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Clinical Nursing Judgment

George C. Koulianos

Department of Nursing, Youngstown State University

NURS 4852: Capstone

Dr. Kim Ballone and Randi Heasley

March 10,2023
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Clinical Nursing Judgment

Clinical nursing judgment is a skill that every nurse uses, regardless of specialty, and is

extremely critical for every nurse to use in their career to promote top quality patient care and

essential safety. Clinical nursing judgment is defined by Nursing Judgment: A Concept Analysis

as “the culmination of education, experience, and insight that allows nurses to execute the best

action possible on behalf of patients” according to (Tantillo & De-Santis, 2019). During a

nurse’s shift there are various instances where a patients status fluctuates and could possibly take

an unexpected turn for the worst, and that’s where clinical nursing judgment comes into play. It’s

the nurse’s ethical responsibility to weigh the risks versus the benefits in hopes of bringing the

patient back to baseline, if not better than upon admission.

Nurses use clinical nursing judgment constantly without having to think about it, due to

constantly revolving patient care around the aspect of what will give the best patient outcome.

Nurses with poor clinical nursing judgment, unfortunately, place their patients in high-risk

situations than can often leave the patient in a poor predicament. According to Practice

Rationale Care Model: The Art and Science of Clinical Reasoning, Decision Making and

judgment in the Nursing Process: “nurses with poor clinical reasoning skills frequently fail to

see and notice patient worsening condition, and misguided decision making arises that leads to

ineffective patient care and adding patients suffering” (Guerrero, 2019). Poor clinical reasoning

skills don’t only leave the patient in state of suffering, but also puts the nurse providing care at

risk for legal charges due to negligence in their care they provide while caring for a patient.
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Clinical nursing judgment is not only used by those licensed in nursing practice, but also

students completing their clinical and educational journey through nursing school. During

nursing school, it is critical we begin attempting to apply our critical reasoning during our

simulations and examinations due to them mimicking real patient scenarios. Plos One mentioned

in a journal “Well-structured, high-quality simulations are useful alternatives to prepare students

for clinical practice” (Jank, 2021) Overall, using critical decision making in nursing school

allows students to understand the complexity of a patient and allows students to make decisions

that won’t affect a patient’s outcome due to being a simulation. Students also receive the

opportunity to receive copious amounts of feedback from their instructors that prepare them for

the real world.

During my nursing career I’ve been faced with multiple times that I’ve used my clinical

nursing judgment, but there is one specific time that I will never forget. When I worked in the

emergency department, I was caring for a recent respiratory distress patient, that was found to be

unresponsive with crashing vitals. Once the patient was placed into the room and we stabilized

him, most of the staff started to clear out of the room. I found myself to be alone in the room

with the patient, and I was cleaning up and finishing some last-minute documentation that

needed to be completed. Minutes after, I heard the patient take an unusual breath and I began to

assess the patient, and began using my clinical nursing judgment. I performed a sternal rub to

attempt to wake the patient, and I received no response from him after multiple attempts. After

no response, I attempted to feel a femoral pulse, and I came to the conclusion that he was

pulseless. Immediately I started chest compression and yelled for help from my colleagues in the

emergency department.
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After when I started compression, I feared I made a poor choice due to my lack of

assessment skills that I could of possibly mistaken the patient for being in cardiac arrest. Once

other staff came to the arrest, they clarified that the patient was indeed arresting and that I made

a heroic choice of assessing the patient and starting compressions. Thankfully the patient was

saved and was stabilized within a timely manner. Till this day, I take pride in the fact that due to

my clinical nursing judgment I saved a patient that potentially would have the chance to

currently not be . Its situations like that were clinical judgment is vital for not only nurses to

know but also students.

In Conclusion, clinical nursing judgment is a skill that is gained from a variety of the

sources. Those sources include nursing instructors, preceptors, educators, and fellow nursing

staff. It is a skill that strengthens overtime with experience and knowledge that is carried on

through-out your career. Nursing judgment is a skill that benefits a patient and allows them to

receive the best possible outcome while maintaining top notch care and patient safety. As

always, a nurse’s number one priority is his or her patient, and the care provide is patient

centered care.
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References

Guerrero, J. G. (2019, February 14). Practice rationale care model: The art and science of
clinical reasoning, decision making and judgment in the nursing process. Open Journal of
Nursing. Retrieved March 10, 2023, from
https://www.scirp.org/journal/paperinformation.aspx?paperid=90491 

Jang, A., & Park, H. (2021, May 3). Clinical judgment model-based nursing simulation scenario
for patients with upper gastrointestinal bleeding: A mixed methods study. PLOS ONE.
Retrieved March 10, 2023, from https://journals.plos.org/plosone/article?
id=10.1371%2Fjournal.pone.0251029 

Tantillo, L. D., & De-Santis, J. P. (2019, September). Nursing judgment: A concept analysis.

ANS. Advances in nursing science. Retrieved March 10, 2023, from
https://pubmed.ncbi.nlm.nih.gov/30531353/