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Clinical Nursing Judgment

Joel A. Hake

Youngstown State University


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Clinical Nursing Judgment

Arguably the most difficult skill to teach nurses in training is the ability to use their

clinical nursing judgment, because it is something that partially can not be taught. Students can

be lectured about a million different scenarios that require nursing judgment, but the skill can not

be mastered until it is practiced in live situations with real patients. It is a skill that takes time.

Clinical judgment is a culmination of all basic nursing skills, including assessment, analyzing

data, and evaluation, combined with critical thinking and decision making to provide the safest

care for a patient.

Before diving further into the topic, it is important to define the term “clinical judgment”.

Manetti (2014) defines it simply as “cognitive or thinking process used for analyzing data,

deriving diagnoses, deciding on interventions, and evaluating care” (p. 103). Although this may

sound simple, many factors can come into play when nurses use this skill. These include past

experiences and situations, culture, the wants of the patient, what is best of the patient, and

hospital rules, to name a few. Many times, the skill of nursing judgment is implemented when a

patient takes a quick turn for the worse, and the nurse must use critical thinking skills to decide

what to do. Other times, it can be implemented for a simple decision, like deciding whether it is

appropriate to administer a certain medication or not. The moral of the story is, nurses

essentially use nursing judgment all day with every decision they make, with the goal being to to

ensure pristine quality of care, and patient safety in care (National League for Nursing, 2014, p.

1). Safety and quality of care is the reason nursing judgment is so important in patient care.

As mentioned before, nurses use clinical judgment with essentially every decision they

make when it comes to patient care. However, one of the most difficult scenarios in which a

nurse must use clinical nursing judgment that some may not realize analyzing and thinking about
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the order or decisions of a doctor, and possibly having to question their decision. When a doctor

puts in an order, nurses should always use their own judgment to determine why they are doing

this for the patient, what the patient will benefit from it, if there are any contraindications, and if

it is safe. Some may not even realize that this is actually a part of nurse’s job description and that

they are legally bound to question inappropriate orders from a doctor (Reuter & Fitzsimons,

2013, p.11). Although sometimes a doctor may make collaborative decisions with the nurse by

asking them for information and opinions on the patient, some may not. This is where the nurse’s

job gets tricky and they must act as an advocate for the patient. This can be especially tough for a

new nurse who may have fear in calling and questioning a doctor. It may be commonly assumed

that doctors are superior to nurses in knowledge, but they are human too, and make mistakes.

Not to mention, nurses often interact more closely with their patients, and are the health care

practitioner that is constantly examining a patient’s status and reactions throughout their shifts,

which definitely comes into play when making decisions on care for patients. It is key for nurses

to understand that the safety of the patient is more important than the doctor’s opinion, and that

most doctors will appreciate it if their error is caught.

I’m going to discuss two situations where I had to implement my nursing judgment

during my clinical experience as a student. I was taking care of an older patient who had a

history of drug abuse. During my shift, he had made comments about wishing he was on acid

(LSD). The patient also had spurts of incontinence during his stay at the hospital. While I was

providing care in the patient’s room, the patient randomly pulled out an orange container and

grabbed a pill out of it, with intention of taking the pill. Using my nursing judgment, I

immediately decided to confiscate the pill from the patient, considering I did not know what it

was. Although the patient did not like my action, it is against hospital policy for the patient to
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take pills not administered by the health care staff. Considering the patient’s history of drug

abuse, the pill could have been an illegal drug. The drug could also have actions that interact

with other medications the patient was taking, which could potentially be unsafe for the patient.

The pill ended up being an anti-diarrheal that the patient was taking in order to prevent him from

soiling his bed. I explained to the patient that he can not take pills from home while in the

hospital, and that we could talk to the doctor about getting an order for the drug, along with

ensuring I would make more frequent rounds in order to see if the patient needed to use the

toilet.

Another simple scenario in which I applied my nursing judgment was when I was

administering the drug metoprolol to a patient. Metoprolol is a beta-blocker, used for multiple

reasons, but has the action of decreasing blood pressure and heart rate. Therefore, the drug

should not be administered if the patient’s heart rate is less than 60 or if the blood pressure is

below 110 or 100, depending on hospital protocol. This is to ensure the patient’s cardiac output

is able to sustain oxygenation to the patient’s tissue. My patient’s heart rate was in the 50’s, so I

held the medication.

In conclusion, it is appropriate to say clinical nursing judgment is the most important skill

a nurse develops in order to provide adequate quality care to patients, while ensuring their safety.

It is something that experienced nurses are usually considerably better at than new nurses who

are just starting their journey into the profession of health care. For this reason, it is an important

part of a new nurse’s clinical judgment to question themselves and their own actions. They can’t

be afraid to ask for help from an experienced nurse when they are unsure. Experienced nurses

need to be accepting and realize it is part of their job to help develop the judgment of other

nurses, since it is such an important skill in patient care.


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References

Manetti, W. (2018). Sound Clinical Judgment in Nursing: A Concept Analysis. Wiley Nurse

Forum, 2019;54, 102-110. https://doi.org/10.1111/nuf.12303 National League for

Nursing. (2014). Practical/vocational nursing program outcome: Nursing

judgment. Retrieved from http://www.nln.org/docs/default-source/default-document-

library/nursing-judgment-final.pdf?sfvrsn=0Reuter, C, & Fitzsimons, V. (2013).

Physician orders. American Journal of Nursing, 113.

Retrieved from

https://journals.lww.com/ajnonline/Fulltext/2013/08000/Physician_Orders.2.aspx