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Clinical Nursing Judgment

Birgitte Kammerdiener

Department Of Nursing, Youngstown State University

NURS 4852: Senior Nursing Capstone

Professor Randi Heasley

February 8, 2023
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Clinical Nursing Judgment

Clinical Judgment is a process. It is not a skill that is achieved over night, but rather one

that is developed over time with reflection, practice, and experience. Clinical Judgment can be

taught but it also needs to be done firsthand. Through the use of skills labs, clinicals and lectures,

nursing students build upon their clinical judgment. With these, nursing students will be able to

graduate with a better understanding and their skills will further develop in the field.

Multiple research studies have found that senior nursing student have walked away with a

higher score on the Lasater Clinical Judgement Rubric than the junior nursing students, showing

that clinical judgment increases overtime. In one study, the juniors showed an accomplished

level in all 4 subscales and the total scale; while seniors showed an exemplary level both for the

total scale and 3 of the 4 subscales (Manetti, 2018). Manettis’ study explains that even within a

year the clinical judgment of these student nurses has increased greatly, while there is still a long

way to go and a lot more to learn, there is progress being made in their skills and judgement.

Another study was conducted over a span of three years where students participated in a

simulation every 3 to 4 weeks. Each scenario was different and reviewed by giving a score. A

score of one meant beginning, a score of two meant developing, a score of three meant

accomplished and a score of 4 meant exemplary. The study covered 11 different dimensions

through the Lasater Clinical Judgment Rubric. Once the study was complete the results had

shown that from the first clinical simulation to the final simulation, the scores went from an

average of 24.10 to and average of 40.17 (Bussard, 2018). This study managed to show an

increase in the students clinical nursing judgment because they had the opportunity to practice

their skill more often, get feedback, and have the ability to correct themselves for the next

simulation.
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The importance of feedback and practice with clinical simulation allows the student

nurses to better gather data on their patients, use evidence-based practice and look not only at the

patients actions but also their own actions as the nurse. Consistent practice and skills labs have

shown an increase in clinical nursing judgment in students allowing them to have a better skill

set when they finally step into the nursing field. Recently, many hospitals and floor nurses have

said that the clinical judgment and readiness of new grad nurses has decreased. New grad nurses

have been seen to not be as prepared when it comes to evidence-based practice and an overall

ability to think through complicated issues. The way to fix this would be for all nursing schools

to increase the number of clinical simulations they do each semester. This would allow for

nursing students to receive more feedback, learn from their mistakes in a safe environment and

improve not only clinical judgment but also critical thinking.

The concept of clinical nursing judgment is knowledge. This involves the ability for the

nurse to interpret data, critically think and recognize patterns. According to Manetti (2019)

“Sound clinical judgment is the foundation of quality nursing care. Nurses make a multitude of

decisions in clinical practice daily that call for careful thought because the decisions made

impact patient outcomes” (p.102). The nurse plays an important role in the outcome of the

patient. Nurses are the ones who pass the medications, assess the patient, listen to the patients

concerns and complaints, and even questions whether or not a doctors orders are correct for the

individual patient. New grads need to have a high level of clinical nursing judgment because of

making these decisions for the patient. Clinical simulations and corrections during them can help

nursing students to learn to make the best decision for their patient, use evidence-based practice,

and be sure to collect all the data so that they can look at the whole picture, not just an individual

problem.
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A personal experience where I had to use clinical nursing judgment was when a patient

began to have a decreased level of consciousness. I has just received handoff from dayshift

where we did a bedside report, said hello to the patient and put our names on the board and

continued with our handoff on other patients. The day shift nurse had stated that this patient was

perfectly alert and aware, responded appropriately and the only issue we needed to be considered

with was watching the post-surgical site for any signs of bleeding or hematomas. While seeing

the patient in bedside handoff she was in good condition. My nurse and I went to look at patient

labs and medication for the night to get an idea of where we needed to start and who was in the

most critical condition and needed to be seen first.

After pulling meds and seeing two of our other patients, we made our way into her room.

Before passing any medications we did a head to toe assessment. By this time the patient was not

responding with words, would hardly open her eyes, and when squeezing my hands only the left

hand would give a weak squeeze. We tried to get her to wake up a bit more and respond but she

continued to decline. As her labs were normal, her vital signs were normal, but her neuro

assessment was not, we decided to call an RRT. The doctors and RRT nurses came in and

assessed the patient as well. We gave them the patient information as they continued to assess

her.

In the end the doctor ordered a CAT scan of the head. Our clinical judgment of calling an

RRT due to her neuro assessment was correct. The patient had a small stroke and was

immediately transferred to a neuro intensive unit for further assessment. From that experience I

learned that clinical judgement is assessing all of the data, really looking at the patients’ actions

and their change in actions, as well as, trusting your gut to make the correct call on a patient to

better their outcomes.

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References

Bussard M. E. (2018). Evaluation of Clinical Judgment in Prelicensure Nursing Students. Nurse

educator, 43(2), 106–108. https://doi.org/10.1097/NNE.0000000000000432

Manetti W. (2018). Evaluating the Clinical Judgment of Prelicensure Nursing Students in the

Clinical Setting. Nurse educator, 43(5), 272–276.

https://doi.org/10.1097/NNE.0000000000000489

Manetti W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing

forum, 54(1), 102–110. https://doi.org/10.1111/nuf.12303