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Nursing Judgment Capstone Paper

Sydney Schisler

Youngstown State University

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Abstract

Nursing judgment is something that is used by nurses across the country every

day. It involved the assessment and data nurses collect from their patients and how they

use this information to make decision and care for their patients. Nursing judgment

involves several different things like assessment, medication administration, and

delegation. From the first day of nursing school nursing judgment is taught to students

and is something that is used and developed throughout the rest of a nurses career.
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According to the Medical Dictionary for the Health Professions and Nursing

nursing judgment is defined as, “Cognitive or thinking process used for analyzing data,

deriving diagnoses, deciding on interventions, and evaluating care” (“Clinical Judgment,”

2012). Nursing judgment is a skill that every nurse should have, it is a skill that takes

time to develop and that will continue to develop over a lifetime. According to an article

written about nursing judgment, “As a rapidly advancing profession, nursing demands

higher cognitive skills from nurses. Critical creative thinking and clinical judgment is

viewed as essential skills for every health professional” (Graan, Williams, & Koen, 2016,

p. 281). As a career that is constantly changing and evolving nursing is a field that

requires someone who can change and evolve with it. Nursing judgment involves a wide

range of different things like assessments, medications, delegation, and experience.

Assessment is a huge part of nursing judgment because as a nurse assesses a

patient and the patient status changes the nurse must then take this information a decide

what to do with it. During an assessment nurses must take what they are seeing and

hearing and process the information to see if it is normal and if not they must interpret

what the abnormal assessment means for the patient. They then must use their nursing

judgment to decide what must be done for the patient and the order things need to be

done in.

Delegation is another important part of nursing judgments because nurses have

the power to delegate and must have the knowledge of what tasks can be delegated and

who to delegate to. Nurses have the ability to delegate tasks to certain other heath care

team members and must know the ability of who they are working with when it comes to
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delegation. Nurses must know what tasks other team members are capable of completing

so that patients are always receiving the safest and most effective care.

Medication administration is a huge part of nursing and nurses must be

knowledgeable about the medications they are giving and when it is safe and appropriate

to give them and when it is not. Nurses must know how to practice safe medication

administration and this involves several steps. First they must know what each

medication is for and that the medication is safe for each patient. Then they must make

sure they are administering the safe medication and the correct dose. Before

administering any medication the nurse must make sure each patient meets the guidelines

to be given the medication. For example if a nurse takes a blood pressure before

administering a blood pressure medication and obtains a blood pressure of 80/55 she

must determine if the blood pressure medication is going to be of any harm to the patient.

If the nurse administers the medication it could cause the blood pressure to drop even

lower and be dangerous to the patient. This is when the nurse must use nursing judgment

to decide what is the safest thing to for the patient.

When it comes to nursing judgment experience has an influence on what nursing

judgments are appropriate and helps nurses know what decisions to make when it comes

to patient care. An article from The National League for Nursing states, “It is important

to emphasize that nursing judgments are always rooted in nursing's core values and best

practices and further informed through the knowledge embedded in integrating concepts”

(Schoessler, 2012, p. 422). Nursing judgment is influenced by what each nurse believes

and the values they hold but they also can’t let these beliefs and values cloud their

judgment if it is not what is best for the patient. The knowledge each nurse has is also
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very important when it comes to nursing judgment because this helps with clinical

decision making.

Nursing judgment is important because it is the key to decision making to the

nurses who are practicing everyday. Nursing judgment is something that develops and

changes the longer a nurse is in practice but is something that is consistently used

everyday. It is how nurses make decisions and what they use to model how they think

and keep patients safe. Without nursing judgment nurses wouldn’t have the right to

choose what can and can’t be done for patients and that would greatly affect patient

safety. It is important the nurses have support when it comes to nursing judgment. It is

important to have resources and others available to them when they run into something

they may not be extremely familiar with. Nurses must be educated and have education

available to them to help them when it comes to nursing judgment and what decisions

need to be made (Thompson, Aitken, Doran, & Downing, 2013, pp. 1722-1723).

A personal experience I’ve had with nursing judgment is recently during

precepting. During a night of precepting when we had students also on the floor they

drew blood from a PICC line with their instructor and sent it to the lab. Their clinical day

had ended before the lab results returned but when they did the potassium was incredibly

high. The doctor was alerted of this result and had ordered Kayexalate for the patient.

Before administering this my nurse and I were talking about how this seemed unusual

because the potassium had been normal since the patient had been admitted and talked

about the possibility of the blood becoming hemolyzed causing the extremely high

potassium result. We called the doctor and obtained an order to redraw the blood for

another result before administering the Kayexalate and when we did the potassium came
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back within normal limits. If we had not questioned the lab result and just given the

Kayexalate this could’ve causes an electrolyte imbalance in the patient.

Nursing judgment is something we have been learning constantly through nursing

school. It is something that we will continue to use and that will continue to develop as

we become a registered nurse and gain more experience. It allows us to make decisions

during assessments, medication administration, delegation, and something that becomes

easier with experience.

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References

Clinical judgment. (2012) Medical Dictionary for the Health Professions and Nursing.

Retrieved March 10, 2018 from

https://medicaldictionary.thefreedictionary.com/clinical+judgment

Graan, A., Williams, M., & Koen, M. (2016). Professional nurses' understanding of

clinical judgment: A contextual inquiry. Health Sa Gesondheid, 21, 280-293.

Retrieved March 10, 2018, from https://ac.els-cdn.com/S1025984816300047/1-

s2.0-S1025984816300047-main.pdf?_tid=d402cb3f-fb49-4c83-8781-

08ed987ca970&acdnat=1521414992_329b00a21a629c6d62a6c5c0b84a2479.

Schoessler, M., EDD, RN, Brady, M., PHD, RN, Englemann, L., EDD, RN, CNE,

ANEF, Larson, J., MS, RN, CNE, ANEFF, Perkins, B., OP, PHD, RN, FAAN,

ANEF, & Schultz, C., PHD, RN, CNE, ANEF. (November 1, 2012). Nursing

Judgment: Educating Nurses to Make Decisions in Practice. Nursing Education

Perspectives. Retrieved March 10, 2018, from

http://eps.cc.ysu.edu:2063/ehost/pdfviewer/pdfviewer?vid=2&sid=2123a058-

af3d-4533-9ffc-037ee76f2d1c%40sessionmgr4008

Thompson, C., Aitken, L., Doran, D., & Downing, D. (2013). An agenda for clinical

decision making and judgment in nursing research and education. International

Journal of Nursing Studies, 50, 1720-1726. Retrieved March 10, 2018, from

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99_ENTITY_TYPE:757490,MAIN_FILE&cs=3DuwNA1FUdd4ti7_gKNdT3xz3

X3hl2u5iZQ9g0rV0PkxYRV4GJ9mI6XEi7UT7NV0S0Vq-

qPMrXrOYI2ePZOUDyQ.
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