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An Insight on Clinical Nursing Judgment

Sarah A. Perry

Youngstown State University

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Abstract

This article will take an in depth look at the definition of clinical nursing judgment and the

importance of critical thinking in the field of nursing. I will cover the process of making a

clinical nursing judgment and the outcomes it may have for a patient. Along with this, I will

include a personal experience of making clinical decisions in my nursing career thus far.
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An Insight on Clinical Nursing Judgment

Clinical nursing judgment is an essential for proper nursing care. Working as a nurse one

uses all of their senses. A nurse comes across many different diagnoses, signs and symptoms of

complications, and quick changes in a patients status that require adequate critical thinking in

life or death situations. Miller-Keane encyclopedia defines clinical judgment as the process by

which the nurse decides on data to be collected about a client, makes an interpretation of the

data, arrives at a nursing diagnosis, and identifies appropriate nursing actions; this involves

problem solving, decision making, and critical thinking. In comparison with this, Margot

Phaneuf (2008) discusses the clinical nursing judgment process. She begins the process by

making an observation with your eyes and ears, with that data you reason is this normal or

abnormal? From there one uses critical thinking skills along with previous experience and

knowledge to make a nursing judgment. Nurses make many decisions throughout their shift.

Estimates on acute care nurses facing a decision or judgment task every 10 min, critical care

nurses every 30 s (Bucknall, 2000). It is clear that clinical judgment between novice and expert

nurses varies greatly. In this profession, you learn from experience. No classroom or professor

can truly prepare a student nurse transitioning into a novice nurse on making clinical judgments.

However they do provide the tools and knowledge to hopefully set the new nurse up for success

in their new career. Clinical, lab simulation and everything that nursing school incorporates is

truly a wonderful tool for students. It allows for a safe working place where it is ok for errors to

be made. These simulations are the basis for new nurses to form their clinical nursing judgment

skills.
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Personally, I dont believe I can put into words truly how important clinical judgment is.

The decisions one makes as a nurse can either save a life or be the cause of the next Code

Blue. I believe that with practice and experience you really learn to pick up on patient cues and

intervene before situations occur. Christine Tanner (2006) makes a comment The beginning

nurse must reason things through analytically; he or she must learn how to recognize a situation

in which a particular aspect of theoretical knowledge applies and begin to develop a practical

knowledge that allows renement, extensions, and adjustment of textbook knowledge. (Pg. 206)

All in all the importance of nursing judgment cannot be stressed enough. From taking care of

patients, their families, admissions, discharges, physician orders there isnt a part that is not

important. One thing that really sticks out when thinking about the importance of nursing

judgment is questioning physician orders. According to LeeAnn Andronico, Rasmussen College

nursing program coordinator, You may be able to flawlessly dress a wound, take vitals like a

pro or give an IV without flinching, but without the ability to make quick and efficient decisions

under pressure, youll struggle as a nurse. This statement couldnt be truer. As a nursing

student, I can contest that we worry about skill. Students complain that they havent put in an IV

or that they have only inserted a foley once. Dont get me wrong these skills are important,

however there are always going to reference manuals on your unit. Its easy to follow the simple

steps of a procedure. What becomes difficult is thinking on your feet, and this is honestly the

most important part of being a nurse. As I stated in the beginning sentence, a student will never

realize how important nursing decisions are until theyre in the middle of a life or death situation

and you see all of these healthcare workers thinking and working together to save a life.

Lastly, I would like to talk about personal experiences that I have come across in my

nursing career. There are so many times throughout a clinical day that I have had to make critical
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nursing judgment. Dont get me wrong theyre not all life or death decisions, but they are

important in how I take care of my patients. There are two experiences that really stick out to me

as important and influential to my furthering career. The first being a few months ago. I was

obtaining vital signs on my patient, whom was placed on a general medical surgical unit, when I

noticed her pulse was 120-130s. I made sure to take an apical pulse to assure that what I was

hearing was correct. This patient had no previous history of any cardiac conditions. I grabbed the

assigned nurse and we immediately placed the patient on a cardiac monitor and obtained a 12-

lead electrocardiogram (ECG). After performing the ECG it was discovered that the woman had

went into atrial fibrillation and a rapid response team was called. The woman was eventually

transferred down to a more intensive floor to receive the proper care. Ill never forget how fast

my heart was racing. The other experience I had was actually this semester. I was preparing

medication with my nurse and getting ready to administer the medicine when I noticed that the

medication order had recently been cancelled. Thankfully, I noticed this and we did not end up

administering the medicine as the order had been finished. I have come to realize how intense

my future line of work will be and how serious my license is. I hope to continue learning and

improve my nursing judgment skills to be the best nurse I can be.

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References

Thompson C., Aitken L., Doran D., Dowding D.

An agenda for clinical decision making and judgement in nursing research and education
(2013) International Journal of Nursing Studies, 50 (12) , pp. 1720-1726.

Bucknall, T. Critical care nurses decision making activities in the natural clinical setting.
Journal of Clinical Nursing. 2000; 9: 2535

clinical judgment. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and
Allied Health, Seventh Edition. (2003). Retrieved March 12 2017 from http://medical-
dictionary.thefreedictionary.com/clinical+judgment

Phaneuf, M., R.N, PH. D. (2008 ). Clinical Judgement An Essential Tool in the Nursing
Profession. Retrieved March 12, 2017, from
http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement
An_Essential_Tool_in_the_Nursing_Profession.pdf

Ruesink, M. (2015, March 23). Rasmussen College. Retrieved March 12, 2017, from
http://www.rasmussen.edu/degrees/nursing/blog/understanding-why-nurses-need-critical-
thinking-skills/

Tanner, C. A., R.N, PH.D. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical
Judgment in Nursing. Journal of Nursing Education, 45, 6th ser., 204-211. Retrieved March 12,
2017, from http://www.mccc.edu/nursing/documents/Thinking_Like_A_Nurse_Tanner.pdf