CLINICAL NURSING JUDGMENT SCHOLARLY PAPER 1

Clinical Nursing Judgment Scholarly Paper

Minnie A. Germano

Youngstown State University

NURS. 4852 Senior Capstone Seminar

Kimberly Ballone and Randy Heasley

March 13, 2023

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Clinical Nursing Judgment Scholarly Paper

Clinical nursing judgment is a concept that is widely known as being one of the most

important skills that a nurse can have. Clinical nursing judgment can simply be described as how

and why nurses make decisions. With that being said, the process of getting to the point of

excellent clinical nursing judgment is much more complex. Nurses obtain clinical nursing

judgment skills through a variety of ways. One of the best ways to gain this skill is by thorough

practice. Clinical nursing judgment is taught in nursing school through research, content,

simulation, and clinicals… ect. A great way that students are able to practice clinical nursing

judgment is through making concept maps for their patients. A book about concept maps written

by Pamela McHugh Schuster PhD FNP-BC (2020) states

In developing a clinical concept care map, critical thinking is used to analyze

relationships in clinical data. Thus, critical thinking used in developing concept care

maps builds clinical reasoning skills. Critical thinking and clinical reasoning are used to

formulate clinical judgments and decisions about nursing care. (pg 5)

This shows how the use of concept maps during nursing school fosters the students ability to use

critical thinking skills, which helps build clinical nursing judgment.

Nursing school provides students with a steady start in having clinical judgment, but

where clinical nursing judgment is truly built to excellence is on the job after years of

experience. New grad nurses are not expected to have the same level of clinical nursing

judgment as well experienced nurses for that reason. Even well experienced nurses have been

facing a difficult time with clinical nursing judgment as healthcare as a whole has changed

tremendously over the past few years due to COVID-19. An article written by Connor, J., et al.
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states “Health care is becoming more complex, and nurses are recognised as key

decision-makers, progressively required to provide safe and effective nursing care in

multi-layered healthcare environments that demand higher cognitive and clinical skills than in

previous decades” (2022). This quote is very powerful due to the fact that it relays that even

though healthcare has changed so much, nurses are still required to be dedicated to learning, and

adapting for the sake of patient safety and outcomes. Although experience and practice is what

builds clinical judgment, it is still vital to be willing to learn new strategies, and keep up with

new evidence based practice as healthcare is forever changing and evolving.

A large part of clinical nursing judgment is made up of the ability to triage patients safely

and effectively. Upon nurses and nursing students, it is very well known that patients having

complications with their ABC’s (airway, breathing, circulation) are patients that need to be

assessed or tended to first. Having good clinical nursing judgment is having multiple patients but

using knowledge and critical thinking skills to know which patient to see first. Like stated

previously, COVID-19 has challenged the healthcare system tremendously. Being able to triage,

and decide which patient to see first has also become more challenging due to this. In a study Xu,

S., et al. writes

The COVID-19 epidemic has attracted global attention and emergency nurses are faced

with many pressures during triage. Since the outbreak of the epidemic, the ED of our

hospital has received about 900 patients per day, including about 100 patients with a

fever. There are many patients in the ED in an urgent condition, which makes triage

difficult (2021).

Although this article is speaking about Emergency Department nurses specifically, the same goes

for nurses everywhere. Nurses recently have been overworked, and have seen an increase in the
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number of patients, and acuity of patients. Even though healthcare has changed in ways that no

one could have predicted, nurses are still on the front lines regarding the safety and outcomes of

patients' lives. This is another reason why clinical nursing judgment is extremely important for

nurses to have.

I am a senior in nursing school, and as far as clinical nursing judgment goes I do have a

lot to learn, but I feel as if I do have a strong foundation of knowledge and skills that helps me

make clinical decisions. One example of a time when I used clinical nursing judgment was this

semester during my preceptorship. I will preface this by saying that I am precepting in Adult

Mental Health. I had just come on to my shift, and my preceptor and I had 5 patients that we

needed to assess and pass medications to. Before we started doing that we noticed that one of our

patients diagnosed with schizophrenia was extremely agitated and actively experiencing auditory

and visual hallucinations. I used my clinical nursing judgment and told my preceptor that we

need to see this patient first. Upon going into her room, she was very paranoid and belligerent.

She was threatening to hit us and at that time I knew that I needed to call security to ensure the

safety of the staff and other patients. During this situation, I used de-escalation techniques and

other strategies I have learned to help with dealing with a violent patient. I reassured her that she

was in a safe place and that we were not going to hurt her. I also positioned myself between the

patient and the door so I would not be able to be trapped in the room. The patient did begin to

start swinging as security arrived. Once my preceptor and I were able to safely leave the room

we immediately called the doctor and requested an order for IM shots. After those were given the

patient did calm down. I feel as if I used clinical nursing judgment in that situation to keep not

only the staff and other patients safe but the patient safe from hurting herself as well.
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In conclusion, clinical nursing judgment is a skill that is formed in nursing school

through a variety of different ways, but it is truly mastered with time and experience of being a

nurse. It remains one of the most important attributes that a nurse can have, as it is the conscious

decision to make the best decisions, and formulate the best plan of care for patients possible.
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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical judgment in nursing – an

evolutionary concept analysis. Journal of Clinical Nursing.

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

Schuster, P. M. (2020). Concept Mapping: A Clinical Judgment Approach to Patient Care (Fifth

ed.). F.A. Davis Company.

Xu, S., Yang, Q., Xie, M., Wang, J., Shan, A., & Shi, F. (2021). Work experience of triage nurses

in emergency departments during the prevalence of COVID-19. International Emergency

Nursing, 56, 101003. https://doi.org/10.1016/j.ienj.2021.101003