Clinical Nursing Judgment

Riley Campbell

Nursing, Youngstown State University

NURS 4852 Senior Capstone

Mrs. Wendy Thomas

02/28/2022
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Clinical Nursing Judgment Defined

Clinical nursing judgment is defined as “cognitive or thinking process used for analyzing

data, deriving diagnoses, deciding on interventions, and evaluating care” (Manetti, 2019). As a

new graduate nurse, clinical judgment is extremely important to develop and apply to patient

care. There is a common concern that new graduate nurses do not have the appropriate clinical

judgment skills to manage patient care in the most effective manner. Sound clinical nursing

judgment is fostered over time and continues to develop throughout the nurse’s career. In

education, the responsibility falls on nursing instructors to teach students the components of

clinical judgment and to provide students with the opportunities to practice what they have

learned. According to Jang & Park (2021), “Instructors are challenged to provide effective

simulations that improve competencies, such as clinical judgment, and prepare students to

become future nurses, but these skills only develop over time through experience.” Early

introduction to the concept of nursing judgment allows the student to apply it to every patient

care scenario throughout their education. Students should also receive feedback from their

instructors focused on how nursing judgment was used appropriately and where the student can

improve their clinical judgment. It is of utmost importance that the nurse is able to notice that a

problem exists or that there is a potential for a problem to exist, interpret data available, respond

to the problem by taking action, and finally, reflect on or evaluate the outcomes of the

interventions (Manetti, 2019). These four components to nursing judgment come directly from

the Clinical Judgment Model (CJM). The components of the CJM are very similar to the

components of the nursing process, which are assessment, diagnosis, planning, implementation,

and evaluation. Nurses are taught the nursing process very early in their nursing education with

the goal that they will use it to begin developing clinical judgment skills. Manetti (2019)
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identifies the key attributes to clinical nursing judgment as, “making a holistic assessment,

critical thinking, clinical reasoning, practical wisdom, intuition, and reflection.” All of these

attributes take time to develop so they must be introduced to nursing students early and evaluated

often throughout the student nurse’s education.

Importance of Clinical Nursing Judgment

Development of clinical nursing judgment is the foundation for nursing education

programs. No matter what area of nursing each student will pursue, they all will be required to

think critically and use nursing judgment to achieve the best outcomes for their patients.

According to Mohammadi et al. (2021), “Clinical reasoning in nursing students emerges despite

professional standards; discipline-specific knowledge, cognitive perception, critical thinking,

learning experiences, and intuitive ability, and the requirements of the professional system affect

its establishment in the nursing discipline.” It is essential that every nurse who graduates from a

nursing program develops the foundational knowledge and skills of clinical nursing judgment to

safely and effectively care for all patients. Clinical judgment applies to all areas of nursing,

making it an integral part of how the nurse approaches problems. Furthermore, clinical nursing

judgment does not directly equate to intelligence. The nursing student does not need to be

scoring at the top of their classes to be successful in clinical judgment. Although a strong

academic understanding of nursing theory is helpful, it must be applied using the nursing process

and therefore, sound clinical judgment. Additionally, Mohammadi et al. (2021) states, “being

competent in clinical reasoning is essential in newly graduated nurses who will engage in

independent decision-making in clinical practice.” A common concern among nursing students is

assuming responsibility for the health and safety of their patients while having little experience

in the profession. Many new nurses leave the field during the first year working as a result of
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feeling inexperienced. These new nurses may not feel they are ready to assume independence

and may worry that they will make decisions that could bring poor outcomes for their patients.

These nurses should focus on developing their clinical judgment skills and refining these skills as

needed during their education. With a good foundation of clinical judgment skills, graduate

nurses will be much better prepared to enter the workforce and assume responsibility for their

patients.

Use of Clinical Judgment In Practice

Throughout my education I have applied the nursing process and clinical nursing

judgment to all of my patients. During my preceptorship in the Intensive Care Unit (ICU) I have

withheld diuretics like furosemide following my initial assessment because administration of the

ordered medication would put the patient at a greater risk than if the medication was not

administered. Furosemide is a potassium wasting diuretic and was prescribed for a patient in

heart failure. The patient’s morning blood work came back showing a potassium that was very

low. The patient was having frequent premature ventricular contractions and short runs of

ventricular tachycardia. These physical symptoms are directly related to the patient’s serum

potassium level. My nurse preceptor and I withheld the ordered dose of furosemide and called

the patient’s doctor. The doctor instead ordered intravenous potassium replacement. After

administering the potassium replacement I reassessed the patient to find a serum potassium level

within the normal range, fewer premature ventricular contractions, and runs of ventricular

tachycardia that were shorter and less frequent. I continued my assessment throughout my shift

with a focus on determining if the patient had symptoms of fluid volume overload since I had

withheld the diuretic that helps the patient to remove excess fluid. In this situation I noticed there
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was a problem, interpreted the data, responded with the appropriate nursing interventions, and

finally reevaluated the patient’s condition to ensure effectiveness of my interventions.

Conclusion

Although every step in the process of sound clinical nursing judgment is important, the

final step of reflection or evaluation gives the entire process meaning. Nurses are able to identify

interventions that work and areas that can be improved. Once the nurse has drawn conclusions

from their reflection, the entire process can begin again. If the nurse incorporates nursing

judgment into their practice, it keeps them constantly alert for changes in the patient’s needs.

When a patient's needs are addressed promptly and accurately, the patient’s outcomes improve.

The nurse should prioritize patient safety and work toward achieving the best possible patient

outcomes. Using well developed clinical nursing judgment is the best way for the nurse to

provide the most effective patient care.

References

Jang, A., & Park, H. (2021). Clinical judgment model-based nursing simulation scenario for

patients with upper gastrointestinal bleeding: A mixed methods study. PLoS ONE, 16(5),

1–12. https://doi.org/10.1371/journal.pone.0251029

Manetti, W. (2019). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102–110. https://doi-org.eps.cc.ysu.edu/10.1111/nuf.12303

Mohammadi, S. F., Khankeh, H., & HosseinZadeh, T. (2021). Clinical reasoning in nursing

students: A concept analysis. Nursing Forum, 56(4), 1008–1014.

https://doi.org/10.1111/nuf.12628