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Clinical Nursing Judgement Paper

Mia L. Stana

Department of Nursing, Youngstown State University

NURS 4850: Senior Capstone

Dr. Randi Heasley

March 1, 2024
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Clinical Nursing Judgement

Clinical nursing judgement is a skill that evolves with experience, education, and practice

that is essential in providing high-quality patient care and ensuring patient safety. According to

the National League of Nursing, clinical nursing judgement is defined as, “ways nurses come to

understand the problems, issues, or concerns of clients/patients, to attend to salient information,

and to respond in concerned and involved ways” (Benner, 2010). Clinical nursing judgement is a

pivotal part of nursing, as it strongly contributes to the evolution of healthcare practices. Through

the nursing process, we have the capacity to apply our clinical judgement by being able to

understand and analyze information as it pertains to patient care. As nurses, we are continuously

applying our clinical judgement throughout our shifts by identifying potential risks, deciding on

the appropriate interventions while ensuring the safety of the patient, and evaluating patient

outcomes by means of optimal patient care through not only legal standards, but also ethical.

As evolutionary findings continue to expand the complexity of the health care field,

knowledge relating to the aspects of clinical judgement is an imperative quality for all nurses to

have. “The advancement of nursing knowledge, established in undergraduate education, then

subsequently developed during professional practice, has emerged as a fundamental basis for

clinical judgement, Customarily, knowledge is generated though research, education, and

professional practice. The discipline of nursing follows this pattern, constructing knowledge

based on explanatory theory which aims to account or understand a situation through description

or explanation, given reason to its place in existence” (Connor et al., 2022). During a nurse’s

undergraduate studies in nursing school, they are given an abundance of opportunities to learn

the concept of clinical judgement through not only in-class lectures, but also hands-on

experiences. Some of these experiences may include insertion of IV catheters, medication

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administration, head to toe assessments, various patient simulations, clinical experiences, and 12-

week preceptorships with a Registered Nurse on a floor. Hands-on learning is highly beneficial

being that nursing is a practice-oriented profession. This allows students to become prepared for

the high demands of health care by challenging them to think on their feet while applying clinical

judgement skills to real-life patient scenarios.

Clinical judgement is heavily lectured on throughout nursing school. “The development

of clinical judgement itself is not a clear linear process, and although years of experience in

nursing appear to support the sounds development of clinical judgement skills in a nurse, almost

all the literature around this concept addresses that it is imperative the skill must be introduced in

foundational studies of a nursing students course study” (Connor et al.,2022). Students have the

capability to enhance clinical judgement while preparing them. By utilizing opportunities such as

clinical placement and patient simulations, experienced nursing educators are able to assess

students’ knowledge and their ability to deliver quality patient care. “Being outside of my

comfort zone further instilled the necessity of continued learning – for myself to grow as a

professional nurse” (Monagle et al., 2018). With the demand for nurses being at an all-time high,

it is essential for students to integrate knowledge of the concepts pertaining to clinical judgement

into clinical practice in preparation for the transition into the role of a Registered Nurse.

Throughout my time in nursing school, there have many numerous times where I have

had the opportunity to apply my clinical judgement in a patient situation, but one patient

experience stuck out to me the most. During my clinical rotation in the SICU, I was assigned to a

27-year-old male who presented to the ED by ambulance around 0200 with 2 gunshot wounds to

the left flank, 1 which hit part of his ureter. The patient was rushed into surgery upon arrival

where he underwent a Laparotomy, Small Bowel Anastomosis, and a right Hemicolectomy. He

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returned to the SICU with an open abdomen that was sealed with a wound vac and multiple

drains. Upon my initial assessment, the patient was heavily sedated on 50mcg of Propofol, but

seemed to still be experiencing discomfort. One of the first things that I noticed about the patient

was that he was profusely sweating and grimacing with pain, even with Fentanyl running

through his IV. Being that his site was not yet surgically closed, and he was susceptible to

infection, I immediately reached for the thermometer to take his temperature. His temperature

was 102. I quickly checked his chart to see if there was a PRN medication ordered, and sure

enough, he was ordered Zosyn. I reported my findings to the nurse that I was paired with for the

day, and we quickly administered the antibiotic. After close monitoring, the patient’s temperature

went down, and he seemed comfortable. This was my first patient interaction where I caught

something abnormal by myself. By using my clinical judgement, I was able to provide quality

care to my patient.

In closing, clinical judgement has a profound impact on patient outcomes. It is a

fundamental skill that enables a nurse to apply their academic learning to real-life patient

situations. Though a challenging concept to teach due to the complexity of the evolving

healthcare system, exposure to clinical practice, mentorship, and patient simulations allows

nurses to implement their decision-making skills and effectively providing high-quality patient

care. With senior year coming to a close, I am grateful for the opportunities that I have been

given to improve my clinical judgement. Although there is always room for improvement, I am

confident that what I have learned will effectively be applied to my nursing care that I provide in

the future.
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References

Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating Nurses: A Call for Radical

Transformation. Sanfrancisco: Jossey-Bass.

Connor, J., Flenady, T., Massey, D., & Dwyer, T. (2022). Clinical Judgement in Nursing – An

Evolutionary Concept Analysis. Journal of Clinical Nursing.

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

Monagle, J. L., Lasater, K., Stoyles, S., & Dieckmann, N. (2018). New Graduate Nurse

Experiences in Clinical Judgment: What Academic and Practice Educators Need to

Know. Nursing Education Perspectives, 39(4), 201.

https://doi.org/10.1097/01.NEP.0000000000000336