Running Head: CLINICAL JUDGEMENT

Clinical Judgement

Alexis DeSantis

Senior Capstone

Youngstown State University

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Clinical Judgement

A novice nurse is defined as a “nurse who has no experience in the situations in which

they are expected to perform”​ (Benner, 1984, p. 1).​ Although this was defined more than three

decades age, it is still applied in today's healthcare setting. ​A new graduate strives to attain

critical thinking skills in which they are able to independently make decisions. So what does it

come down to in a nursing student’s education to prepare them to make good clinical judgement?

First, one needs to know what the definition of clinical judgement is. Clinical is defined

as “of, relating to or conducted in or as if in a clinic: involving direct observation of a patient;”

and judgement defined as “the process of forming an opinion or evaluation by discerning and

comparing” (Manetti, 2019, p. 1). It is said that as a new nurse, sound clinical judgement is an

important characteristic to possess (van Graan & Williams, 2017, p. 3). As a patient, one would

want the best care provided to them, which means that if something subtly changes, they want

their nurse or provider to be able to identify it. If, as a graduate, one does not have the “ability to

think critically or have poor clinical reasoning skills, they often fail to detect impending patient

deterioration, including failure to synthesize and act on clinical information” (van Graan, 2017,

p. 1). It comes down to that if a new nurse does not have the appropriate clinical judgement, then

they are not able to provide optimal care for their patients. Noticing pertinent information in an

uncommon situation is a skill that an expert nurse has been practicing for years. That nurse has

seen these remarkable situations happen and are able to use their years of critical thinking skills

to diagnose, plan, and implement interventions.

The importance of clinical judgement in the healthcare setting can determine the life or

death of a patient. It is also a skill that is based off clinical experience, not something that can be
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taught or learned. The nurses who obtain the best clinical judgement are those who have seen the

situations before. They are much better adapted to picking up on key indicators that a patient

may start to deteriorate. For students, clinicals and preceptorships may provide the opportunity

for the student nurse to expand on their efficient clinical judgement skills. Although students are

able to grasp a few of the tips and tricks that their instructors have, the student will still have

limited amount of time and opportunities to pick up on judgement skills. When a student sees a

patient deteriorating, they are usually pushed to the side while the floor nurse intervenes and

takes over the job. There is sufficient clinical reasoning behind this due to the floor nurses not

trusting the nursing student, or the fact that they don’t want a bad outcome for a patient that is

their responsibility. Although students understand that in a critical situation, it is best to let the

experienced nurse take over, it is still a missed opportunity to assess the client, and personally

implement interventions based on those assessments.

The most significant time I remember using my clinical judgement was during my labor

and delivery clinical. Another student nurse and I were in the nursery by ourselves doing the

morning assessments on the newborn babies. The other student nurse was giving her baby a bath

while I was listening to the apical pulse on my baby. While listening to the apical, my baby

started to spit up. I quickly picked her up and turned her onto her side, tapping her back to try to

prevent any of the spit-up from entering her airway. The baby then started coughing and looked

to be having difficulty breathing. I then realized that I had no idea what to do in case of an

emergency. I quickly called over the other student nurse, who then ran and grabbed a nurse that

was at a nurses station on the other end of the hallway. All the while, I was holding this coughing

baby on its belly, tapping his back. The nurse came in and had me grab a bulb syringe to suction
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out the babies mouth. After doing this, the baby then went back to the appropriate color, and her

respiratory rate and effort returned to normal.

This use of clinical nursing judgement may have seemed like a big deal to me, but the

experienced nurse who came in to assist seemed very in control and made it seem like this was a

common occurrence. I was lucky to have such a great nurse who was able to talk me through

what to do with the baby, and had me perform the interventions instead of taking over and

performing them by herself. I also learned more about clinical judgement from the experience

that I will now be able to apply to other experiences. Now, when I am on a new floor, I always

ask what button I need to push in case of an emergency. I also had the realization that during

clinicals, students are almost never told what call button they need to push in a room in order to

call for an emergency. My clinical instructor later that day showed me where the switch was that

I could have pushed. It would have been useful to know the information beforehand, but I

learned from the experience to ask before I am put into a situation where I will actually need to

use it.

Clinical nursing judgement is a critical skill that all nurses need to obtain. In critical

situations, it can determine whether the patient will live or die. Nursing instructors and students

need to work to put the ‘big picture’ together of the patient and their disease process. With the

help of the nursing staff, clinical instructors, and the students ambition to become a better nurse,

sufficient clinical nursing judgement can be developed through our everyday nursing

experiences. With better decision-making comes better patient outcome, which makes for a much

more informed and safe patient.

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Reference Page

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing

practice.Menlo Park: Addison-Wesley, pp. 13-34.

Cazzell, M., & Anderson, M. (2016). The Impact of Critical Thinking on Clinical Judgment

During Simulation With Senior Nursing Students. ​Nursing Education Perspectives

(National League for Nursing),​ ​37(​ 2), 83–90. ​https://doi.org/10.5480/15-1553

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. ​Nursing Forum,​

54​(1), 102–110. ​https://doi.org/10.1111/nuf.12303

van Graan, A. C., & Williams, M. J. S. (2017). A conceptual framework to facilitate clinical

judgement in nursing: A methodological perspective. ​Health SA Gesondheid,​ ​22,​

275–290. ​https://doi.org/10.1016/j.hsag.2017.01.004