Running Head: NURSING CLINICAL JUDGMENT 1

Michael Guterwill

Nursing Clinical Judgement

Youngstown State University

February 19, 2019

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Abstract

Clinical nursing judgment is used every single day by nurses. Whether they are working in home

health, ICU, ED, or medical surgical, they will use clinical nursing judgment during their work.

Nursing clinical judgment is something a nurse gains through their knowledge and expertise

about their profession. It comes with time and experience. It helps define the nurse and allows us

to stand out as advocates for our patients. In this paper I will discuss my definition of the term

"clinical nursing judgment" and talk about why I believe it is so important. In addition, I will

also give an example where I have experienced a moment where I used my clinical judgment to

be advocate for one of my patients.

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The term clinical nursing judgment could be defined in many different ways. To me this

term has many meanings. Clinical nursing judgment is when the nurse assesses the patient, looks

at their laboratory work, their baselines and as a nurse they use their knowledge and experience

to take care of this patient to the best of their abilities within their scope of practice. It also means

looking out for your patients best interests. One way this is seen is when there is an order from a

doctor for their patient and the nurse uses their judgment to decide it may not be safe for the

patient and they will go ahead and contact the doctor with their concern. This term is very

important and I feel that this is a big reason why we do simulations towards the end over every

semester. An interesting article called "The Impact of Critical Thinking on Clinical Judgment

During Simulation with Senior Nursing Students" states "When nurse educators teach or

encourage deductive skills, critical thinking and clinical judgment may be improved, enhanced,

or developed. Simulation may be a strategy to facilitate deductive skills" (Cazzell, Anderson,

2016, pg. 89). I agree with the information founded in this article and it helps make sense why

we do all of these simulations as nursing students. It has helped me realize why clinical nursing

judgment is so important.

Over the semesters at Youngstown State University, I have really begun to grasp the

importance of understanding clinical nursing judgment. It helps define us as nurses. I feel that it

helps differentiate a good nurse between a great one. As graduation approaches I realize why we

were always taught why critical thinking is such a huge part of nursing. Nurses throughout their

careers are constantly using critical thinking and clinical judgment. An article I found called

"Factors Influencing Nursing Students’ Clinical Judgment: A Qualitative Directed Content

Analysis in an Iranian Context" supports this by stating "Clinical judgment is essential for

decision making and is considered an inseparable part of high quality nursing care. Therefore,
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nursing students are expected to have clinical judgment capability at the time of graduation"

(Pouralizadeh, 2017, pg. 1). In summary this article agrees with the fact that senior nursing

students should have a good concept of clinical nursing judgment. It mentions that clinical

nursing judgment is essential for decision making and I couldn't agree more. There are many

decisions nurses must make throughout their careers. Whether it's hold a blood pressure

medication because their patient's blood pressure is too low. Or maybe the patient has family

there with them and it is doing more harm than good. The nurse would then use their clinical

nursing judgment to be an advocate for the patient and do what is right. The nurse is there to

advocate for their patient and help promote healing for them. This is extremely important

because the patient is there putting his or hers trust within the treatment team. The patient may be

unfamiliar with their new diagnosis, or their new medications, or how their test is going to go

tomorrow. We need to remember that just because we are familiar with these processes and that

we understand everything that is going on with their care does not mean that the patient does.

The term clinical nursing judgment is so important as a nurse because if we understand that then

we would be able to use our "clinical nursing judgment" to realize that it is important for the

patient to also understand these things. With that said we can sit down with the patient as their

advocates and go through their new medications, or their new diagnosis, or why they are going

for a stress test tomorrow. We are there to teach. If the patient does not understand something

then we need to change that. Patient understanding is necessary for patient healing. It is

important for them to understand and take part in their health care decisions. Another interesting

article I found is called "Sound Clinical Judgment in Nursing: A Concept Analysis" and she

starts her article out by saying "Sound clinical judgment is the foundation of quality nursing

care" (Manetti, 2018, pg. 102). I just thought this beginning statement really supports what I
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have been saying about why clinical nursing judgment is so important. I read over this article and

I loved how she mentioned that nurses who had clinical judgment will also have evidence based

knowledge. That nurses who have clinical nursing judgment are basically able to think quickly

on their feet and provide exceptional nursing care while looking out for their patients best

interests. After talking about this topic so much and mentioning why I think it is extremely

important I will now talk about a time where I had to use my clinical nursing judgment that I

have acquired over the years.

Now this particular event happened during my preceptorship at the PCCU in

Youngstown. I am also very proud of myself for what I ended up doing. One of the patients my

preceptor and I received report on was a new admit that came in overnight. He had a diagnosis of

atrial fibrillation with rapid ventricular rate. Patients with atrial fibrillation are on anti-

coagulants. This patient was on Eliquis which is normal. When I was writing down his

medications I noticed one that I was unaware of which was a medication called Brilinta. After I

looked this medication up I discovered that it was also an anti-coagulant. I am still very new to

the floor, but I found this extremely bizarre that he would be on two anti-coagulants. I mentioned

this to my preceptor and she also did not understand why. We talked to the patient about this and

he said it was for a procedure he had, but did not think he was still supposed to be taking it. She

told me I was going to talk to the doctor about this when he made his rounds. Prior to this we

went to give the patient his medications and just held the Brilinta until we spoke to the doctor.

With that said the cardiologist arrived and I brought my concern for this medication order to his

attention. He was also surprised and originally said he was going to discontinue the medication.

However, with further discussion between the cardiologist, the nurse practitioner, and the patient,

it was decided that he was actually supposed to be on this medication due to his recent surgery
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during the summer. With that said, I was still very proud of myself for using my clinical nursing

judgment and brought this to the attention of the cardiologist. Even though the patient was

supposed to be on both of those medications, I was still there advocating for my patient and

looking out for their safety. I didn't want to just blindly administer this medication because it was

ordered, I decided that it did not seem right and I made sure with the cardiologist before

administering.
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References

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,54(1),

102-110. doi:10.1111/nuf.12303

Pouralizadeh, M. (2017). Factors Influencing Nursing Students’ Clinical Judgment: A Qualitative

Directed Content Analysis in an Iranian Context. Journal Of Clinical And Diagnostic Research.

doi:10.7860/jcdr/2017/25753.9822

Weatherspoon, D. L., Phillips, K., & Wyatt, T. H. (2015). Effect of Electronic Interactive

Simulation on Senior Bachelor of Science in Nursing Students Critical Thinking and Clinical

Judgment Skills. Clinical Simulation in Nursing,11(2), 126-133. doi:10.1016/j.ecns.2014.11.006