Running head: NURSING JUDGEMENT 1

Clinical Nursing Judgement

Alexis M. Stutz

Youngstown State University

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A well-rounded clinical nursing judgement is a concept that student nurses strive to

achieve upon graduation. To achieve a clinical nursing judgement, the student nurse must go

through a vigorous four-year curriculum combined with numerous clinical and preceptor hours

accompanied by lecture. A clinical nursing judgment is the accumulation of knowledge and skills

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

presentation, objective, and subjective date, and then provide evidence-based nursing

interventions to improve patient outcomes; clinical decision making (Embler, 2021). From day

one the student nurse is learning why forming a clinical nursing judgment is important because

once graduated the nurse is going to be caring for patients and treating them on their own, and

without the foundation and the learning process to achieve a clinical nursing judgement it can be

very harmful to the patient’s well-being.

Nursing students are expected to graduate at the advanced beginner level moving into the

competent level, in which they begin to understand their actions in relation to setting long-range

goals (Walker, 2021). If that foundation of an appropriate clinical judgement is not made than

when the student graduates and enters the real world, they are at risk at not being able to properly

analyze the information about a patient to make a safe clinical nursing judgement. It is very

important to have a clinical nursing judgement in nursing practice, because if not formed then it

places the patients at risk. If the nurse has not learned the ability to assess a situation, analyze the

important information provided by the patient and the information observed, and then form an

appropriate nursing judgment in practice then the patient can be affected. In some cases when

student nurses enter the real world and have not yet learned how to properly form a nursing

judgment, they then encounter a reality shock. This reality shock has been referred to as the

theory - practice gap in nursing, wherein nursing students may find themselves torn between the
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values they acquired at their learning institution and the reality of the clinical challenges

(Maeland et al). This practice gap that is created by not being able to take the information they

acquired in school and turn into a nursing judgement will put the nurse at risk for making a

mistake and the patient at risk to be harmed.

Throughout my time in nursing school and learning how to appropriately form a clinical

nursing judgement, there has been several situations where I have had to use my own judgment

when caring for a patient I had in clinical. One personal experience I had to use my clinical

nursing judgement, was my junior year when I was in professional three. I was at St. Joseph’s

Memorial Hospital on the fourth floor, a Telemetry unit. I was caring for several patients that

shift and I was passing both of their 9am medications. The one patient I had was a post-operative

surgery patient who was scheduled to have an insulin injection, that was set with certain

parameters based on the patients’ blood glucose levels to give the insulin or withhold it.

However, before I gathered the supplies needed to administer the insulin, I quickly looked at the

patients’ chart and looked at what their past blood glucose levels have been and if the insulin has

been needed. Over the past two days, I read that the patients’ blood glucose levels were high, and

that the insulin was given to help stabilize the patients’ blood glucose levels. Knowing that

information I went, and I got the glucose monitor and checked the patients’ current blood

glucose level before gathering the insulin medication to be administered. When I checked the

bloods glucose, it came back a lot lower than what the patient has been for the past two days.

Although, the patients’ levels were almost back at baseline from before surgery it was still a few

off from the parameters the physician set to withhold the medication. Due to the blood glucose

level only being 2 above the lowest parameter to withhold it, I was still required to give it.

Therefore, the next step I took into consideration was how the patient was presenting. I checked
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the patient’s status, their vitals, their overall appearance, and any subjective data that I could

collect. The patient did not appear to be in any distress, had a normal appetite, did not report an

increase in thirst or frequent urination and reported no shortness of breath. Overall, the patient

presented back to baseline and no apparent signs of distress, leading me to form a clinical

nursing judgement that the patient no longer needed the insulin injections. After forming my

nursing judgement, I then communicated the information I gathered and presented it to the nurse,

and she also agreed the insulin was no longer needed to be given. She then called the physician

who confirmed that the patient no longer was required insulin and discontinued the medication

until further notice. Instead of administering the medication, the physician consulted with dietary

and formed a plan to monitor the blood glucose levels through a strict diabetic diet and the nurse

and I were still in charge to monitor the patients’ blood glucose levels for any discrepancies. It

was great experience to be able to use the nursing skills I have acquired throughout nursing

school to form an appropriate clinical nursing judgment to ensure the safety of my patients.

To conclude, it is extremely important to form a clinical nursing judgement to make the

most informed decision a student nurse can, to protect the patient and abstain from any harm.

The most prioritized lesson that is stressed to a new nursing student is to keep the patients safe.

In order uphold that lesson the nursing student needs to be able to analyze the patient

appropriately, obtain as much subjective and objective data they can, and provide nursing

interventions based on the data collected to improve the patients’ outcomes for the better.

Overall, forming a clinical nursing judgement is the foundation to providing the safest care a

nurse can, to keep their patients safe and free from harm.
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References

Imparting clinical judgment leading to sound clinical decision-making and patient advocacy.

Back to top. (2021, March 9). Retrieved February 9, 2022, from

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

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

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

Walker, N. M. (2021). More Than Meets the Eye: Critical Thinking, and Correctional Nursing.

American Jails, 35(1), 29-31.

Maeland, Marie Kyamme, Britt Saetre Tingvatn, Linda Rykkie, and Sigrunn Drageset.

“Nursing Education: Students’ Narratives of Moral Distress in Clinical Practice.”

Nursing Reports 11, no. 2 (June 2021): 291-300. doi:10.3390/nursrep11020028.