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Clinical Nursing Judgement

Morgan Palange

Nursing Department, Youngstown State University

NURS 4852: Senior Capstone

Dr. Ballone & Mrs. Thomas

March 4, 2020

In order to understand the concept and importance of clinical nursing judgement, one

must know the definition: “Clinical judgment is an interpretation or conclusion about a patient’s
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needs, concerns or health problems and/or decision to take action or not, use or modify standard

approaches or improvise new ones as deemed appropriate by the patient’s response” (Sharon et

al., 2016). The nurse’s judgement is a huge component on delivering exceptional health care to

patients. A nurses clinical judgement allows her to identify and interpret the signs of any given

condition from both a clinical and rational perspective.

Whether you are in nursing school or working as a registered nurse, it is important to be

able to utilize clinical nursing judgement with daily care because “clinical judgment is the

foundation of quality nursing care. Nurses make a multitude of decisions in clinical practice

daily that call for careful thought because the decisions made impact patient outcomes”

(Manettie, 2018). Starting from the first semester of nursing school, it is very clear from the

professors how important clinical judgement is going to be throughout our careers. We started

off by learning the nursing process, but not fully understanding how that will impact our clinical

judgement. Each step of the nursing process, which is Assessment, Diagnosis, Planning,

Implementation, and Evaluation, help the nurse make the right judgement call when caring for

patients in order to make favorable outcomes for their patient.

Many nurses that are just starting out are not very comfortable with making clinical

judgement decisions, but this will improve over time as the nurse gains experience of nursing

patients. “The speed and ability by which the nurses make sound clinical judgement is affected

by their experience. Novice nurses may find this process difficult, whereas the experienced nurse

should rely on her intuition, followed by fast action. Therefore education must begin at the

undergraduate level to develop students’ critical thinking and clinical reasoning skills”

(Siewdass, 2020). Throughout nursing school, we have continued to learn the basis of how to

form clinical judgement through lectures, clinicals, and simulation. With this education, I feel
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confident enough to form clinical judgement based on my intuition, but until I have real world

experience, it will be hard to trust my gut completely.

Throughout these past four years as a YSU nursing student, I have had ample

opportunities to utilize clinical nursing judgement, but one situation stands out above the rest. It

was my junior year during my professional 3 clinical on the PICU at St. Elizabeth’s. One of the

nurses had gone up to my clinical instructor, Mrs. Thomas, and asked if any of us students would

like the opportunity to insert a foley catheter on her female patient. I had never done that skill, on

a person, so I jumped at the chance to get real experience. When we entered the patient's room,

we noticed she was on a BiPAP, but still seemed to be struggling to breath as evidenced by use

of accessory muscles, labored breathing, some confusion, and restlessness. Due to these

symptoms, we decided it would be best to keep her up in a fowlers position, instead of the usual

supine, for the catheter insertion to allow for easier breathing. Once the catheter was inserted, we

decided to give her a bed bath and change the sheets since we were already in the room, and this

is when I really began to notice her struggled breathing and pallor skin.

The patient’s confusion then began to worsen and I could feel a ton of air coming out of a

hole at the top of the tubing right before the mask that covered her mouth. I immediately knew

something was wrong and got my instructor and the nurse, who ended up calling an RRT on the

patient. Once all the nurses and doctors began filling into the room, I found myself in the back

observing. Blood gases were being drawn and an intubation kit was getting readied by one of the

residents, however, before that could happen, the respiratory therapist came in and quickly

realized she forgot to put the cap over that hole. It turned out that she had turned off the alarm

and forgot to put that cap on, which allowed the oxygen to exit through the tubing before

reaching the patient, causing all her symptoms. The patient was then transferred over to the ICU
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for closer observation. I usually do not feel confident in my decisions, but if I wouldn’t have

trusted my gut and brought my findings up to my instructor and the nurse, who knows how long

it would have taken someone to notice, and the patient could have ended up needing intubation.

Using clinical nursing judgment will help the nurse come to a decision based on

observations that allow the nurse to connect pieces of information, review them, and analyze the

presenting symptoms to provide quality care to patients.. A nurses clinical judgement is

something that is very important and will continue to grow over time with experience.