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Nursing Clinical Judgment

Kayleigh C. Rickard

Department of Nursing, Youngstown State University

NURS 4852: Senior Capstone

Dr. Kim Ballone & Mrs. Randi Heasley

March 13, 2023

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Nursing Clinical Judgment

Substantial qualities that a nurse should have include being a critical thinker, problem

solver, and decision maker. These features help make up a nurse and provide the ability to use

clinical judgment. The National Council of State Boards of Nursing defines nursing clinical

judgement as “the observed outcome of critical thinking and decision-making” (Billings, 2019,

p.300). The outcomes of clinical judgement contribute to the outcomes of the patients who

received the interventions during the care provided to them by the nurses. Clinical judgement

guides the way nurses practice and care for their patients, so it is critical.

To start out, it is pertinent to check out what clinical judgment even is. The National

Council of State Boards of Nursing defines nursing clinical judgment as “an iterative process that

uses nursing knowledge to observe and assess presenting situations, identify a prioritized client

concern, and generate the best possible evidence-based solutions in order to deliver safe patient

care” (Billings, 2019, p. 300). In simple words it can be explained that they look at their patients

to determine who to see first based on the diagnoses and what they learned through nursing

education. Aspects that go into clinical nursing judgment include prioritization, critical thinking,

decision-making skills, and appropriate delegation. How much experience the nurse has, client

situations, and complexity of the environment are all factors that affect how a nurse organizes the

plan of care. The NCSBN lays out six steps for clinical judgment, which is similar to the nursing

process, that allows for the nurse to rank and prioritize the patients. The steps in order include

recognizing the cues, analyzing them, prioritizing, generating solutions, taking action, and

evaluating the outcomes (Billings, 2019, p. 301). Nursing students in their preceptorship and new

graduate nurses can find it challenging to prioritize their workload, but these can help ease that.
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There is a lot that goes into applying clinical judgment in order to carry out sufficient patient

care but is the basis for nursing.

On the other hand, it can also be beneficial as a nursing student or new nurse to reach out

for help from your preceptor or other nurses to further enhance clinical judgment. As stated by

Beck et al. (2022), “both the expert nurses and the new graduates emphasized the importance of

having a supportive clinical environment for the new nurses to develop their confidence and

skills, where they could ask for help they needed” (p. 6). Having support and a positive

environment influences growth for those newer, but also those with advanced experience too.

Collaboration amongst new and older nurses utilizes clinical judgement from both sides. Having

collaboration can enhance judgement in the new nurses, but even the more experienced nurses as

well because healthcare is always changing. No matter the experience of the nurses, everyone

can always improve their way of thinking.

Therefore, it is very important to possess clinical nursing judgment as it influences the

outcomes of the patients. Connor et al. (2022) states that “nurses' development of clinical

judgement is crucial because it guides appropriate nursing diagnoses, clinical decision-making,

and health outcomes” (p.3). Nurses are the ones who use what they know to make the right call

when faced with different situations. Although nurses do collaborate with other members of the

health care team, they are independent in their work and uphold the autonomy of the patients in

doing so. Respecting a patient’s wishes as well as involving the family in their care can help you

as a nurse to make the right judgement call. There is an abundance of factors that go into clinical

nursing judgment when caring for patients.

Furthermore, as I am in my final year of nursing school, I have been learning different

skills along the way relating to clinical nursing judgement. Being a student and soon to be a new
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graduate nurse I will find that prioritization will be something I need to work on. I have received

incite from my preceptor in my transitions clinical that will help me when I am on my own. For

my preceptorship, I am on a medical surgical floor and with each shift I have been taking on an

additional patient. I have had a few situations where it has challenged me to use clinical decision

making when providing care. There was this one patient where we had to decide a few different

things. I was obtaining vital signs on this one patient prior to medication administration and his

pulse oximetry reading was between 88-90% on room air with no activity which is low. I put him

on a couple liters of nasal cannula oxygen. I managed to wean him down to one liter and then the

next shift, I managed to get him off oxygen and back onto room air by doing spot checks. This

same patient had not voided in his urinal the entire shift nor was incontinent of urine. He would

ask for the bedpan and urinal but was not producing anything. I gave him one last chance to void,

but he was unable to and complaining of pain. We did a bladder scan on him and called the

doctor to confirm a foley catheter insertion order. I was the one who got to put the foley catheter

in using sterile procedure. I was able to obtain over 800cc of urine after a few minutes upon

insertion. The rationale for the intervention stemmed from knowing that a normal urine output

per hour should be 30cc. When a patient does not void, it is called urinary retention which poses

many risks. He was receiving bumetanide, which is a loop diuretic, to help get fluid off since he

was diagnosed with acute kidney injury. We were trying to wait a little after to see if that would

help him, but it did not seem to help, that is why we intervened. There will be many situations

like this where it will force me to use my nursing clinical judgement to intervene and prioritize

actions in assisting with patient safety and care.

In conclusion, as one continues to obtain more experience through their career of nursing,

all parts of their clinical judgement will improve. With healthcare changing all the time, there is
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always room for growth and change no matter if you are just starting out or a seasoned nurse.

With each shift and all the situations that nurses go through, these will constantly influence how

they critically think to make the proper clinical judgement call. Utilizing accurate clinical

judgement affects the outcomes of the patients so it is a crucial feature of nursing.

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References

Beck, J., Kelly, J., Rummel, L., & Watson, S. (2022). Workplace support and familiarity are vital

for the confidence of new graduate nurses. Kai Tiaki Nursing New Zealand, 28(1), 1-10.

https://eps.cc.ysu.edu:8443/login?url=https://search.ebscohost.com/login.aspx?

direct=true&AuthType=ip,uid&db=rzh&AN=155792315&site=ehost-live&scope=site.

Billings, D. (2019). Teaching nurses to make clinical judgements that ensure patient safety. The

Journal of Continuing Education in Nursing. 50(7), 300-302.

https://doi.org/10.3928/00220124-20190612-04.

Connor, J., Dwyer, T., Flenady, T., & Massey, D. (2022). Clinical judgement in nursing - An

evolutionary concept analysis. Journal of Clinical Nursing. 00, 1-13.

https://doi.org/10.1111/jocn.16469.