Clinical Nursing Judgment

Nicholas Esmail

Youngstown State University

NURS 4850: Capstone

Dr. Randi Heasley

February 20th, 2024

 Clinical nursing judgment is a crucial attribute of professional nursing. Clinical nursing judgment

involves the processes of how nurses make decisions based on their nursing knowledge and experience.

For professional nurses, this is used every day and often becomes a natural way of thinking. Clinical

nursing judgment is important in professional nursing. It is an essential skill for nurses because it leads

them to make appropriate diagnoses, health promotion, and patient decision-making. (Tanner, 2006.)

Clinical judgment has evolved immensely over time, going back to World War 1 specifically where

nursing developed quickly due to the extreme circumstances and minimal resources nurses were working

with. As a result, nurses realized how important it was to provide rapid care and develop problem-solving

skills based on their knowledge and judgment, while also having the ability to treat them efficiently.

(Tanner, 2006.) The constant development in medicine and health care has made nurses’ duties and

responsibilities more complex, as they are now recognized as essential decision-makers in healthcare

environments requiring more progressive or advanced cognitive thinking and clinical skills from nurses.

Nursing students need good clinical judgment to take and score well on the NCLEX exam.

Clinical nursing judgment is complex and can not be taught to nurses through textbooks or schooling

alone. Most nurses develop the needed skills through real-life situations and experience. Understanding

the patient’s diagnostic and pathophysiological aspects and the illness experience for both patient and

family is also important in good clinical nursing judgment. In real-life situations, nurses often care for

multiple patients at a time and deal with complicated processes beyond textbook knowledge and have to

be able to make safe, accurate, and timely decisions in regards to the patient. Nurses must consider

placing patients in appropriate levels of care, family conflict, care provider information, and coordination

of complex discharges. (Connor, J., Flenady, T., Massey, D., & Dwyer, T. 2023). Furthermore, clinical

judgment requires more than just a nurse’s various types of knowledge, which can include a nuanced and

flexible ability to recognize, interpret, and respond appropriately to undefined clinical situations. (Connor,

J., Flenady, T., Massey, D., & Dwyer, T. 2023.)

For nursing students to gain sound clinical judgment, they must engage in activities encouraging

analyzing, discriminating, information-seeking, and open-mindedness. Students in nursing develop strong

clinical judgment by deciding the best response among alternative actions with consideration of other

expected outcomes, ongoing evaluative reflections on patient responses, and the ability to modify

interventions accordingly. (Timmo, 2022) The Tanner clinical judgment model breaks down the four

processes of clinical judgment. As students learn to think like a nurse, the process develops from noticing,

interpreting, responding, and then reflecting. Noticing is the perceptual grasp of the situation at hand or

the process of perceiving essential and salient aspects of the situation. Interpreting involves the nurse's

ability to take data in a situation, determine patterns, etiology, and additional information, and come to a

conclusion. Responding is the next step, which requires the student to have the ability to decide on a

course of action, including no action. They have to develop a plan of care considering the patient’s goals,

nursing response, and intervention. The last process is reflection, which is the attention or action of the

patient. The nurse can identify what occurred, what they did, and what they might adjust or do differently

in the future. (Timmo, 2022) Although this process breaks down the different steps and identifies the

processes of clinical judgment, it cannot replace years of practice and experience in nursing. As

mentioned before, sound clinical judgment cannot be developed in a classroom alone, but student nurses

can acquire the needed skills through proper education. While pursuing their degrees, students have the

opportunities to hone in these skills through labs, case studies, and clinicals, which prepare them for their

future careers in nursing. The classroom is a place where student nurses can make mistakes, reflect, and

learn from them to later apply their knowledge in real-world situations. (Why Is Sound Clinical Judgment

Vital to Primary Care, 2022)

I used accurate clinical nursing judgment for the first time as a student nurse extern while

working on 4 West at the Boardman St. Elizabeth campus. I began the day like any other day. I received

my assignment for the day and went around getting reports and introducing myself to my new patients.

After the report and introductions, I began reviewing my work list for each patient and reviewing each

patient’s chart to learn more about the patient I was going to be taking care of, gathering knowledge to

create a story in my head of what was going on with each of my patient’s. While reviewing, I noticed one
of my patients had a history of cerebrovascular accidents; because of this, I made sure to pay very close

attention to this patient. When I first walked into the patient room at 0800, I completed a full head-to-toe,

focusing on my patient’s neuro status, and grabbed a set of vitals. My patient was alert, oriented x 4,

friendly, and cooperative. My patient seemed to be in no distress, with everything indicating the patient

was stable, as evidenced by a WDL head-to-toe and stable vitals. I checked on the patient around 1100 for

a routine blood sugar check. I noticed the patient did not seem as talkative and was not as cooperative.

The blood sugar results were also abnormal. Usually, this would not seem significant, but I felt something

was wrong in my gut so I conducted a neuro assessment, the patient was no longer alert, dozing in and

out, having trouble speaking, and unable to state where she was, her name, birthday, the year, etc. I did

not panic, but I knew these were early signs of a stroke. I grabbed a vital machine right away and took

another set of vitals. Her blood pressure and heart rate were elevated and while conducting my head to toe

I noticed the patient’s left arm was limp. I then paged my nurse and let her know the situation. Once she

arrived, we called a code, and she admired me for being able to pick up on all the cues the patient was

exhibiting. We caught it early so the patient was able to get appropriate treatment. I reflected on the

situation afterward and wished I could have gotten there sooner, but I was happy that I was the patient’s

first line of defense in solving the problem.

In conclusion clinical nursing judgment is an extremely important skill and valuable for nurses to

have. Nurses make decisions everyday and some decisions they make are life or death for their patients.

Poor clinical judgment or missteps can be detrimental and heighten malpractice risks. Additionally poor

judgment skills can harm a nurse’s reputation or even the facility/practice they work for. Nursing is

continuously changing and good clinical judgment will always be needed to ensure patient safety and

outcomes.
 References

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

evolutionary concept analysis. Journal of Clinical Nursing, 32, 3328–3340. https://doi-

org.eps.cc.ysu.edu/10.1111/jocn.16469

Tanner, C. A. (2006, June 1). Thinking Like a Nurse: A Research-Based Model of Clinical

Judgment in Nursing. Retrieved February 25, 2024, from https://www.researchgate.net/profile/Christine-

Tanner-3/publication/7003793_Thinking_Like_a_Nurse_A_Research-

Based_Model_of_Clinical_Judgment_in_Nursing/links/0c9605294f14427681000000/Thinking-Like-a-

Nurse-A-Research-Based-Model-of-Clinical-Judgment-in-Nursing.pdf

(2022, October 5). Developing clinical judgment skills in nursing students. Retrieved February

25, 2024, from https://kb.wisc.edu/instructional-resources/page.php?id=121687

(2022, May 16). Why Is Sound Clinical Judgment Vital to Primary Care? Retrieved February 25,

2024, from https://degree.astate.edu/online-programs/healthcare/msn/fnp/sound-clinical-judgment-

primary-care/