Effective, evidenced -based clinical decision making is one of the most significant contributions made by health care

providers in patient care. Consciously or not, almost all health professionals make clinical judgements daily. Tanner defined

clinical judgment as “an interpretation or conclusion about a patient’s needs, concerns, or health problems and/or the

decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the

patient’s response.” (Manetti, 2017) As per the definition of nursing clinical judgment entails, nurses have a duty to

provide care that will result in good outcomes for the patients, whether by doing or not doing something. However, as with

any career having the knowledge on a field does not necessarily correlate to having experience in that field. Lack of

experience is the difference between a competent nurse and a novice nurse. Experienced nurses over time develop the

knowledge to recognize the patient symptoms and how to respond to them. This is consisted with Benner’s findings which

states that a novice nurse develops, over a trajectory, novice to expert and that achieving competence often takes 1 or 2

years of clinical experience. (Manetti, 2017) It is extremely vital that nursing students surround themselves with knowledge

to enhance their competence and know why and when higher order thinking is essential to provide the best outcomes to

their patients. Contrarywise, poor critical thinking, lack of necessary skills and knowledge will contribute to poor patient

care and outcomes, as it also can cause sentinel events. (Graan, Williams 2017)

With this being said, the question arises as to how the nursing schools in the United States prepare nursing students for the

work force? Are nursing students and new graduate nurses able to make the right nursing clinical judgements? To answer

this question, Wendy Manetti, PhD nursing educator conducted a study (LCJR) to evaluate clinical judgment of junior and

senior nursing students in the clinical setting. To be included in the study, subjects had to be older than 18 years old, spoke

English, and were junior or senior student in their nursing program. Only traditional students were included in the study.

GPA of the students ranged from 2.74 to 3.80, with third of the juniors reporting health care work experience and eighty-

five percent of seniors with health care work experience. (Manetti, 2017). The results were promising; the mean total score

for juniors was 30(SD, 4.7), indicating an accomplished level of clinical judgment with a range score of 20 to 40. The mean
total for seniors was 36 (SD, 5.4), indicating an exemplary level of clinical judgment with a range of 25 to 44.

(Manetti,2017). However, while the juniors and the seniors reflected accomplished clinical judgement, juniors scored low in

interpreting while the seniors showed accomplishment in that area as well. This is a clear picture that reveals the

importance of education and experience.

There are many other factors that influence nursing student’s ability to learn and dwell on their clinical experiences which

make them gain or hinder nursing clinical judgment. For me, first and foremost is being able to connect with my patients.

Patients understand that we are students, however, when a care is provided with genuineness, they understand and help

back even when a mistake is made. Next, is gaining confidence with my skills is crucial, not only with competence level but

also with the quality of care I provide to my patients. When genuineness and competent skills are combined, most patients

are content with the care they receive. I had a great experience with one of my patients during my preceptorship. A male,

80-year-old patient was admitted to my unit from ICU with a diagnoses of acute kidney failure. I took care of him the very

first day that he was admitted to our unit. As per my preceptor, the patient and the patient’s family’s opinion, I provided

my patient an excellent care. The following week, this patient was still in our unit and was assigned to my preceptor, hence

to me, as we work as a team. I walked into the patient’s room, the patient and his family greeted me with much kindness

and respect. They stated how happy they were to see me and the fact that I was assigned to take care of him. The patient

was on a continuous 0.9 normal saline IV at a rate of 125 mL/hr., 2 packs of Metamucil and 2 packs of Questran to be

administer through his Peg tube. I followed the order as it was prescribed, however, short after the patient started to

complain of abdominal pain. I made few interventions that provided some comfort, however, he still had some pain. After

carefully assessing the patient, and his condition I made the clinical judgment that the pain resulted from administering the

large volume of fluids at once, as Metamucil and Questran were mix in water totaling up to a volume of almost one-

thousand mL’s. All at one administration. I notified my preceptor the complaints of my patient. When the afternoon

medications were due, after consulting my preceptor, I suggested that we administer, Metamucil and Questran couple of
hours apart to allow time for my patient to process the fluid. She agreed. The patient found much relief from this

intervention. Few hours later, the patient started complaining of Shortness of breath. After listening to his lungs, I heard

some crackles, accompanied with edema on hands and lower extremities. At that point I started questioning the rate of the

IV 0.9 normal saline, as I thought that was a high rate. When the doctors came around for their rounds, the doctor put in

the order to discontinue the IV, 0.9 normal saline. At the end of my shift, I was highly complimented by the patient and his

family. The patient’s son said, “I would’ve never guessed that you were a student if your badge did not say so!”. That was a

great boost to my self-confidence, as it helped me gain comfort in self as a graduating nurse. Another important matter

that I find extremely useful in enhancing clinical judgment is; building a great relationship with the staff. When you have

strong relationship with the staff on the grounds of mutual respect, kindness, helpfulness and the student taking the

initiatives to work hard, the more everyone on the unit are willing to help, teach and understand the perspectives of being

a student. I met some of the greatest nurses during my preceptorship.

As approved by evidenced based data, new graduate nurses may not have the knowledge and competence as well as an

experienced nurse. This is probably true for any career. It takes roughly 1 to 2 years for a novice nurse to build the

competence, improve higher-level thinking skills, and the intuition necessary to make conclusions about a problem.

However, with a positive attitude, initiative to learn, motivation and drawing conclusions from mistakes, as well as

providing genuine care with kindness, novice nurses can learn to function at a higher-level and provide a safe, effective,

patient-centered care for their patients.