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Clinical Nursing Judgment
Emma Shemasek
Nursing Department, Youngstown State University
NURS 4852- Senior Capstone
Dr. Ballone & Mrs. Thomas
March 2, 2020
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Within the career of nursing, not a day goes by that clinical judgment is not implemented.
Nurses use clinical judgment constantly and it is important that they do so. Clinical judgment is
used to determine the best course of action in the treatment and care of every patient. It is used in
every situation, whether the situation is emergent or one that is not as crucial. A nurse must be
able to analyze patient data, view the patients’ signs, symptoms and condition, determine what
they should do next in terms of treatment, all while thinking about the possible outcomes that
could arise from the current situation. “Sound clinical judgment is the foundation of quality
nursing care. Nurses make a multitude of decisions in clinical practice daily that call for careful
thought because the decisions made impact patient outcomes,” (Manetti, 2019). A patient is in
the hands of the health care professionals treating them, so that is why it is very crucial that the
nurse is always using their best clinical judgment.
Furthermore, there are many factors that go into a nurse becoming proficient in making
appropriate clinical judgments. Many of the times, it does take experience for a nurse to become
proficient and confident in making “the right” clinical judgment, however, no matter how long a
nurse has worked, it is important for them to use all of their critical thinking to make their
judgments. In the Clinical Judgment Model, it describes sound clinical judgment as “consisting
of four features: noticing, interpreting, responding, and reflection,” (Manetti, 2019). With that
being said, as a nurse you have to notice and take note of the presenting symptoms and problems
a patient is experiencing, use reasoning and critical thinking to come up with your next step and
course of treatment, then put that into action and respond, and finally reflect and evaluate your
outcomes. As a nurse this is crucial that you use this with every patient because if you do not
then that is when a problem can occur. If a nurse does not use clinical judgment or think things
through and instead makes a rash decision, then they are putting the patient’s life in danger. The
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care and treatment of a patient is always the number one priority for a nurse, so that is why the
use of clinical judgment and reasoning must always be used, no matter who the patient is.
While discussing the topic of clinical judgment, it is also vital that new graduate nurses
understand how critical it is to have. “Nursing leaders have indicated that most new graduates are
not practice-ready, particularly in their ability to make clinical judgments,” (Mongale, et al.,
2018). It is known that a new nurse will not have had many experiences or dealt with many
situations where they had to use clinical judgment fully on their own, so that is why is it crucial
for them to start to develop those skills when they are in school and that they keep expanding
them once they start practicing. As a soon to be graduate nurse, I have had my own experiences
in clinical judgment. Throughout nursing school clinical judgment is something that has
developed and has definitely grew since my first clinical. On every unit or floor that I have had
the chance to experience, I see nurses constantly use it, which has made me get a better
understanding of how important it is. This semester has pushed me even more to use my clinical
judgment because as a student completing a preceptorship, you are expected to use more of your
own critical thinking and judgment skills while treating patients. While, you are expected to use
your own judgment, it is very beneficial to have a nurse help guide you in the right direction.
Nurses guiding you now and teaching you how to develop these skills, will shape you as a nurse
and prepare you to fully make your own clinical judgments in the future. For example, while
precepting this semester, my nurse and I were treating a patient with chest pain. This patient was
prescribed Nitroglycerin to help relieve this pain, so my nurse and I went to administer it. First,
we checked the patient’s vitals and assessed her to make sure that this medication was safe to
administer. Next, we administered the medication, monitored her for 5 minutes, then reassessed
to see if another dose was needed. After that, we determined that yes, another dose was needed
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and was safe to administer. Lastly, after the next 5 minutes pass, we once again assessed the
patient and her vitals. At this point the patient was somewhat dizzy, which can be a common side
effect, however, after taking her vitals, I had noticed a large drop in her blood pressure. When I
noticed the drop, I said something to my nurse because I was not sure if the third dose should be
given. My nurse then determined that the third dose should not be administered. By me noticing
and notifying my nurse, I believe it was a good use of my clinical judgment skills. As for my
nurse, by her deciding that we should not administer the third dose of Nitroglycerin, she was
using appropriate clinical judgment skills. This situation helped me build on my critical thinking
and judgment, as well as made me realize how essential it is for me to continue to do so.
In conclusion, the use of proficient clinical judgment, not only in all nurses but in all
healthcare professionals, needs to be implemented in every healthcare facility nationwide.
“Clinical creative thinking and clinical judgment is viewed as essential skills for every healthcare
professional,” (Van Graan, et al., 2016). With that being said, critical thinking and clinical
judgment kind of go hand in hand, so it is crucial to constantly use the two while working. In any
situation a nurse is faced with, these skills must be put to action. Decisions and treatments can
tremendously effect the life of a patient that is why it is vital to notice and asses your patient,
analyze the problems that arise, implement what you believe to be the best course of action, and
always evaluate your patient and their outcomes while still monitoring them. If a nurse uses this
kind of thinking with every patient, then there will be less errors and better patient outcomes.
Sometimes, it can be beneficial to think about yourself as a patient and how you would want to
be treated. Would you rather have a nurse that makes rash decisions and does not think things
through, or one that uses critical thinking and the clinical judgment to give you the best course of
treatment? Every patient deserves an advocate and a nurse that can determine the best possible
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treatment and care for them, that is why good and appropriate clinical judgment is one of the
most important skills a nurse can possess and use every day.
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References
Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing
Forum, 54(1), 102–110. doi: 10.1111/nuf.12303
New Graduate Nurse Experiences in Clinical Judgment. (2018). Nursing Education
Perspectives, 39(4). doi: 10.1097/01.nep.0000000000000361
Van Graan, A. C., Williams, M. J. S., & Koen, M. P. (2016). Professional nurses' understanding
of clinical judgment: A contextual inquiry , 280–293. Retrieved from
https://eps.cc.ysu.edu:2255/docview/1818059880/fulltextPDF/D319CAC5C9024138PQ/1?
accountid=29141
