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Polixeni Chirgott
Nurses. What do they do? Today, there is a large misconception and underappreciation
for everything that is required by individuals who decide to enter this field. Not many people
fully understand what it truly takes to commit one’s life to saving others. It is much more than
physicians. Perhaps the most important aspect of this job is clinical nursing judgement.
Clinical nursing judgement is defined as, “the way nurses come to understand the
in concerned and involved ways,” (Benner, 2010). This requires extensive knowledge and
comprehension of numerous health issues and disease processes along with the accurate
treatments, thorough observations and assessments, critical thinking, and problem-solving skills
to name a few. A combination of all of these different skills is used in order to determine the
best possible course of action that will be of greatest benefit to the patient while also reducing
This is an extremely important and necessary part of nursing for a number of reasons. On
a day to day basis, it is rare that everything goes absolutely perfect and as planned with patients.
Instead, the harsh reality of the matter is that things never run that smoothly. More often than
not, there are many unexpected occurrences and turn of events that require the nurses caring for
these clients to think fast and appropriately in order to rectify the situations that challenge them.
acute care nurse is faced with a decision to make, while a critical care nurse will need to do this
every thirty seconds. The decisions that these nurses make based on the information that they
gather will directly impact their patient outcomes, and inevitably the family members of the
clients receiving care. This may be the difference between a full recovery and permanent injury,
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or even the deciding factor that results in life or death (Thompson, 2013). Physicians and
residents are not always readily available on the units to consult when things do not go as
expected. In certain situations, problems require immediate attention and interventions in order
to protect the patients and provide them with the best possible outcomes. When these problems
arise, it is the nurses who need to be competent and confident enough to step up and come to a
decision, especially because not every situation will follow the textbook when it comes to
problem-solving. But clinical nursing judgement goes far beyond the ability to come to a
decision. It requires the ability to determine how these decisions will affect the patients once
these interventions are put into place (Lockwood, 2011). It is extremely vital that nurses are able
to think critically and appropriately under pressure, and that they be aware of the consequences
Clinical nursing judgement is something that every nurse will utilize during their
practice, and I have already had my own experiences even as a student preparing for graduation
and the start of my nursing career. One of the most memorable personal experiences that I have
had that required me to use clinical nursing judgement occurred this semester while in the
Coronary Medical Intensive Care Unit. For my Transitions course, I am lucky enough to be able
to precept in the CMICU at St. Elizabeth Hospital in Youngstown, Ohio. I have completed well
over one-hundred hours on the floor, and with that has come many different experiences. During
one of my twelve-hour shifts, I was caring for a patient diagnosed with ARDS. In the CMICU,
we utilize Rotoprone beds as a treatment option for patients with this diagnosis. This type of bed
straps the patients in and rotates, allowing the patient to essentially remain suspended in the
prone position which tremendously improves their respiratory status. While patients are in this
bed, it is required that they be both sedated and paralyzed using a neuromuscular blocking agent.
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In order to ensure that the patient is properly paralyzed, a nurse will test the client using train of
four. This is a peripheral nerve stimulator that involves the use electrical stimulation and the
recording of the following muscle responses. A result of two to four twitches is indicative of
effective dosage of the neuromuscular blocking agent, while less than two twitches may indicate
that the patient is over paralyzed, and that the dosage of medication may need to be lowered. On
the other hand, four or more twitches may be indicative of a patient not being paralyzed enough
and requires a higher dose of medication. This particular patient was on a ventilator and was
significantly breathing over the set rate of breaths per minute. However, when the train of four
was performed, the result was zero twitches, indicating that the patient was over paralyzed,
according to textbooks. Along with my assigned nurse, we used clinical nursing judgement
based on our assessment and observations and decided to increase the dosage of the paralytic
medication, despite the fact that the patient was “too paralyzed.” Our assessment findings went
against what the results of the train of four said. If in fact our patient had been over paralyzed,
then he would not be breathing over the ventilator. However, because he was, it showed us that
he was not paralyzed enough. We decided to increase the dose of medication so that the
patient’s respirations matched the set rate, in order to decrease the work of breathing and
preserve the patient’s energy as much as possible. This is a perfect example of clinical nursing
With the support of evidence and research, it is undeniable that clinical nursing judgment
is easily one of the most important parts of nurse’s job requirements. It is something that comes
with much practice and experience, and the way a nurse thinks and the decisions that he or she
makes may change over time due to different situations encountered. Often times, it is the
utilization of clinical nursing judgement that allows nurses to do what they do best, save lives.
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References
Benner, P., Sutphen, M., & Leonard, V. (2010). Educating nurses: A call for radical
transformation. Stanford CA: Jossey-bass.
Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision
making and judgement in nursing research and education. International Journal of
Nursing Studies,50(12), 1720-1726. doi:10.1016/j.ijnurstu.2013.05.003