Danielle Snovak

March 13, 2017

Scholarly Paper

Dr. Ballone

Nurses Role in Decision Making

Clinical nursing judgment is defined as the process by which the nurse decides on data to

be collected about a client, makes an interpretation of the data, arrives at a nursing diagnosis, and

identifies appropriate nursing actions; this involves problem solving, decision making, and

critical thinking. Clinical judgment is used before making decisions on all patients during every

shift. It is very important for the nurse to have good critical thinking skills and knowledge of

each patients diagnosis and current state. According to Carl Thompson, estimates vary but

nurses make a lot of decisions: acute care nurses facing a decision or judgment task every 10

min, critical care nurses every 30 seconds and family or public health nurses making up to 10

judgments for each contact have with new mothers(Thompson 2013). This alone shows the

frequency and the importance to good clinical judgment and decision making skills. Clinical

judgments are influenced by multiple factors. Throughout this paper, I will discuss the

importance of decision making skills, factors that influence these decisions, how these decisions

affect patients, and examples of times clinical judgments are used.

First, there is a lot of importance with decision making regarding patient care and clinical

judgment. In one study, Eleven percent of the patients in the UK NHS experience some form of

adverse event resulting in iatrogenic harm. Of the 34 % these events that are serious some 6%

lead to permanent injury and 8% of patients die. Half of these deaths are preventable(Thompson

2013). These injuries and deaths cost about 1.5 billion dollars per year for healthcare facilities.
This directly corresponds with nursing clinical judgment and decision making skills. The

outcomes of these decisions of course differ based on facilities and patient preferences but it is

important to recognize that how nurses use their critical thinking skills affects such situations.

However, it is important to recognize that if a nurse fails to make decisions appropriately it can

affect not only patients poorly but the whole healthcare facility as a whole. All in all, the

importance of decision making for the nurse can negatively affect patient care and hospitals

negatively if not done correctly.

Second, when making decisions in the clinical setting it is important to avoid making

assumptions. According to Tracey Levitt Jones, Clinical reasoning is dependent upon a critical

thinking disposition (Scheffer & Rubenfeld, 2000) and is influenced by a persons attitude,

philosophical perspective and preconceptions (McCarthy, 2003). Preconceptions and inaccurate

assumptions such as most indigenous people are alcoholics; Young women tend to have a low

pain threshold; and elderly people often have dementia, can negatively influence the clinical

reasoning process (Alfaro-LeFevre, 2009) (Levitt Jones, Sundin, Bagnall, & Hague, 2017).In

order to make a decision appropriately you must throw out all biases before doing so. It is not the

time to use your own personal philosophies and stigmas to decide what is best for the client. This

is a huge factor that many struggle with during clinical judgments. For example, if you assume

that a woman is over exaggerating regarding pain and withholds pain medication you are doing

her an injustice because pain is subjective. This is where you use tools such as the pain scale and

other physical assessments to justify her pain. These things are examples of critical thinking

skills and problem solving tactics. This would be a good example to show how something as

simple as pain related to clinical judgment can affect a patient. All in all, it is important to avoid

assumptions when making decisions.

 Lastly, when researching the topic of clinical judgment, it allowed me to focus on

particular times I used my own decision making skills throughout my education. During my

preceptorship, I have realized that clinical judgment is used on every patient, multiple times a

day. It is very important to be on your toes constantly. One example is during a shift with my

nurse at preceptor; a patient was prescribed an antibiotic intravenously and was on a potassium

chloride drip. As a nurse it is important to have the knowledge to know which medications can

and cannot interact with each other. The nurse was able to make the decision to hold the

potassium while giving the antibiotic because the two were not compatible. This in return kept

the patient safe and saved the hospital from experiencing further problems. Another example

would be when assessing a client who is at risk for pressure ulcers and making the decision to

prevent the formation, such as developing a turning schedule for this client. All in all, I have

used clinical judgment a variety of times throughout my education and will continue to develop

it throughout my career.

Clinical judgment is very important in nursing. It can determine life and death in certain

situations. According to Laura Cascella, Clinical judgment is developed through practice,

experience, knowledge and continuous critical analysis. It extends into all medical areas:

diagnosis, therapy, communication and decision making (Cascella n.d.). Nurses need to have

brilliant critical thinking skills and the knowledge that allows them to make decisions accurately

and quickly. Clinical judgment is not only taught in nursing school but something that is taught

and developed over a nurses entire career. Clinical judgment is used when communicating with

patients and when developing plans with other health care professionals. Many things can affect

a nurses clinical judgment but it is important for the nurse to constantly be aware and on his or
her toes. All in all, clinical judgment is extremely important and affects many different areas

critically in the nursing field.

 Citation

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2017). An agenda for clinical
decision making and judgement in nursing research and education. journalsofnursingstudies.com.
Retrieved 13 March 2017, from

Levitt Jones, T., Sundin, D., Bagnall, M., & Hague, K. (2017). Learning to Think Like a
Nurse. University Of Newcastle, 15-20.

Cascella, L. (2017). Clinical Judgment: Lets Think About Thinking. Medpro Group, 1-9.