Clinical Nursing Judgement

Aaron W. Williams
Department of Nursing, Youngstown State University
NURS 4852: Senior Capstone
Dr. Kim Ballone
March 13th, 2023
 Without clinical nursing judgement patients would be prone to mistakes in nursing

diagnoses, clinical decision-making, and health promotion. Every day nurses are using their best

judgement for the patients that they are caring for. For example, a nurse in the ICU is going to

make their best clinical nursing judgement as soon as they get patient handoff report in the

morning or night. With the assistance of handoff report from the previous nurse, doctors,

residents, and other health care staff on the unit the nurse will be able to use their best judgement

for that patient at that time. Clinical judgment is one of the key attributes of professional

practice. It is a prerequisite for establishing professional identity and is mainly based on nurses’

knowledge and experience as well as their reasoning, intuition, clinical thinking, and evidence-

based practice skills (Seidi et al, 2015). Clinical judgement comes with experience. A young

nurse in the field of nursing may not have the best clinical judgement. This should not be seen as

a negative thing, but it will be something that improves over time. There are allowed to be

mistakes in nursing. The biggest thing is to learn from those mistakes so that they never happen

again. A mistake in clinical judgement does not have to be your own mistake that you learn

from. If you see a coworker who makes a mistake, that should also be a time of reflection where

everyone can improve and learn from that. The concept of clinical judgement is making

decisions based on a nurse’s knowledge at that time. Clinical judgement should be seen as what

needs to be done for the patient’s safety and benefit at that time or for the better of that patient’s

future.

As health care becomes more complex every year the importance of clinical nursing

judgement also increases every year. Before COVID-19 clinical nursing judgement was

important, but during COVID-19 at its peak and even to this day clinical nursing judgement has
been at an all time high. It has put stress on nurses never seen before and has drove multiple

health care workers out of the field of nursing indefinitely. I think that within itself shows how

important clinical nursing judgement is in the field of nursing when clinical nursing judgement is

at an all time high. The demands of complex clinical practice settings mean nurses are

multitasking more involved takes, have further increase their scope of practice, and make

important judgements about the care they provide (Manetti et al, 2019).

Clinical nursing judgement is not something that is strictly for nurses that have already

graduated and obtained their registered nursing license. A nursing aid on the unit must use their

best clinical nursing judgement with the tasks delegated to them. For example, if a patient has

blood glucose reading of 40 that was taken by a nursing aid it is extremely urgent for that nursing

aid to report back to the nurse immediately that the patient is in severe hypoglycemic territory. It

is then the nurses job to use their best clinical nursing judgement to alleviate the problem and

risks that could come from such a low blood glucose reading. Clinical nursing judgement is not

just you making all the judgements by yourself. In most cases it is a team effort of clinical

nursing judgement to create the best outcome for the patient.

I currently work as a nurse extern in the intensive care unit at Trumbull Regional Medical

Center. There have been numerous amounts of time where I had to use my own clinical nursing

judgement. One example that stands out to me using clinical nursing judgement is with blood

glucose monitoring. There was a patient who kept on complaining of feeling light headed and

dizzy. The patient was also on the call light the whole night. The nurse that was in charge of the

patient told me that the patient was being needy and that they were fine. After assessing the

patient myself I noticed increased diaphoresis across the whole body, paleness to the face, and

the patients mental status was deteriorating quickly. Although the patient had been needy the
whole shift, I knew that upon assessment that none of this was normal. I let the nurse know what

I noticed when I did the assessment on the patient and she told me to get the patients blood sugar.

The patients blood sugar was in the 30’s currently. They were complaining of rapid heartbeat and

that they felt like they were falling. When I told the nurse the blood sugar reading she

immediately rechecked it and got current vital signs for the patient. We ended up calling a RRT

on the patient due to the assessment I had made, the blood sugar, and the increased heart rate

with a rapid drop in blood pressure. As the RRT came into the room I stepped out and let them

do their thing. I was younger, so I didn’t think to stay in the room and learn about what was

happening to the patient. The patient ended up making a full recovery, but because of my clinical

nursing judgement I was able to save this patients life.

Although clinical nursing judgement improves overtime with nurses there should be

some expectation for new nurses to already have a good idea what to do in certain situations.

This all stems from learning from others who have been in these positions many times before.

Nursing teachers and instructors play a huge role in developing a student and graduate students

clinical nursing judgement. Nursing teachers can help students develop their clinical judgment

skills by providing a secure psychological environment, proper training conditions, using

instructional strategies to reinforce deep thinking processes, education of professional ethics and

applying scientific evidence and principles (Res et al, 2017).

It is important for health care providers to understand the reasoning and concept behind

clinical nursing judgement. Without this critical part of nursing patients would not be getting

their care needed and increase the risk of potentially harming the patient. Clinical nursing

judgement is a key attribute in the nursing profession.

 References

Jamal Seidi, Fatemeh Alhani, & Mahvash Salsali (2015).

Nurses’ Clinical Judgement Development: A Qualitive Research In Iran, 17(9)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601210/

J Clin Diagn Res (2017). Factors Influencing Nursing Students’ Clinical Judgement:

A Qualitative Directed Content Analysis in an Iranian Context, 11(5), JC01-JC04

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

Justine Connor, Tracy Flenady, Deb Massey, & Tracey Dwyer (2022).

Clinical judgement in nursing – An evolutionary concept analysis

https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.16469