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Clinical Nursing Judgement

Emily M. Russell

Youngstown State University

4850 Capstone

Ms. Randi Heasley

March 1, 2024
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Clinical Nursing Judgement

Clinical Nursing Judgement is an important, honed skill that we nurses use on the first

day of taking care of patients, until the very last. It is a concept that varies among individuals and

is evolving every day. One nurses clinical judgment may differ from anothers. Nurses use

clinical judgment in every aspect of their career. No matter what field of nursing someone is in,

clinical judgement is used everywhere. So, what exactly is the definition of clinical nursing

judgement? How is it important in everyday life while in the field? I will define, and discuss the

importance including a personal situation in which clinical judgment was used during patient

care.

When taking care of patients, depending on what type of floor you are on, you can have

two patients or five. A common thing nurses are faced with each shift, is which patients they

need to see first, and planning care based on patients priority needs. As nursing students, we are

frequently asked on exams and practice questions, “Which patient will the nurse see first?” So,

how do you decide which patient needs to be seen first? That is where clinical nursing judgement

comes in. Clinical nursing judgement, in my own words, is the ability to make decisions on

patient care based on nursing knowledge and critical thinking skills. There are many other

situations in which clinical judgement is used. A few examples include when deciding on how to

give the patient the best outcome possible for their situation, making informed decisions, paying

attention to close detail when receiving medication orders, interpreting labs, EKG strips, the list

goes on and on. It is important for students and new graduate nurses to understand in depth how

to use clinical judgement. “Tanner’s Model of Clinical Judgement” is a tool that provides a

comprehensive framework for students to develop their crtitial thinking and decision making
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abilities. (SimpleNursing, 2023) The tool consists of four categories that correpsond to

improving critical thinking. The first is Noticing, which utilizes observation skills and the

gathering of information you already have on the patient. (SimpleNursing, 2023) Examples of

noticing is the observation of vital signs, patient cues and patient responses. The second

component of the model is Interpreting, which involves analyzing and applying the information

collected from the noticing stage. (SimpleNursing, 2023) The third component is Responding,

which is when the nurse then decides what nursing interventions must be used for patient care.

An important aspect of this component is communicating with other members of the health care

team to implement these interventions. (SimpleNursing, 2023) The last component is Reflecting,

which is when the nurse self-reflects and reviews the decisions made and how the care will affect

the patient’s outcome. (SimpleNursing, 2023)

The importance of clinical nursing judgement is critical to nursing care. The clinical

setting can be a fast-paced, high stake environment that requires fast thinking skills on the spot.

It is important in providing effective, safe, and evidence-based care. (Meijer, 2022) As I stated

earlier, clinical judgement is always evloving and it is important to keep up with it. A prime

example of this is the health care field post-COVID outbreak. During and after COVID, things in

the health care world became more virtualized. Zoom meetings with doctors, the implementation

of Telehealth, and remote learning in schools. (Meijer, 2022) Boosting clinical judgement skills

can help students and new graduate nurses, or even experienced nurses have the confidence and

knowledge to make decisions during these new and unprecedented events. Another example of

why clinical judgement is so important in nursing is when it comes to medication administration.

If the doctor or pharmacy makes a medication error, it is overall the nurses responsibility to use

their medication rights to avoid this error. Using critical thinking and clinical judgement is how
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we avoid these errors. Overall, clinical judgment is one of the most important skills for a nurse to

have in the field. It is also important to remember that clinical nursing judgment is a process, and

is learned with experience and over time. Students and new graduate nurses should never get

discouraged and expect to have professional skills when they first begin working, and must work

towards honing the skill overtime. (Embler, 2021)

With all of this information being said, I can recall an important time when I, as a student

used my clinical judgement during patient care. The situation occured when I was working as a

student nurse extern. The patient was an older adult, who was admitted to the unit with confusion

and later it was determined the patient had elevated WBC’s and concluded that they had a UTI.

Throughout the shift, we monitored the patient closely for worsening confusion and made sure to

do neurological checks frequently. The patient remained alert and oriented to person, place and

time throughout the shift and was treated per standard protocol for UTI’s with IV antibiotics. The

patient remained stable during the shift and tolerated treatment well. The patient was pleasant

with little complaints of pain and talked to us throughout the shift. I happened to be working the

next day as well with the same nurse with the same patient assigment. When I had returned the

next day, the patient clearly deteriorating. When we had done an initial neurological assessment,

the patient could not recall the place, time, month or president. The nurse I worked with that day

and I both concluded that something was wrong and the patients condition was worsening,

Futher into the shift, the patient had begun to slur their words, leading us to call a RRT for the

patient. The team came into the room, and then decided to send the patient for a scan to

determine if they were having a stroke. This was a clear example of how we as nurses use

clinical judgement. It was a critical situation in which we made the decision to call a RRT for

further treatment of the patient.

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In conclusion, clinical nursing judgement is one of the most important skills a nurse can

have in the health care field. It is important to begin teaching these skills during the very first

clinicals as a nursing student. These skills are learned through experience and learning from

experienced RN’s. Critical thinking skills and judgement should be thoroughly taught all

throughout nursing school to prepare students for the real nursing world.
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References

5 Ways to Boost Clinical Judgment Skills in Nursing Education. (n.d.). Www.kaptest.com.

https://www.kaptest.com/blogs/nursing-educators/post/5-ways-to-boost-clinical-judgment-skills-i
n-nursing-education

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical
decision-making and patient advocacy. Www.wolterskluwer.com.
https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement

Team, S. E. (2023, June 27). Developing Clinical Judgment in Nursing - SimpleNursing. Simple
Nursing. https://simplenursing.com/clinical-judgment-in-nursing/