Running head: Nursing Judgement 1

Clinical Nursing Judgement

Julia E. Kirchner

Youngstown State University

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It was August 2014, the first day of classes at Youngstown State University and

for roughly 100 students, it was the start of the future, it was the first day of nursing school.

Before learning how to take vital signs or complete a head to toe assessment we were taught

steps to the nursing process. We began learning objective and subjective data, what a nursing

diagnosis consists of and how to implement the necessary interventions for each patient. This is

vital information because it is the foundation of nursing. Like we have been told every semester

anyone can be taught how to complete an assessment, but a nurse must be taught think critically

and learn how to interpret the assessment data. It is very true, while anyone can complete an

assessment it is very important that a nurse piece it together to get an overall picture of how the

clients are progressing. Clinical nursing judgement as defined by Margo Phaneuf R.N., Ph.D. is

the conclusion or enlightened opinion at which a nurse arrives following a process of

observation, reflection and analysis of observable or available information or data (2008). This

encompasses the fundamentals of nursing. It is the nurses job to assess and gather information on

their patients to provide them with optimal care.

Every interaction with a client can and may include some form of clinical nurse

judgement. Nurses are constantly analyzing and collecting data on their patients. Every time labs

are sent, every time medications are administered, and every time a new order appears the nurse

must use their critical thinking skills, organizational skills, and assessment skills to determine

when and how effective the interventions they are performing are going to be for their clients. It

is a delicate balancing act that improves with time and experience but begins the very first day of

nursing school. Nurses are constantly on the lookout for any decline or adverse effects that

interventions may produce in the patient. No two patients are ever the same, while there may be

similarities in illness and presentation two patients may respond in drastically different ways to
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the same interventions. This is way clinical nursing judgement is so important. A nurse must

prepare for the unexpected to the best of their ability and be ready to ensure safe and effective

care for every patient no matter how effective or lack of effectiveness their interventions may be.

Take for instance two male patients in their 50s both present with crushing chest pain, labs are

drawn and both patients have suffered an acute myocardial infarction. Both patients are put on

oxygen, receive nitroglycerin and aspirin. Patient A states he is no longer having the intense pain

and is feeling much more like himself, while further interventions are carried out and the patient

is continuously monitored patient B is worsening and the doctor has decided the patient must be

started in tPA therapy (Maxwell 1999). The nurse is carrying out every intervention and must be

skilled enough to promptly react to both patients needs even though they are responding in

drastically different ways.

Now, not every clinical nursing judgement made will have serious outcomes, but some

judgements could be the difference between life or death. Nurses are the ones in the medical

profession that will interact and spend the most time with the patient. Nurses gather the most

information from the client and act as the liaison between all medical interdisciplinary teams that

collaborate on a patients plan of care. Nurses act as the advocate for the patient when the patient

cannot advocate for themselves. It is important for the needs of the patient to always be at the

forefront of the nurses agenda. Therefore, nurses must use clinical nursing judgement when

interacting not only with the patient but when working with the doctors planning care for the

patient.

Nurses are on the forefront of patient care. Carl Thompson states Nurses have a key role

to play in overcoming the major challenges facing developed healthcare systems: ageing

populations; rising healthcare costs; promoting population health through preventative

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healthcare; reducing health inequalities; and employing evidence based practice to produce the

biggest health gains in the most efficient and acceptable manner possible (2013). This provides

a broad but encompassed summary of current challenges and implementing the nursing process

to solve them.

It was during my complex care rotation that I remember a time I used clinical nursing

judgement to help better the patients care and provide more appropriate interventions for the

patient. Upon the first assessment, the client was alert and oriented time 4, able to follow

commands and overall pleasant. As the day continued and the next assessment to be complete I

began speaking to the patient who was now confused and began making bizarre statements and

was perspiring. This was a new finding not previously documented or seen from this client but

when I began to think of the patients history knowing they were a type one diabetic I knew this

new onset of symptoms could be caused from a low blood glucose. I promptly reported these

new findings to my charge nurse and we performed a blood glucose check. The patients blood

glucose level was 56 mg/dl which is a significantly low finding. Luckily the patient was still

conscious enough to drink a cup of orange juice and within about 10 minutes the patient became

alert and oriented once again and after 20 minutes upon rechecking their blood glucose the

reading was now 105 mg/dl which is within normal range. Blood glucose monitoring may seem

like a simple task but it can also be the difference between a stable client and one of the verge of

unconsciousness.

This time will forever stick with me because it was an instance that I was able to take the

skills I have been learning throughout nursing school and combine them to help better my

patients health and avoid further complications. It was not major save the day instance but it was

still equally important just like every decision a nurse makes. Using clinical nurse judgement
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every day will continue to develop the nurses skills and better the patient outcomes. As we

progress in our profession it is important to always learn from each experience and to use that

knowledge to further our clinical judgement skills. Nursing is continuously evolving and we

must evolve with it.

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References

Maxwell, S. (1999, September). Emergency management of acute myocardial infarction.

Retrieved February 21, 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014343/

Phaneuf, M. (2008, December 17). Clinical Judgement An Essential Tool in the Nursing
Profession. Retrieved February 21, 2017, from Clinical Judgement An Essential Tool in
the Nursing Profession

Thompson, C., Atkein, L., Doran, D., & Dowding, D. (2013, December). An agenda for clinical
decision making and judgement in nursing ... Retrieved February 21, 2017, from
http://www.journalofnursingstudies.com/article/S0020-7489(13)00144-2/fulltext
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