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Clinical Nursing Judgment

Anthony Scandy

Senior Capstone

Youngstown State University

Clinical Nursing Judgment

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When analyzing the concept of clinical nursing judgement, I believe that it should be

defined as the ability for a registered nurse to have the competency and skillset to do their job

sufficiently and properly, as compared to the national standard of professional nursing care.

“Clinical judgment provides the basis for nurses’ actions and is essential for the provision of safe

nursing care” (Fedko, 2016). It is crucial that all registered nurses have enough clinical

judgement to provide safe nursing care. “In nursing literature, the terms "clinical judgment,"

"problem solving," "decision making," and "critical thinking" tend to be used interchangeably”

(Tanner, 2006). These terms are used interchangeably because all of the terms can be applied to

nursing in the clinical setting. The terms are almost synonyms.

Clinical judgement is developing in the nursing profession in many ways. “In current

health care settings, nurses are expected to make clinical judgments for the welfare of the

patients. One aim of nursing education is to help students learn to be beginning practitioners,

which includes making clinical judgments that ensure patient safety. Clinical judgments often

determine how quickly a life threatening complication is detected, how soon people leave the

hospital, or learn to take care of themselves. However, current research shows that students do

not perform well at the task of making clinical judgments. This occurs despite the fact that

students have graduated from accredited schools of nursing and have passed the NCLEX exam”

(Etheridge, 2004).

I believe that the best way to learn something is with hands on experience. In nursing

school, this is something that we did not get much of until the last semester of college during our

preceptorship. A nursing student or freshly licensed nurse, compared to a nurse of 20 years, will

not have the same clinical judgement abilities. The nurse of 20 years has been performing the

same nursing skills, assessing patients with all types of different issues, and has been in the
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workplace for 20 years. There is not a single way possible that a student nurse, or brand new

nurse, could have the same clinical experience as the 20 year veteran. This goes for all aspects of

life. Therefore, when put in certain situations, the nurse of 20 years may excel and make clinical

judgements faster because he or she has already been in the situation during the prior 20 years, or

is likely more comfortable to take on a new situation that they have not dealt with prior. The

experience and comfortability that a veteran nurse has compared to a new nurse is just not

matched. This does not go to say how intelligent either of these people are, or how their work

ethic matches up, but it does acknowledge the fact that experience will always be the best

teacher. The only way to get nursing experience is to stay involved and be on the lookout for

new opportunities and situations that may arise in the workplace as a new nurse, and when all of

the new nurses do this, that is how clinical nursing judgement is developed as a whole.

In my personal experience, I believe that I have developed my clinical judgement and

abilities as expected when looking at other students and new nurses around me. Coming into this

last semester of college after have been in nursing school for nearly 2.5 years already, I felt that I

was good at taking notes, studying, and applying the knowledge I learned to these tests, but I did

feel that my clinical judgement was not the best, and it was due to a lack of hands on experience.

During my 120 hours of preceptorship in the ED at Boardman St. Elizabeths I got to see and do a

lot of things I hadn’t experienced prior. My preceptor and some of the staff there taught me that

the main goal of the ED was to be able to use your clinical judgment to get the patients in the

doors, triaged, and out the doors as rapidly as possible. There are times when there are people in

the waiting room of a higher importance medically than some of the people actually taking up a

full room and bed in the department. This doesn’t mean one patient is more important than

another, but when one patient comes into the ED presenting with sudden chest and shoulder pain
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with no acute injury explaining these symptoms, versus when someone comes in because they

stubbed their toe on their dresser, we as nurses can use our clinical judgement to determine

which patient is of higher “importance” medically. When on a medsurg or telemetry floor, or

even in peds, OB, or psych, during our clinical experiences we often only had one patient for the

full 6-8 hour shift. In the ED, I sometimes could see 6-8 people in a 2 hour span! I believe that

this developed my clinical judgment more than anything else has because I was exposed to more

patients, issues, and nursing skills in the ED than I have dealt with anywhere else prior. My

clinical judgement is not quite where I want it to be, but with the right mindset, work ethic, and

being ready and open to learn as much as I can about nursing, I believe that with time and

experience I can give patients the proper, safe, professional nursing care that they deserve.

In conclusion, proper clinical nursing judgement is one of the most important skills it

takes to be a good nurse. “Clinical judgment is considered an essential outcome for the

baccalaureate nurse graduate and is important for fulfilling the role of patient advocate as well as

for designing, coordinating, and managing care” (Fedko, 2016). All aspects of nursing are

important and when you have a nurse who is well rounded with clinical judgement, intelligence,

proper communication skills, transfer of care, working with teammates, and performing hands on

nursing care in general is when you have a really great nurse.

References

Fedko, A. L. (2016). Examining the relationship between clinical judgment and nursing

action in baccalaureate nursing students.

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doi:https://eps.cc.ysu.edu:2255/nahs/docview/1849023460/6837860855EF443FPQ/2?accountid=

29141

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

Judgment in Nursing of critical thinking, grade point average, and college experience on the

clinical judgement skills of baccalaureate nursing students.

doi:https://eps.cc.ysu.edu:2255/nahs/docview/203965102/7BF72B7438954264PQ/17?accountid

=29141

Etheridge, S. (2004). Learning to think like a nurse: Perceptions of new nurse graduates.

doi:https://eps.cc.ysu.edu:2255/nahs/docview/305157223/6837860855EF443FPQ/3?accountid=2

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