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Clinical Nursing Judgement: From the Perspective of a Nursing Student

Michael Bryant
Nursing Department, Youngstown State University
4852: Senior Capstone
Dr. Kim Ballone, Mrs. Wendy Thomas
March 2nd, 2020
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Clinical Nursing Judgement is easily defined; however every nurse or clinician may interpret its

meaning differently. To me, a senior nursing student working on my Bachelorette in the Science of

Nursing, clinical nursing judgement is a form of intuition backed by science, facts, and observable

assessment characteristics. Clinical judgement is a vital skill that can separate a good nurse from an

excellent nurse. In this paper, my goal is to define the concept of clinical judgment, identify the

importance of clinical nursing judgment, and then discuss a personal experience in which I used clinical

nursing judgment.

In the journal “Educating Nurses: A Call for Radical Transformation, by Patricia Benner, Molly

Sutphen, Victoria Leonard, & Lisa Day”, Clinical nursing judgment is defined as, “Ways nurses come to

understand the problems, issues, or concerns of clients/patients, to attend to salient information, and to

respond in concerned and involved ways.” (Benner et al, 2010) In 2014, the National League for Nursing

adopted this definition for their Practical/Vocational Nursing Program, and builds on this idea by stating:

Nurses employ clinical judgment in complex patient care situations, working with

interprofessional teams to ensure health care quality and safety. Critical components include:

changes in patient status, uncertainty about the most appropriate course of action, accounting

for context, and the nurse’s practical experience. Making clinical decisions is rooted in the

nurse’s theoretical knowledge; ethical perspectives; relationships with patients, the patient’s

caregivers, and the community; and understanding of the influence of systems on health care

outcomes.

I have learned to interpret this explanation as this: Clinical Nursing judgment exists in the nursing

process, and its purpose is to help the nurse intuitively plan care based on a patient’s specific needs. The
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nursing process has 5 steps. The steps are assess, diagnose, plan, implement, and evaluate. Clinical

Nursing judgment exists throughout the entire process, and it is used in many different ways. Let me

provide a few examples.

In the assessment step, a good nurse would use clinical judgment by recognizing that a patient

with a fast pulse and shallow, rapid respirations is exhibiting signs of shock, and would then assess the

patients blood pressure. In the diagnostic step, the nurse would look at all the facts obtained from the

assessment, objective and subjective, and conclude that the patient is in hypovolemic shock. In the

planning and implementation stage, the nurse would use clinical judgment by deciding that

interventions focused on returning fluid volume have higher priorities over interventions to correct a

slight nutritional deficit. The nurse would plan to correct the highest priority first and worry about

nutritional needs once the patient is stable. In the final step, evaluation, the nurse would assess the

patient’s response to the interventions and decide, based off their clinical judgment, if the patient is

responding well to treatment or if they need additional interventions. Clinical judgment would even help

the nurse decide what those additional interventions might entail.

The importance of clinical nursing judgment is evident by the fact that it can be found in almost

all aspects of nursing. One aspect where clinical judgement is essential is medication administration.

Nurses must be able to use clinical judgement to identify medications they should give, question, or

withhold during every single shift. In the article titled, “Nurses’ Clinical Reasoning Practices That Support

Safe Medication Administration: An Integrative Review of the Literature” published in the Journal of

Clinical Nursing, Emily Rohde writes, “Clinical reasoning is an integral component of safe medication

administration as nurses assess patients and situations, apply foundational knowledge, plan and

administer medications, evaluate patients’ responses to medications and teach patients about taking

their medications safely. Nurses’ knowledge, interactions with patients, and clinical reasoning about
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patients’ conditions and the environment contribute to safe medication administration processes.”

(Rohdes, 2017) Medication administration is much more than just handing a patient a pill or pushing an

IV syringe. Nurses must always be aware of what medication they are giving, why they are giving it, how

it will work, etc. in order to maintain the highest level of competency and patient safety.

One example of when I used clinical judgement took place while I was working as a nurse’s aide

at St. Joseph Hospital. An RN delegated the task of obtaining vitals on a patient for her while she passed

medications to another patient. When I entered the room, I became concerned because the patient did

not respond to my voice or open his eyes. I quickly hooked him up to the blood pressure machine to

obtain an automatic reading. His blood pressure came back 70/50. I recognized that that value was

extremely low, and I decided to double check his blood pressure against the machine to test its

accuracy. After notifying the RN of the low pressure, I obtained a manual cuff and took the blood

pressure myself on the opposite limb. The pressure I obtained was 66/40. I immediately notified the RN

of the pressure and charted the data. Upon looking at his chart, the RN decided that this blood pressure

wasn’t too abnormal for the patient and asked me to take it again in 15 minutes. Because of my clinical

judgment, I decided that this pressure was extremely low regardless of the downward sloping trend. I

then notified the charge nurse of the situation. After she obtained her own blood pressure reading on

the patient, she decided to activate a Rapid Response, and the patient was transferred from our unit to

the ICU. I believe that the patient’s condition would have continued to deteriorate had I not intervened

and notified the charge nurse. I was later thanked by the charge nurse and nurse manager for acting

when I did.

In summation, nursing judgement is a quality that all employers are looking for in a nurse. It is

the foundation of nursing itself and provides the backbone by which each and every one of us will

practice by. In order for a nurse to maintain good clinical judgment, they must always be striving to
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remain educated: Educated about healthcare, educated about science, and educated about our

patients’ status. Knowledge can only take a nurse so far, but clinical judgement tells us what to do with

that knowledge. It is what makes a nurse, a nurse.

References

Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating Nurses: A Call for Radical
Transformation. San Francisco: Jossey-Bass.

Practical/Vocational Nursing Program Outcome: Nursing Judgment. (2014, September).

Rohde, E., & Domm, E. (2017). Nurses’ clinical reasoning practices that support safe medication
administration: An integrative review of the literature. Journal of Clinical Nursing, 27(3-4).