errors, poor nursing interventions, and overall poor patient care. Nurses should know why they

are giving medications prescribed by the doctor and why they are implementing certain

interventions. Nurses can advocate for their patients and help prevent further complications using

their clinical judgement and communicating with other team members. For example, if a patient

has orders for fluids to be hung, but the nurse assesses the patient and hears crackles in their
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lungs and observes peripheral edema, the nurse should contact the doctor to see if they want to

proceed with the order.

Many different factors go into clinical nursing judgment including someone’s education,

skills, years of experience, and self-awareness. Benner & Tanner (1987) explain, “As a nurse

becomes more skilled in practice, they will apply clinical reasoning and judgement from

intuition” (as sited in Eisenmann, 2021, p. 144). Overtime, nurses can recognize patterns and

outcomes after seeing the same diagnoses so many times. The more years a nurse has working,

the more confident they become with their skills and clinical judgement. Clinical nursing

judgement may be intimidating to a new nurse due to their lack of experience. Clinical

experience or a previous hospital job can help new nurses gain confidence in the clinical setting

and help expand their knowledge. I think it is important for us as student nurses to learn as much

as we can during clinicals, communicate with the team members and practice our clinical skills

before we graduate. I also believe that a positive work environment can help improve our nursing

clinical judgement. Being in a positive workplace where team members help one another and

teach each other is important when communicating with one another. Overall, I think experience

is the best way us as nurses can improve our clinical judgement and improve our knowledge.

Throughout nursing school as a student, there have been a few times where I have used

clinical nursing judgement. The first example was this semester during my precepting hours. I

was helping clean and turn a patient and I noticed the patient’s sacrum was very red. I knew the

patient had not been getting up and moving around because they were unsteady on their feet.

Using my clinical nursing judgement, we applied cream to the patient’s sacrum and placed pads

under the patient to keep them from laying on the one side. As a student nurse, I knew it was

important to turn this patient every two hours to prevent the patient from having further skin
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breakdown. Ore and Carver (2020) mention, “Prevention, treatment, and management of

pressure ulcers (PUs) is a key indicator of quality, safety, and patient care experience” (p. 52).

Once the spot becomes opened, that can lead to a whole new list of problems including infection

and difficulty healing. It is important for patients to have adequate nutrition, mobility, and

staying dry to help prevent skin breakdown.

A second time I used clinical nursing judgement in nursing school was during one of my

clinical rotations. I was taking care of a patient and upon reviewing my patients’ labs, I noticed

their potassium was low. I went to the orders and saw an order from the doctor that said if the

patient’s potassium was this low, then we were to administer IV potassium as ordered. With

what I had obtained from the patient’s chart, I approached my clinical instructor and nurse and

was able to obtain a patent IV and start the patient on IV potassium. Not only was I able to use

my nursing clinical judgement, but I also got to use my clinical skills and insert a patent

peripheral IV. Low potassium can cause heat dysrhythmias that can be life threatening or even

fatal. It can be intimidating as student nurses to approach other team members with questions or

concerns, but it is important to maintain patient safety and ask questions when needed.

In conclusion, clinical nursing judgement is a major aspect that nurses need to exercise to

maintain patient safety. As we gain experience in the workplace, our clinical nursing judgement

will improve, and nurses will become more confident in their practice. Clear communication

between team members is also an important aspect when using clinical nursing judgement. If

there is no communication between team members, then that can lead to a decrease in patient

care and safety. In healthcare, there is always something new to learn to everyday and as we

expand our knowledge, we can provide better care to our patients.

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References

Eisenmann, N. (2021). An Innovative Clinical Concept Map to Promote Clinical Judgement in

Nursing Students. Journal of Nursing Education, 60(3), 143-149. https://doi-

org.eps.cc.ysu.edu/10.3928/01484834-20210222-04

Kinyon, K., D’Alton, S., Poston, K., & Navarrete, S. (2021). Improving physical assessment and

clinical judgment skills without increasing content in a prelicensure Nursing Health

Assessment course. Nursing Reports, 11(3), 600–607.

https://doi.org/10.3390/nursrep11030057

Ore N, Carver T. Implementing a new approach to pressure ulcer prevention. (2020). Journal of

Community Nursing. 2020;34(4):52-57. Accessed March 1, 2022.

https://search.ebscohost.com/login.aspx?

direct=true&AuthType=ip,uid&db=rzh&AN=145177030&site=ehost-live&scope=site

Pouralizadeh, M., Khankeh, H., Ebadi, A., & Dalvandi, A. (2017). Factors Influencing Nursing

Students' Clinical Judgment: A Qualitative Directed Content Analysis in an Iranian

Context. Journal of clinical and diagnostic research: JCDR, 11(5), JC01–JC04.

https://doi.org/10.7860/JCDR/2017/25753.9822