Running Head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Madison Aranda

Youngstown State University

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Clinical nursing judgment is something that nurses use everyday in all of their

assessments, evaluations of orders, and before providing care. Wendy Manetti, author of Sound

clinical judgment in nursing: A concept analysis, revealed a few different definitions she found

on clinical judgment. The one I found most appealing in her journal was from Tanner stating that

clinical judgment is “an interpretation or conclusion about a patient’s needs, concerns or health

problems and/or the decision to take action (or not), use or modify standard approaches, or

improvise new ones as deemed appropriate by the patient’s response” (2019). This one appealed

to me the most because it recognized the decision to take action or not because not taking action

when one needs to be taken, is a conscious choice, therefore it is an action.

Clinical judgment is an important skill for all health care providers to have, whether it is

a technician, nurse, or physician. On every floor or facility, there is a set of rules and procedures

set in place for safe and effective care. However, sometimes there are reasons with the patient’s

safety in mind to bypass or change a plan of care set in place for the patient. Examples of this

that I have seen are withholding a medication. Some of these include, not giving a beta blocker if

a patient’s blood pressure is too low, or not giving a long acting insulin due to blood sugar being

in the 40’s. These are examples of good clinical nursing judgment. Having good judgment

comes with experience overtime and continued patient care.

Clinical judgment will come to nurses over the course of their career as they get more

experience but must also start to be taught in nursing school, so the students have a sense of what

using appropriate clinical judgment means and the importance of this for the outcome of their

patients. An article by Michelle Bussard stated that “A clinical judgment model was developed

by Tanner and includes 4 phases: noticing, interpreting, responding and reflecting” (2018). Then
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she goes on to state that “Developing clinical judgment skills will afford nurses the ability to

provide safe, quality care to all patients across the health care spectrum. Therefore, using the

clinical judgment model provides faculty a means of focusing end-of-program and end-of-course

outcomes on this essential skill”. She expresses a great deal that clinical nursing judgement must

start in school during clinical practice. This is the foundation of the students nursing career.

Noticing is the first step which I believe is the most basic.

While in nursing school I have seen nurses that I have been paired with notice and

interpret, without responding. Learning from other nurses can be a good way to understand

clinical judgment because everyone’s skills and intentions differ. Some nurses come to work for

the pay check and some nurses come to work to give patients the best quality of care possible,

and I’ve seen both. It’s good for nursing students to see other nurses on their clinical floor

perform good clinical judgment and recognize that not all nurses are good at this skill and it can

negatively affect their patients. I have realized what type of nurse I want to be by observing other

nurses’ clinical judgment in nursing school.

Nurses knowledge of the patient and their baseline from the beginning of the shift is just

as important as knowledge of a patient in their current situation. Knowing a patient’s baseline is

important for acknowledging a change and need for intervention using clinical judgment. A

study of clinical judgment and reasoning determined that “Sound clinical judgment rests to some

degree on knowing the patient and his or her typical pattern of responses, as well as engagement

with the patient and his or her concerns” (Cappelletti, 2014). In order to make sound clinical

judgment, the nurse must know the patient inside and out. The nurse must grab from all aspects
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of knowledge in assessment, evaluation, and putting it all together to come up with a solution.

During my time on clinical rotations I have seen many nurses use their clinical judgment.

I have especially found this to be true during my night shift preceptor rotation. Many times, it is

harder to get in contact with the health care provider on night shift. This causes many nurses to

make clinical judgments for their patient’s health and safety before informing a health care

provider and sometimes the health care providers don’t even get the message for hours. A few

weeks ago, I had to tell my nurse that I thought my patient had a fast decrease in level of

consciousness that didn’t seem right. Earlier in the night when we passed medications, she was

able to tell us her name and date of birth. This time when I checked on her, I was not able to

make out any clear speech and she didn’t open her eyes when I was talking to her. My nurse

wasn’t very concerned but something in my gut was telling me it just didn’t seem normal. It was

about 3 a.m. and my nurse told me that it was just because she was tired and didn’t want to be

woken up. I knew that she was a diabetic and her blood sugar wasn’t due to be checked until 6

a.m. but I asked her if I could check it now. When I checked her blood sugar it was 48. I was so

relieved that I went with my gut and didn’t wait until 6 a.m. to check it. My nurse told me that I

used good clinical judgment when I just couldn’t agree with her and took it upon myself to check

her blood sugar.

I know that using clinical judgment in my nursing career is one of the most important

skills I can have. As I get more experience, I hope to be able to develop my judgment more and

more. I tend to see that the nurses that are the most invested in their patient’s wellbeing are the

ones that are able to catch swift declines and changes in their patient’s statuses that other nurses
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don’t. Having good clinical nursing judgment is a skill that I believe separates good nurses from

the best ones. I hope one day to be a great nurse that comes into work everyday to provide the

best quality of care to every patient I care for.

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References

Bussard, M. E. (2018). Evaluation of Clinical Judgment in Prelicensure Nursing Students. Nurse

Educator, 43(2), 106–108. doi: 10.1097/NNE.0000000000000432.

Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and

reasoning in nursing. Journal of Nursing Education, 53(8), 453-458.

doi:http://dx.doi.org/10.3928/01484834-20140724-01

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing

Forum, 54(1), 102–110. https://doi.org/10.1111/nuf.12303