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Clinical Nursing Judgment

Jayme Ritchie

Youngstown State University

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Abstract

Clinical nursing judgment is a key component to being a successful nurse.

Nurses are required to make decisions based on information given and by using

their knowledge to help their patient’s well being. The three nursing articles I found,

describe what clinical nursing judgment is and the importance of it.

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Nurses need to have observational and reasoning skills in order to make

sound, reliable clinical judgments. This concept is critical to the nursing profession

as a result of its outcomes. Overtime as you become a professional nurse, your

clinical judgment progresses because of the experience you gain. The concept of

clinical judgment can often be confused with critical thinking. In an article written

by Mindi Anderson and Mary Cazzell, both terms are defined. Clinical nursing

judgment is defined as a deep understanding of knowledge, allowing for certain

responses to problems. Where as, critical thinking is “logical reasoning” and

“making decisions based on reflection (Cazzell, 2016). Although both terms are

different, they both are very crucial in the medical field, especially as a nurse.

Clinical nursing judgment is further described through four steps (Cazzell, 2016).

First, noticing or understanding the situation at hand, then interpreting or reasoning

what possible actions to take. Then responding or deciding on the course of action,

and lastly reflecting which includes looking back on decisions and interventions

performed. In a different nursing article, they describe nursing as “the use of clinical

judgment.” Nursing truly is all about making decisions that will best benefit your

patient. “In addition to knowing why an intervention is needed and how to perform

it completely, nurses have a professional responsibility to ‘justify, explain, and

defend judgments and decisions’” (Standing, 2013).

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A nurse is expected to quickly react to certain situations while providing care

and interventions in a safe/timely manor. The interventions are decided and applied

based on the clinical judgment of the nurse whom is providing care for their patient.

Thus, nurses must demonstrate clinical judgment in each and every decision they

make. “Acute care nurses facing a decision or judgment “task” every ten minutes,

critical care nurses every thirty minutes, and family or public health nurses making

up to ten judgments for each contact they have with new mothers” (Thompson,

2013). By using clinical judgment it provides safe care for patients and reduces

harm, while the patient is in the healthcare system. “6% of harm is said to result in

permanent injury and 8% leads to patient fatality” (Thompson, 2013). Research

shows “850,000 injuries occur and half of these healthcare associated injuries, as

well as reported $1.5 billion in expenses, can be avoided through the clinical

judgment and decision-making skills by all healthcare professionals, including

nurses” (Thompson, 2013). In addition to promoting health and providing safe care

to patients, “Nurse’s judgments and decisions have the potential to help healthcare

systems allocate resources efficiently, promote health gain and patient benefit, and

prevent harm” (Thompson, 2013). Therefore, clinical judgment is very key for most

importantly the safety of the patient, but as well as being cost effective for the care

being provided.

Over the past three years, I have learned so many different skills and

knowledge while becoming a nurse. I am lucky enough to say I have provided care to
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a vast and diverse population over the years. These experiences have provided me

with the techniques and proficiency needed to become an efficient nurse. Through

the countless hours of clinicals and precepting, I have watched myself grow into a

more confident nurse. I have learned to apply my clinical nursing judgment in

different situations more efficiently as my knowledge has expanded over the past

few years. I just recently finished up my preceptorship on a medical surgical floor at

St. Elizabeth’s Boardman, where I had to use my clinical nursing judgment to decide

the best thing to do for my patient. My patient was post op day two for a kidney

stone. I helped admit him from surgery two days prior. Both days I had the

opportunity to provide care for him. First day post op, he was in a lot of pain, but his

vitals were all within normal range. We gave him two mg of morphine, IV push,

every four hours as needed. The second day, I assessed him and did the normal

morning routine, documented his assessment and provided care like I would any

other patient. However, as the day had gone by, he was becoming very agitated and

didn’t have much of an appetite and was continuously complaining of pain, even

after we gave him the morphine. I checked his vitals routinely, every twelve hours,

like we normally do on that floor and documented it. He didn’t have a fever, and his

vitals once again were all within normal. My last day precepting, his third day post

op, I went in to get his vitals, did an assessment, and he was fine. He was still in pain

but felt relieved after we medicated him with the morphine. Around lunchtime, he

wasn’t eating for us and was very lethargic. As I reassessed him, he felt very warm

and was sweating. I told my preceptor, I think I should take his vitals again, because

he seems to be running a temperate and seems a little out of it. After getting another
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set of vitals, his BP was really low, 98/52, his pulse was 148, respiratory rate 18, and

his temperature was 101 degrees Fahrenheit, and his SpO2 was 98% room air. I

immediately reported them to my nurse after documenting them, and knowing that

he just had surgery he could be at risk for becoming septic. My preceptor told the

charge nurse who contacted the doctor immediately, and based off his vitals, he had

a MEW’s score of five, which isn’t stable for him to be on that floor. The doctor

ordered for him to be transferred down to the ICU on the second floor so they could

monitor his heart, and run other tests to see if they could figure out what was going

on with him.

At the time, I could tell something was off with my patient because I assessed

him the past two days, and then on that day of care I knew something was wrong. I

instantly used my clinical nursing judgment to check his vital signs, and I was so

relieved I did. If I didn’t get his vitals, he may have easily been lying there until the

next set of vitals were due, and it may have been too late. After looking back, I

realized how much I have grown as a student nurse, and how much I still have to

learn. As nurses we are constantly making clinical judgments. Even the simplest

decision can make the biggest difference in a patient’s life.

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References

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.
doi:10.5480/15-1553

Standing, M. (2013). Clinical judgment and decision-making in nursing – nine modes

of practice in a revised cognitive continuum. Journal Of Advanced Nursing,
62(1), 124-134. doi:10.1111/j.1365-2648.2007.04583.x

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical
decision-making and judgment in nursing research and education.
International Journal Of Nursing Studies, 50(12), 1720-1726.
doi:10.1016/j.ijnurstu.2013.05.003