Senior Capstone: Clinical Nursing

Judgement

Olivia Millsop
Senior Capstone: Clinical Nursing Judgement
Youngstown State University
02/27/2017
 Senior Capstone: Clinical Nursing
Judgement
Judgement is defined by the Merriam-Webster dictionary (2017) as

the process of forming an opinion or evaluation by discerning and

comparing. Entering the nursing program, students are told use your

nursing judgement, but as a new nursing student, those words do not

make sense. As a sophomore nursing student, those words can mean a

million different things to each student. As time has gone on, those

words have come to mean something more simple for me. I define

nursing judgment as making the best medical decision for my patient

at the given moment. Each student will have a different definition of

what nursing judgement means to them. According to Coulter Smith, M.

Smith & Crow (2014) a decision involves choosing between alternatives,

whereas judgement involves the assessment of alternatives.

In the sophomore of nursing school students are placed into

clinical rotations, which can be very overwhelming at first. Students

are now responsible for a patient and need to make medical decisions

for the patient based on the head to toe assessment each student must

complete. Nurses or nursing students face a judgement or decision

every ten minutes in an acute setting and around every 30 seconds in

a critical care setting (Thompson, C., Aitken, L., Doran, D., & Dowding,

D,2013). This came as quite a shock. I would have never guessed that

nurses make decisions or judgment calls this often during a shift when

caring for a patient. But when thinking about this statistic, it becomes

more clear. When nurses ask a patient about how they would rate their
 Senior Capstone: Clinical Nursing
Judgement
pain, nurses make a decision to either give the patient a stronger type

of pain medication or not. It does not need to be only when asking a

patient about pain, but also making a judgement call based on blood

pressure, or heart rate, or other labs results.

Variation (in patient care) becomes a problem however when we

do know which interventions are clinically effective and or not valued

by patients (Thompson, C., Aitken, L., Doran, D., & Dowding, D, 2013).

Being a student nurse can be a positive experience or a negative

experience. Every nurse is different and every nurse does things

differently. With being a student comes the decision to follow what you

see or make a change, and do what you think is right. I had an

experience with a nurse that changed how I treat my patients. As a

student I had patient in the ICU who was there for a gunshot to the

abdomen. The patient had recently come back from surgery with many

different types of equipment. The patient had an NG tube, a Foley

catheter, and two Jackson Pratt drains in the abdomen. This patient

had blood draining from every site, and at an amount that seemed to

be on the higher side. I went to talk to the cover nurse to voice my

concerns of the patient. The patient seemed to have lost a large

amount of blood, and his blood pressure was running 89/40 with a MAP

in the 50s. The cover nurse was not concerned for this patient at all

even though I had told her the clinical findings multiple times. The

nurse blew me off, and stated He is young, he can compensate. This

 Senior Capstone: Clinical Nursing
Judgement
came as a shock to myself. The nurse here made a decision to not be

concerned with the current status of our patient. But when the

residents and attending came to round on the patient, they showed a

little more concern then the nurse did. The attending wanted to give

the patient a bolus of fluids to increase his blood pressure, placed an

order to take the patient back to surgery to find the source of the

bleeding and ordered two units of PRBCs. The nurse in that time made

her decision to not be concerned all while the patient was

decompensating right before her eyes. From this experience I can say

that the cover nurse showed poor nursing judgement. This was an

excellent learning experience for myself.

During the time in school students have a limited exposure to real

life patients during education and training period leads to limited

clinical practice for role taking (Van Graan, A. C., Williams, M. J., & Koen,

M. P, 2016). Each semester students partake in simulations to increase

critical thinking skills and clinical judgement skills. Because this

simulation is not on a real patient, student tend to not take it seriously

and in turn does not help the students clinical judgement skills. When

in the clinical setting student tend to say Well I will get the nurse for

you, once graduation comes that saying is useless. Students need to

start making those clinical judgements because in a few years they will

be that nurse that needs to make those calls.

 Senior Capstone: Clinical Nursing
Judgement
Graduating with a BSN-RN does not make that new nurse an

expert nurse. According to Van Graan, Williams, & Koen (2016) most

graduate nurses do not meet the expectations for entry level clinical

judgement. Graduating with a BSN is not going to make any student an

expert, but that comes with time. Nurses are always learning new

policies and information is always changing. Because of the always

changing field, nurses need to apply those changes when they are

making clinical decisions for their patients.

Clinical judgment is different to everyone, and everyone will make

different decisions based on the current situation. But when it comes

down to the bottom line, nurses need to make the best decision for the

patient in that current moment. I know that I am not an expert at

making clinical decisions, but as I grow as a nurse, and grow my

knowledge making clinical decisions will come easier.

 Senior Capstone: Clinical Nursing
Judgement

Reference

Coulter Smith, M. A., Smith, P., & Crow, R. (2014). A critical review: a
combined conceptual framework of severity of illness and clinical
judgement for analysing diagnostic judgements in critical illness.
Journal of Clinical Nursing, 23(5-6), 784-798. doi:10.1111/JOCN.12463

Hacker. 2017. In Merriam-Webster.com.

Retrieved February, 2017, from

https://www.merriamwebster.com/dictionary/hacker

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

Van Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses'
understanding of clinical judgement: A contextual inquiry. Health SA
Gesondheid, 21, 280-293. doi:10.1016/J.HSAG.2016.04.001