Beruflich Dokumente
Kultur Dokumente
Joel A. Hake
Arguably the most difficult skill to teach nurses in training is the ability to use their
clinical nursing judgment, because it is something that partially can not be taught. Students can
be lectured about a million different scenarios that require nursing judgment, but the skill can not
be mastered until it is practiced in live situations with real patients. It is a skill that takes time.
Clinical judgment is a culmination of all basic nursing skills, including assessment, analyzing
data, and evaluation, combined with critical thinking and decision making to provide the safest
Before diving further into the topic, it is important to define the term “clinical judgment”.
Manetti (2014) defines it simply as “cognitive or thinking process used for analyzing data,
deriving diagnoses, deciding on interventions, and evaluating care” (p. 103). Although this may
sound simple, many factors can come into play when nurses use this skill. These include past
experiences and situations, culture, the wants of the patient, what is best of the patient, and
hospital rules, to name a few. Many times, the skill of nursing judgment is implemented when a
patient takes a quick turn for the worse, and the nurse must use critical thinking skills to decide
what to do. Other times, it can be implemented for a simple decision, like deciding whether it is
appropriate to administer a certain medication or not. The moral of the story is, nurses
essentially use nursing judgment all day with every decision they make, with the goal being to to
ensure pristine quality of care, and patient safety in care (National League for Nursing, 2014, p.
1). Safety and quality of care is the reason nursing judgment is so important in patient care.
As mentioned before, nurses use clinical judgment with essentially every decision they
make when it comes to patient care. However, one of the most difficult scenarios in which a
nurse must use clinical nursing judgment that some may not realize analyzing and thinking about
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the order or decisions of a doctor, and possibly having to question their decision. When a doctor
puts in an order, nurses should always use their own judgment to determine why they are doing
this for the patient, what the patient will benefit from it, if there are any contraindications, and if
it is safe. Some may not even realize that this is actually a part of nurse’s job description and that
they are legally bound to question inappropriate orders from a doctor (Reuter & Fitzsimons,
2013, p.11). Although sometimes a doctor may make collaborative decisions with the nurse by
asking them for information and opinions on the patient, some may not. This is where the nurse’s
job gets tricky and they must act as an advocate for the patient. This can be especially tough for a
new nurse who may have fear in calling and questioning a doctor. It may be commonly assumed
that doctors are superior to nurses in knowledge, but they are human too, and make mistakes.
Not to mention, nurses often interact more closely with their patients, and are the health care
practitioner that is constantly examining a patient’s status and reactions throughout their shifts,
which definitely comes into play when making decisions on care for patients. It is key for nurses
to understand that the safety of the patient is more important than the doctor’s opinion, and that
I’m going to discuss two situations where I had to implement my nursing judgment
during my clinical experience as a student. I was taking care of an older patient who had a
history of drug abuse. During my shift, he had made comments about wishing he was on acid
(LSD). The patient also had spurts of incontinence during his stay at the hospital. While I was
providing care in the patient’s room, the patient randomly pulled out an orange container and
grabbed a pill out of it, with intention of taking the pill. Using my nursing judgment, I
immediately decided to confiscate the pill from the patient, considering I did not know what it
was. Although the patient did not like my action, it is against hospital policy for the patient to
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take pills not administered by the health care staff. Considering the patient’s history of drug
abuse, the pill could have been an illegal drug. The drug could also have actions that interact
with other medications the patient was taking, which could potentially be unsafe for the patient.
The pill ended up being an anti-diarrheal that the patient was taking in order to prevent him from
soiling his bed. I explained to the patient that he can not take pills from home while in the
hospital, and that we could talk to the doctor about getting an order for the drug, along with
ensuring I would make more frequent rounds in order to see if the patient needed to use the
toilet.
Another simple scenario in which I applied my nursing judgment was when I was
administering the drug metoprolol to a patient. Metoprolol is a beta-blocker, used for multiple
reasons, but has the action of decreasing blood pressure and heart rate. Therefore, the drug
should not be administered if the patient’s heart rate is less than 60 or if the blood pressure is
below 110 or 100, depending on hospital protocol. This is to ensure the patient’s cardiac output
is able to sustain oxygenation to the patient’s tissue. My patient’s heart rate was in the 50’s, so I
In conclusion, it is appropriate to say clinical nursing judgment is the most important skill
a nurse develops in order to provide adequate quality care to patients, while ensuring their safety.
It is something that experienced nurses are usually considerably better at than new nurses who
are just starting their journey into the profession of health care. For this reason, it is an important
part of a new nurse’s clinical judgment to question themselves and their own actions. They can’t
be afraid to ask for help from an experienced nurse when they are unsure. Experienced nurses
need to be accepting and realize it is part of their job to help develop the judgment of other
References
Manetti, W. (2018). Sound Clinical Judgment in Nursing: A Concept Analysis. Wiley Nurse
Retrieved from
https://journals.lww.com/ajnonline/Fulltext/2013/08000/Physician_Orders.2.aspx