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Analysis of Clinical Nursing Judgment

Josh Lyder

Senior Capstone Class


The clinical judgment of a nurse is an essential tool that is required of all registered

nurses in the field of medicine. It is what sets the position of RN apart from the technical side of

medicine. Nurses are given more in depth training so they can not only do what they need to do,

but also think as an independent medical caregiver. This puts a nurse in a very specific brand of

care that no other practitioner has. The nurse is involved with the hands on, personal care of the

patient, but is still responsible for the assessing, critical thinking, and clinical judgment of those

same patients.

It is inarguable that critical reasoning within the daily practice of nursing very much

improves patient outcomes. Without these critical reasoning skills not only is the best care not

being provided, but there is also a higher risk for mistakes and malpractice. The foundation of

ones ability to use critical reasoning in nursing judgment is active engagement (Levett-Jones,

Sundin, Bagnall, Hague, Schumann, Taylor, & Wink, 2013). Not only does actively engaging in

the nursing process promote learning, but it also increases the nurses observance of what is going

on around him/her. These factors both very much play a role in the nurses ability to make a

clinical judgment in any given situation. A nurse who is less actively involved with their patients

is less likely to use effective clinical reasoning for 3 reasons. Firstly, without regular interactions

with a patient it is hard for a nurse to have a completely up to date picture of what is currently

wrong, therefore any clinical judgments made could be inaccurate (Levett-Jones, et al, 2013).

Secondly, without any real empathetic relationship with a patient the nurse is much less likely to

take the time to think through and use clinical reasoning. Lastly, not engaging enough with a

patient leads to a lack of communication and a lack of trust from the patient, therefore hindering

the nurses ability to critically reason.


One of the major reasons for decreased clinical judgment use among nursing staff

is the mass integration of technology into the daily nursing setting (Graan, Williams, & Koen,

2016). With the power of technology nurses are able to attain much more information on their

patients with much less effort. They are also able to quickly run through assessment and other

documentation requiring far less thought and attention to detail. Computerized medicine has

offered immense help to medical field in both reliability and in efficiency. However, it creates the

opportunity for nurses to do the extent of their obligation without the full interaction and

attention to detail Nurses must prioritize seeing patients and engaging in the care for these

patients in order to be fully suited to conduct clinical judgment concisely and accurately.

Another issue that can hinder clinical judgment is poor teaching or environment

(Cappelletti, Engel, & Prentice, 2014). This can refer to instructors in nursing school, nurses

interacted with in school, orienting nurses, or experienced co-workers. Many experienced nurses

have developed their own ways of doing their jobs on a daily basis. Some of these are good

practices that give adequate patient care while being efficient. However, many of these practices

by certain nurses can be ineffective, irresponsible, and at times even dangerous. If a student or

new nurse is exposed to an environment like this they will have a tendency to adapt to their

environment (Cappelletti, Engel, & Prentice, 2014). This can be detrimental to the nurses

clinical judgment to take on these poor practices that tend to be based in short-cuts and lazy

practices. Judgment is something that must be trained and adopted by every new generation of

nurses and it must be done properly. A nurse can very easily believe that she is using good

clinical judgment, however if it is not based on safe, effective nursing practices it could do more

harm than good.


The benefits, however, to properly developed and carried out clinical judgment

are immense. When a nurse is properly trained and has developed an effective ability to

analyze a situation and make the best, safest, and most efficient nursing decision. These

attributes lead to better patient outcomes, more efficient work, better atmosphere, and

higher patient satisfaction (Graan, Williams, & Koen, 2016). In many medical situations,

advanced practice providers are not always immediately available and at times cannot

even be contacted immediately, in this common situation the nurse must rely on their

foundation of knowledge and judgment based upon that knowledge. This can be as

simple as providing comfort measures to patients with physical pain or discomfort. It

could also be as complex as picking up on the initial signs of internal bleeding and

implementing the first steps of damage minimalization.

To conclude, the impact of clinical judgment on the care of patients in any setting

is inarguably beneficial when it is taught and implemented correctly. It is critical for

young nurses to be alert and intuitive about their nursing responsibilities and use critical

thinking at all times. It is also important for experienced nurses to talk to the younger

ones to share insight and help to facilitate proper judgment that will have a benefit on the

nursing process and improve patient outcomes. With properly implemented clinical

judgment; patients are safer, patients are happier, staff works better together, and a

medical facility runs more efficiently. Therefore, developing proper nursing clinical

judgment should be a priority for all nursing personnel whether they are a new nurse

finding their footing or an experienced nurse helping usher in the new generation.


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.


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

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293.


Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C., & Wink, J.

(2013). Learning to Think Like a Nurse. HNE Handover: For Nurses and Midwives, 3(1).

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