Running Head: CLINICAL NURSING JUDGEMENT

Clinical Nursing Judgement

Morgan McAllister

Youngstown State University

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Clinical Nursing Judgement

Clinical nursing judgement is an essential key to nursing. Margot Phaneuf came up with

her own definition of clinical nursing judgement as, “a concept which is critical to the nursing

profession as a result of its outcomes.” Essentially, clinical nursing judgement is when there is a

situation related to a patient. It is the nurse’s responsibility to use clear judgement and opinion in

order to make the best decision for the best possible outcome. This can be difficult for some

nurses, especially those who are just starting their career, because much like any other time when

a decision is being made, you may be torn in different directions as to what is the best decision.

Understanding of the situation and being knowledgeable on what is at hand is a must. In order to

make the best judgement, it requires close observations to identify the situation and have the best

outcome.

To obtain a nursing license, it takes multiple years along with many clinical hours.

Nurses receive an extended amount of training and education in order to become a great nurse.

With many years of experience, making sound decisions may be easier than those who are just

starting out. Mary Cazzell (2018) says in a recent journal the gap between nursing education and

practice will not be bridged until baccalaureate curricula address the complexities and rapid

changes in nursing practice (p. 1). There may be times where decisions are obvious and by the

textbook, but a nurse will not always run into a clear-cut situation. Sometimes, no matter how

many years of experience and education a nurse has, they will have to make decisions based of

their intuition and knowledge to the best of their ability. That is what we call clinical nursing

judgement.

When it comes to caring for a patient, nursing judgements are being made every day. In

Manetti’s (2018) journal over nursing judgement, she says bedside nurses must notice subtle
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cues and changes in a patient’s condition to prevent complications and detect problems as soon

as possible (p. 102). As a nurse, obtaining vitals, performing assessments, and bed side care are a

part of their daily routine. When they sense something is off, it is key for their nursing judgment

to be used. A patient may have a fever, sore throat along with a rash while in the process of

receiving blood. A clinical nursing judgement would be for the nurse to recognize these

symptoms as an allergic reaction to the blood transfusion and stop the treatment.

When it comes to transitioning from nursing school to life as an employed nurse, it can

be hard for new graduates who don’t have very many opportunities to use their judgement due to

assignments being much smaller and having focus on only one or two patients in the clinical

setting. As a senior nursing student from Youngstown State University (YSU), our professors

and clinical instructors do everything they can to teach us about making clear, educated decisions

and using nursing judgement when in the clinical setting. I have been taught in many clinicals

how to prioritize patients and their illnesses in order to give the best care I can. Critical thinking

is a huge part of making clinical nursing judgements and in nursing school it is a large part of the

education. At the beginning of the program at YSU, a critical thinking test is to be taken as a

brand-new student to see how sound your judgements are before starting the program and being

educated. At the end of the program, before graduation as a senior, you take the critical thinking

test again to see how far you have come with the educational background to make better

judgements.

With simulations, clinical experience, case studies, and exams to test critical thinking,

YSU’s nursing program conditions us for using clinical nursing judgement in our future careers.

In a recent study, Lavoie (2019) states how important debriefing is after clinical simulation to

understand how the student interpreted the simulation and how well it was understood. In his
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study, students went to simulations with different scenarios and cases. Randomly selected

students reflectively debriefed afterwards while others only self-debriefed. Situational awareness

was measured for clinical nursing judgement. The students who did not debrief did not perform

as well or retain the knowledge they were supposed to receive out of the simulations. Those who

participated in reflective debriefing showed much greater improvement in their knowledge to

understand changes in patients and the recognition of abnormalities (p.514). This study proves

how important it is to have students experience a clinical situation and learn from it through

reflection and understanding changes to bring that bridge together between being a student nurse

to a registered nurse.

In my time as a nursing student, I have been challenged to make my own judgement calls

in order to give the best possible care to my patients. An example of a time I used clinical

nursing judgment was when I was at Akron Children’s Hospital. A teenage girl came through the

emergency room due to suicidal ideations. My nurse and I did an assessment but could not calm

her down to talk to us. She was extremely distraught and breathing fast. My nurse became easily

frustrated and wanted to wait for the doctor. Due to knowledge of psychiatric patients, I used my

education to perform milieu therapy with the patient to prevent harm to herself. Sitting with the

patient and allowing her to talk when she was ready and calm was what she needed. She asked to

hold my hand because she was scared and instead of leaving the room and giving up on her when

she wouldn’t talk, I sat patiently with her and recognized her feelings, so she felt safe and heard.

I never left her alone because of the risk of harming herself. This quickly calmed the patient

down where if I would have left, she may have felt even more panicked, scared and would not

have controlled her breathing.

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Clinical nursing judgement is an extremely important part of having a career in nursing

because your patients well-being and lives depend on it. Without nursing judgement, we put

many patients at risk. Having excellent judgement makes a world of a difference in the type of

nurse you will be. I am thankful for my experiences at YSU in order to prepare me to be the best

nurse I can in my career.

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References

Cazzell, M. (2018). The Impact of Critical Thinking on Clinical Judgment During Simulation

With Senior Nursing Students. Journal of Nursing Education, 1–9. doi:

http://dx.doi.org/10.5480/15-1553

Lavoie, P., Pepin, J., Cossette, S., & Clarke, S. P. (2019). Debriefing approaches for high-

fidelity simulations and outcomes related to clinical judgment in baccalaureate nursing

students. Collegian, 26(5), 514-521. doi:10.1016/J.COLEGN.2019.01.001

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Journal of Nursing

Education, 54(1), 102–110. doi: 10.1111/nuf.12303

Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession. Journal

of Nursing Education, 1–3. doi:

http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–

An_Essential_Tool_in_the_Nursing_Profession.pdf

Standing, M. (2008). Clinical judgement and decision-making in nursing – nine modes of

practice in a revised cognitive continuum. Journal of Advanced Nursing, 62(1), 124–134.

doi: 10.1111/j.1365-2648.2007.04583.x