Running head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment

Alex Mickler
Youngstown State University
March 1st, 2016

CLINICAL NURSING JUDGMENT

Countless hours of research have gone in to finding what makes

a great nurse. Intelligence, charisma, leadership, and dexterity are all
important aspects of nursing, but what makes a good nurse a great
nurse is a learned ability known to most as clinical judgment (also
referred to as clinical reasoning, or critical thinking). This ability is
learned through active engagement in practice and reflection (LevettJones, Sundin, Bagnall, Hague, Schumann, Taylor, & Wink, 2013).
Clinical judgment is what allows an experienced nurse to immediately
draw pertinent information from a patients situation and begin
appropriate therapeutic intervention. This separates the experienced
nurse from the novice.
My experience with nursing judgment is an interesting one. As a
student nurse trying to develop critical thinking skills, I am constantly
trying to pick up on other nurses ability to use reasoning. For example
as I pick up hours in my class where I work alongside a nurse we had a
patient who was admitted for acute kidney injury. Throughout the shift
the patient was experiencing some diarrhea, the nurse and I would
clean her up several times throughout the night, during the third time
cleaning her up the nurse looks at me and asks; What should we do?
As a novice nurse I began assessing my patient. I ask myself is she
breathing okay? Yes shes breathing fine. Is she in any immediate
danger? No shes not bleeding profusely, or dropping oxygen
saturation, and her skin is warm and pulses present. The nurse I am

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with watches me struggle to identify the problem shes noticed. Finally

she throws me a hint to lead me in the right direction. She says; What
have we had to do several times tonight? I instantly begin thinking of
stool, and assessing the color, texture, and scent. And with a few more
inner contemplations I enthusiastically announce, Hem occult. The
patients stool was darker than average and smelled a lot like iron, but
the patient wasnt on an iron pill, of course the texture was loose and
watery because she was experiencing diarrhea. This story is a great
example of the difference between a skilled, experienced nurse and a
novice nurse. As a student I immediately jumped to assess if my
patient was safe, which is a correct practice but the more experienced
nurse had already done that, and began assessing further. She was
also able to put into place a plan and actuate that plan all the time
while I was still assessing. The experienced nurses ability to
immediately note pertinent information allowed her to act in a much
more efficient manner saving time, and ultimately leading to more
comfortable and more safe patients.
As much as Id like to take credit for the discovery of this learned
skill, there are many others before me that have noted this need for
clinical judgment. In fact nursing schools around the world are held
responsible for measuring the critical thinking of their students. In fact,
without a measurement of critical thinking, schools are unable to file
for accreditation (Roberts, & Petersen). Further, The National League of

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Nursing (NLN) expects nursing graduates to demonstrate clinical

judgment.
To further stress the importance of nursing clinical judgment Ill
refer to a qualitative study performed by the nursing department of
Tarblat Modares University in Iran. In this study Seidi, Alhani, and
Salsali followed 24 nurses with greater than three years experience, all
in differing levels of education ranging from fourth year students to
PhD professionals. Their purpose in this study was to explore the
process of the development of critical judgment. One method of
developing critical judgment identified in the study was termed
Striving for Integrating Clinical judgment Skills. In this method
participating nurses strived to use different clinical judgment skills
based on patients condition and the immediate situation. The example
provided in the study of this method depicts a practicing nurse in an
emergency situation; after delivering a baby the patient develops a
pulmonary emboli, the nurse states We had foreseen this problem
based on our previous experiences. This allowed the nurse to begin
cardiopulmonary resuscitation and lead to a positive patient outcome.
Conversely, in an emergency situation and inexperienced nurse had no
option but to rely on physicians knowledge and experience to utilize
clinical judgment. This accurately portrays the need for clinical
judgment, in the event of an emergency situation time is of the

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essence and any small time saving intervention employed can greatly
affect the patients outcome.
In conclusion, Clinical judgment comes with experience. This
experience should be fostered throughout the education of a nurse
through methods of concept mapping and clinical simulation. We can
see in the example provided above that as a nursing student my
clinical judgment to assess the safety of the patient is the budding
beginning of clinical judgment and is common for nursing students to
develop, but further development of clinical judgment shall come with
experience of active reflection on clinical decisions and outcomes.

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References
Edwards, S. (2003). Critical thinking at the bedside: A practical
perspective. British Journal of Nursing Br J Nursing, 12(19), 11421149.
LEVETT-JONES, Tracy et al. Learning to Think Like a Nurse. HNE
Handover: For Nurses and Midwives, [S.l.], v. 3, n. 1, May.
2013. ISSN 2201-179X. Available at:
<http://journals.sfu.ca/hneh/index.php/hneh/article/view/65>.
Date accessed: 05 Mar. 2016.
Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses Clinical Judgment
Development: A Qualitative Research in Iran. Iranian Red
Crescent Medical Journal Iran Red Crescent Med J, 17(9)