Clinical Nursing Judgment

Senior Capstone Paper:

Clinical Nursing Judgment

Clinical nursing judgment is one of the skills a Registered Nurse is required to possess to

safely practice nursing. Society depends on and trusts nurses to make the correct decisions

regarding their care, administer the correct medications, and having a wealth of medical

knowledge to educate others. It is one of the skills of a nurse that earns the well-deserved respect

of the community. The ability to “think like a nurse”. But what is clinical nursing judgement?

How is it acquired? Is it a learned behavior, or is it taught in a class room? I will discuss the

concept of clinical nursing judgment, how it is acquired and provide a personal example in this

paper.

Let’s first start with the widely accepted Tanner’s Clinical Judgment Model (2006) to

define the concept of clinical judgment. “The processes of clinical judgment include noticing,

interpreting, responding, and reflecting” (Modic 2013). Noticing requires the nurse to be

observant and determine normal from abnormal findings. This requires the nurse to have a strong

background in identifying abnormal objective and subjective data and sometimes rely intuition..

Recognizing when something is abnormal or what is importance is knowledge based. Through

the nurses education, she is taught the that normal assessment finding of an abdomen should be

soft and non-tender. If the nurse discovers a tender and board like abdomen, that should be a red

flag there is an issue that needs addressed. After recognizing abnormal findings, the nurse then

interprets them and decides on a course of action. Interpreting depends on utilizing critical

thinking and reasoning skills to come to a response or intervention. The next step is responding,
Clinical Nursing Judgment

or intervening to protect the patients safety. Nurses must also keep in mind that taking no action

is taking action. The last step in clinical judgment is reflection, which is where learning takes

place. The nurse should reflect upon the situation and determine if the actions taken, or the

interventions resulted in a desirable result. Clinical judgment is part application of knowledge

and the other critical thinking and reasoning. Why is it important to develop clinical nursing

judgment as a practicing RN?

“Estimates vary but nurses make a lot of decisions: acute care nurses facing a decision or

judgment “task” every 10 min, critical care nurses every 30 s and family or public health nurses

making up to 10 judgements for each contact they have with new mothers.” (Thompson, 2013)

There is immense responsibility with being a registered nurse. Countless decisions are made by

nurses daily, this leaves a lot of room for error or poor decision making. According to a recent

study conducted by John Hopkins University, medical errors should be the number 3 leading

cause of death in the United States. That is more than 250,000 deaths per year, which surpasses

respiratory disease, currently the 3rd cause of death according to the CDC. There is not room for

error in healthcare. If a server at a restaurant brings the wrong entrée to a customer, the meal is

simply taken back and corrected. If a nurse administers Dixogen to a patient with a heart rate of

55 bmp, it could have disastrous effects. This risk and responsibility is what makes nursing the

respectable field that it is today. This is why nurses need to always be diligent and observant

when providing patient care. Poor clinical judgment costs people their lives.

Nursing simply isn’t about administering medications