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Mary Jo Wardle

Capstone Scholarly Paper

Ballone and Thomas

March 19th, 2018

Clinical Nursing Judgement

Every nurses goal should be to provide safe and compassionate care for their patients.

Therefore, there are parameters and best practice guidelines developed to help ensure that the

patient is safe while in your care. However, a guideline, parameters, or algorithm is not the only

thing that will help ensure the patients safety and this is where clinical judgement comes in. This

clinical judgement is not just bestowed upon the nurse once they graduate with their bachelor’s

degree, it is developed through years of practice, mistakes, furthering education, and good

mentors on the floor. “A nurse who is prepared and trained through national certification

preparation will have clinical judgement that is highly valued and can recognize safety and quality

issues early” (Cherri, 2017).

Clinical nursing judgement is developed through new nurses making mistakes, “between

49% and 53% of novice nurses are involved in errors of nursing care” (Saintsing, 2011). Without

making a few mistakes it would be hard to develop a foundation for clinical nursing judgement.

The mistake does not have to be a serious error, but any error that helps the new nurse to better

understand their role and responsibilities. In school they will tell the students a STAT medication

is more important than a medication that is regularly due at the same time and that you need to
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learn how to prioritize care, but the students are often only taking care of more than one patient

in the last part of their senior year. This is probably why most of the mistakes are made. Not

many people can prioritize the care of four or more patients who are putting their entire trust in

to help make them better. Knowing which medication should be given first is not the only thing

that clinical nursing judgement is used for, it is also needed to help understand when you need

to call doctors, hold medications, and be a patient advocate.

Although my clinical rotations have enabled me to grow my clinical nursing judgement I

do not think I exercised it until I began my preceptorship rotation since it is easy to rely on your

cover nurse. My preceptor however has really encouraged me to take control which has allowed

me to practice not only my skills but advocating for my patients and using my clinical judgement.

For example, I had a patient that was having severe abdominal pain and therefore had multiple

different pain medications ordered. The patient received her scheduled dose of morphine but

was having breakthrough pain in the hour before her next dose, so I talked to the doctor and got

a one-time order for additional morphine and an order for Toradol as well. When the doctor put

the orders in the one-time order for morphine would be for twenty minutes before her scheduled

dose of morphine and then the Toradol would be due at that time as well. Since the order for

Toradol was for breakthrough pain when the morphine was wearing off I rescheduled the dose

to try to better cover her pain and prevent giving her all the patients pain medications at once

possibly causing respiratory depression. Clinical judgement is about being able to pull the

knowledge from school together with the skills and decide what best benefits your patient.

Nurses’ ability to use knowledge, experience and evidence, as well as their critical thinking

skills in daily practice reflects their skillfulness in clinical judgment (Seidi, Alhani, & Salsali, 2015).
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Although I know my clinical nursing judgement is not completely developed I do feel that my

experiences at school has really helped to develop it. I feel that throughout the years, having

simulations with debriefing afterwards has been an important part. The simulations give you a

chance to make those mistakes that are essential for clinical nursing judgment, but there is no

risk to a patient. I think another great part of nursing school for developing clinical nursing

judgement has been having a specific clinical nursing instructor. Having someone there who is

available for questions and to watch over what you are doing so you can have some freedom to

go through the day of care, but you are not totally alone in case you do have questions or run

into a situation that you have never experienced before which really helps develop your

confidence in your clinical nursing judgement.

I also believe that the two trips I have taken with the nursing program have helped me

develop my clinical nursing judgement. Going to a different country and learning about the

differences between cultures and ways that nurses do things has helped me gain a better

perspective of what nurses need to do. When you are in a different country doing charitable

work, you are learning to handle things that you might not have seen in your clinical rotations or

even in your entire nursing career. It forces you into a situation where you are not comfortable

or really have a safety blanket, so you are forced to use your clinical nursing judgement.

In my opinion though, clinical nursing judgement will only develop if a student or nurse

wants it to develop. Although you hope that everyone in nursing is there because they have a

passion for it, it is not always the case. A nurse could get by without a strong passion and just

basic nursing skills, but nurses that will make differences in patients’ lives, help prevent

complications, and catch critical changes in patient’s conditions quickly are nurses that are
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passionate about their job and actively try to develop and improve their clinical nursing

judgement.

Although clinical nursing judgement is not a skill that every nurse has it is a skill that every

nurse should have. It is not something that anyone can force someone to develop and although

there are some tests that evaluate a student’s clinical nursing judgement, it is ultimately up to

the nurse to trust their judgement and never stop refining and expanding their clinical nursing

judgement to ensure they are the best nurse they can be for their patients.
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Bibliography

Ashley, J., & Stamp, K. (2014). Learning to Think Like a Nurse: The Development of Clinical

Judgement in Nursing Students. Journal of Nursing Education, 519-525.

Cherri, P. (2017, July). Risk Tools vs. Nurse Perception. Letters to the editor, 13. American

Journal of Nursing.

Huoston, F. K. (2014, February). Letters to the Editor. American Journal of Nursing .

Lasater, K. (2011). Clincal Judgement: The Last Frontier for Evaluation. Nurse Education in

Practive, 86-92.

Saintsing, D. (2011). The Novice Nurse and Clinical Decision-Making: How to Avoid Errors.

Journal of Nursing Management, 354-359.

Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses' Clinical Judgement Development: A Qualitative

Research in Iran. Iran Red Crescent Med Journal.

Tanner, C. (2006). Thinking Like a Nurse: A Research-Based Model of Clincal Judgement in

Nursing. Journal of Nursing Education, 204-209.