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Clinical Nursing Judgment

Amanda Franko

Youngstown State University

NURS 4850: Capstone

Mrs. Randi Heasley

29 February 2024
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Clinical Nursing Judgment

There are many very important aspects of patient care in nursing. These can include

critical thinking, health promotion, and patient education. One of the most important aspects of

nursing, however, is clinical nursing judgment. Clinical nursing judgment can be defined as

when a nurse makes decisions based on their nursing knowledge. Nursing judgment includes the

nurse using assessment skills, observation skills, and identifying relevant information to help

provide the best care to their patients. Clinical judgment helps nurses use objective and

subjective data to form nursing diagnoses through a four-step approach. According to AAFP,

you are to determine your probabilities, gather data by further evaluating the patient, update your

probabilities based on the data you've gathered, and consider an intervention to see whether it

crosses your treatment threshold (AAFP, 2018). Nursing diagnosis leads to nursing interventions,

and good interventions lead to better patient outcomes.

Clinical nursing judgment has certainly evolved over the years. Evolution is a must as

things, like technology, advance over time. Clinical nursing judgment also evolves as new

advancing skills come about. Nurses use their clinical judgment every day. Nurses everywhere

use these skills, but skills may vary depending on where that nurse is working. Every day a nurse

is learning and improving their judgement skills. Clinical nursing judgment is not something you

can be taught in one day; it takes a lot of time and experience to form proper clinical judgment.

The more you use your clinical nursing judgment skills, the better they will become. According

to Anita Karaca, students from the beginning should be working on clinical nursing judgment,

along with critical thinking skills all throughout nursing school to assist in developing new ideas

and solutions to new problems (Anita Karaca et al., 2023). Students offer a new set of minds to

help formulate new ideas.

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Nursing school certainly helps prepare a student to start using their clinical judgment

skills. According to Nancy Eisenmann, nurses who use the nursing process to help them make

priorities and plan their care are incorporating their clinical judgment (Eisenmann, 2021). Nurses

learn how to prioritize and plan their care in nursing school with paperwork that is required. All

the concept maps and care plans are meant to help develop clinical nursing judgment. This

paperwork helps develop a stronger nurse and stronger clinical judgment.

Clinical nursing judgment is important for many things. For one, it helps nurses take

better care of their patients. When a nurse uses their clinical judgment, it allows for a safer

environment. Nursing judgment is also important to assist in making appropriate nursing

diagnoses. Appropriate nursing diagnoses help to give our patients the best suited care for them.

As Justine Connor said, patient safety and quality of care relies heavily on a nurse’s ability to use

their clinical judgment (Justine Connor M. Phil et al., 2022). When a nurse uses their clinical

judgment, it prevents less adverse events from occurring. If a nurse does not use their nursing

judgment, or makes a bad judgment, they are much more likely to make a life-threatening

mistake. It is so important for nurses to learn nursing judgment in nursing school. They cannot

teach a student how to perfect their skills, but they can teach them how to develop these skills

towards perfection.

I have personally had to use my clinical nursing judgment in many situations. For

example, I was taking care of an 87-year female who was in the hospital with a broken hip. She

had surgery the day prior to my day of care, was in a major amount of pain, and wanted pain

medication. I assessed her vitals prior to grabbing her medication from the Omnicell. Her

respiratory rate was already low, sitting at 11 breaths per minute. I used my clinical nursing

judgment skills to determine that she was unable to receive pain medication due to the possibility
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of respiratory depression occurring. If I did not use my clinical nursing judgment correctly in this

situation and had just given her the pain medication, my patient could have gone into respiratory

failure. I knew that the pain medication, Dilaudid, causes respiratory depression, and I also knew

I had to check my patient’s vitals before medication administration. Once I noticed her low

respiratory rate, I knew it was not in the patient’s best interest to receive this medication. If I did

not use my nursing clinical judgment, I could have caused harm to my patient. A couple hours

later into my shift, my patient was having dyspnea and was stating at 86%. Her respiratory rate

was 23 and her pulse was 115 beats per minute. My patient was diaphoretic and had chest pain

upon inspiration. We immediately notified the doctor of a possible pulmonary embolism and

bumped her oxygen up to 6 Liters. The doctor ordered a chest x-ray and CT scan. My patient had

a pulmonary embolism, a complication of having hip surgery. I was monitoring the patient’s

oxygen saturation and respiratory effort after the surgery to watch for any signs of a pulmonary

embolism. I used my clinical nursing judgment and immediately put oxygen on my patient, as

well as notifying the doctor. If I didn’t use my clinical nursing judgment correctly and notify the

doctor of a possible pulmonary embolism, my patient could have died.

Clinical Judgment is one of the most important aspects of any nurse’s job. Virtually

everything a nurse does in their day-to-day care of patients requires some form of clinical

nursing judgment. Without it, many patients could be hurt or even killed. Examples above, such

as checking vitals to see if my patient was stable enough to receive her pain medication or

notifying the doctor of a possible pulmonary embolism, are just some of the ways clinical

nursing judgments are used; and those were just a couple of examples from my very young

nursing career. That is why it is so important to teach nursing students these skills, and why it is
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so important to continue to hone these skills throughout your nursing career. It will be used every

time you are in a room with a patient for as long as you are a practicing nurse.
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References

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2023). Clinical judgement in nursing – An

evolutionary concept analysis. Journal of Clinical Nursing, 32, 3328–3340.

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

Editors, F. (2018, August 3). A four-step approach to clinical decision making. AAFP.

https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/decision_making.html

Eisenmann, N. (2021). An Innovative Clinical Concept Map to Promote Clinical Judgment in

Nursing Students. Journal of Nursing Education, 60(3), 143-149.

https://doi.org/10.3928/01484834-20210222-04

Karaca, A., Kaya, G., & Kaya, L. (2023). The Relationship between Critical Thinking Skills and

Caregiving Roles of Nurses. Journal of Education & Research in Nursing / Hemşirelikte

Eğitim ve Araştırma Dergisi, 20(4), 360–366. https://doi-

org.eps.cc.ysu.edu/10.14744/jern.2023.22354