1

Clinical Nursing Judgement

Jaden Barton

Department of Nursing, Youngstown State University

NURS 4850: Nursing Capstone

Dr. Randi Heasley

February 27, 2024

Clinical Nursing Judgement

Clinical judgement is a key part when looking into medical management and patient care.

This paper will specifically gauge towards nursing clinical judgement and the importance of

utilizing it when providing that patient care. Nursing judgement is based on a combination of a

person’s experiences, critical thinking, and evidence-based practice. Together, all of these

components are what help aid nurses when caring for patients appropriately and safely.

Critical thinking and clinical judgement are two areas that theorist, Patricia Benner, PhD,

RN, developed and studied intently. Though this theory was developed in the past, the

definitions hold value when comparing and contrasting these concepts. When looking at

Benner’s theory on clinical judgement, her theory revolves around the Dreyfus Model of Skill

Acquisition. These levels being: novice, advanced beginner, competent, proficient, and expert.

Benner was able to take this standard model and apply it to nursing and clinical nursing

judgement. The Benner “From Novice to Expert” model was developed to reveal the power

experience has on clinical judgement and the development over time. When looking at the

novice level and what that entails, Benner writes, “Beginners have no experience with the

situations in which they are expected to perform tasks,” (Benner, 1982, p.403). This reveals

where beginning nurses are expected to be in terms of their clinical judgement and their patient

care. She then goes on to write that the “Common attributes accessible to the novice include

weight, intake and output, temperature, blood pressure, pulse, and other such objectifiable,

measurable parameters of the patient's condition,” (Benner, 1982, p.403). This begins the nursing

“fundamentals” and the beginning steps to acquiring clinical judgement. By starting with simple

tasks, the nurse has the opportunities to gain experiences. By gradually increasing the difficult of

the tasks and the independence, the nurse will eventually reach the expert stage. By the expert
3

stage, Benner writes that, “The expert nurse, with her/his enormous background of experience,

has an intuitive grasp of the situation and zeros in on the accurate region of the problem without

wasteful consideration of a large range of unfruitful possible problem situations,” (Benner, 1982,

p.405). The nurse should be able to rely on one’s own intuition, knowledge, experiences, and

clinical judgement rather than the guidelines or rules. This allows the nurse to become more

efficient in their patient care and can help create autonomy and independency.

Critical thinking and clinical judgement have been discussed as key components when

providing nursing care. When looking at possible people groups that may have poor clinical

nursing judgement or may discover difficulties when performing nursing tasks, many look at

undergraduate nursing students. Researchers did a study looking at just that in Taizhou

University, China. The study took a total of 143 undergraduate nursing students and surveyed

their clinical nursing abilities. The researchers wrote in their results that, “100 students reported

that they understood clinical thinking while 42 students reported that they had only learned about

it,” (Xu et al., 2023, p.202). This reveals the lack of understanding of clinical judgement among

the undergraduate nursing and the need for education on this matter. When looking at the

importance, then looking at these results, there is a call for additional teaching. This university

observed these results and knew there had to be changes made in order to meet this need. They

stated that, “Gradually formed PBL, high simulation teaching, comprehensive design

experiment, simulated clinical cases, virtual simulation teaching, mind mapping, and combined

narrative nursing are required,” (Xu et al., 2023, p.203). In this manner, there is a need for more

clinical related ways of teaching. Rather than sticking to traditional methods, this school realized

the need for transformative teaching through simulations, case studies, and others. Seeing the

results from this study indicates that this is not an issue subjected to one school. This serves as a
4

revelation that many undergraduate nurses need to focus in on clinical nursing judgement so that

they can be prepared to work in the field after their education.

When looking at clinical nursing judgement and how it pertains to my education and

patient care, there were several instances where these concepts proved to be effective. One

instance that I was able to utilize my clinical nursing judgement was while at clinical, I was

assessing my patient. I noticed hypoactive bowel sounds as well as a rigid area of his abdomen.

Not only was it rigid, but it was almost bulging or protruding. After realizing this, I sought out

my clinical instructor and his cover nurse. After they reassessed his abdomen, knowing my

findings, they were able to concur with my assessment. The patient had developed an abdominal

hernia and because of that, it was cutting off the normal gastrointestinal functions. The nurse was

able to consult the physician and a treatment plan was made for this patient. This experience

helped me to become more confident in my assessment abilities, but also to advocate for my

patient even when things may not appear as an immediate problem.

All in all, clinical nursing judgement is an important tool to utilize when managing

patient care and evaluating patient outcomes. Obtaining this particular skill is a progressive

process and takes time to reach expert level. The lack of knowledge on clinical judgement has

sparked a need for transformative teaching in ways that can incorporate a clinical setting. As

Nicole Walker writes in a journal article titled, More than Meets the Eye…, she writes that, “All

nurses need solid critical thinking skills and clinical judgment, of course,” (Walker, 2021, p.2).

She reinstates the importance and need for this concept and phrases it to be a core expectation in

regard to nursing practice. By improving upon these things and through continuous experience,

clinical nursing judgment will continue to strengthen in not only undergraduate nursing students,

but also seasoned nurses as well.

References

Benner, Patricia. From Novice To Expert. AJN, American Journal of Nursing 82(3):p 402-407,

March 1982.

From novice to expert. Nursology. (2023, December 9).

https://nursology.net/nurse-theories/from-novice-to-expert/

Hai-Yan Xu, & Xin-Juan Wang. (2023). Analysis of the Current Situation and Factors

Influencing the Clinical Thinking Ability of Nursing Undergraduates. Alternative

Therapies in Health & Medicine, 29(8), 200–208.

Walker, N. M. (2021). More Than Meets the Eye: Clinical Judgment, Critical Thinking, and

Correctional Nursing. American Jails, 35(1), 29–31