Running Head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Kara Whitman

Youngstown State University

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Clinical nursing judgment is a term all nurses should be familiar with. According to the

National League for Nursing (2014), “Clinical judgment refers to ways nurses come to

understand the problems, issues, or concerns of clients/patients, to attend to salient information,

and to respond in concerned and involved ways”. Many nurses will have to use their judgment

on average every 10 minutes (Thompson, Aitken, Doran, & Dowding, 2013). When compared to

the typical 12-hour shift that nurses work, that equates to 72 times on a shift. This alone should

showcase the importance of having sound nursing judgment. One area of nursing that I have

witnessed the most nursing judgment is with medication administration. Before giving any

medication, nurses must use their judgment to consider the desired outcome for their patient.

Their judgment should incorporate their knowledge base, assessment of the patient, events that

may affect the patient and interventions needed to maintain patient safety. A nurse’s assessment

is crucial to detecting any abnormalities in a patient’s condition prior to giving medications

(Rohde & Domm, 2017). Nurses also use their intuition when caring for patients. As said by

Holm and Severinsson (2016), “research validates intuitive knowledge in sound decision-making

among nurses”. Intuition is built on as nurses gain clinical experience. Clinical nursing judgment

allows a nurse to see the big picture when caring for patients rather than focusing on one

problem at a time. As a connection with a patient grows, so may the intuition a nurse feels about

them. “Intuitive thinking can be a sixth sense, as well as a cognitive skill for developing clinical

action and a valid form of knowledge” (Holm & Severinsson, 2016, p. 420). There may be times

when we, as nurses, feel something is wrong with our patients before there is physical evidence.

It is then that clinical nursing judgment could save a life. We can prevent further deterioration by

paying attention to changes in patient status.

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The unit that I am on for precepting is primarily a cardiac floor and we pass a lot of

cardiac medications. I am using my nursing judgment during every med pass to ensure my

patient’s safety. If a patient is experiencing bradycardia or hypotension I know that I do not want

to give them a medication that may potentially drop their heart rate or blood pressure even lower.

Although decisions like that may not seem critical, it could save my patient.

One situation especially sticks out in my mind when I think of a time I used clinical

nursing judgment. This semester while precepting, I had a patient that was scheduled for surgery.

They had been planning surgery for a few days but the morning of the surgery upon entering the

room, the patient seemed to be having some respiratory distress. She was typically a mouth

breather and had been wearing a venti-mask over night to assist with her breathing. In the

morning she is to be switched over to nasal canula but this particular morning she was

struggling. We tried to wean her oxygen down on the venti-mask before attempting the nasal

cannula and were unsuccessful. She was unable to maintain an SpO2 greater than 85% while we

were weaning her down. During my assessment of her lungs, I could hear that she was not

moving much air. She was using accessory muscles to try to breathe and her respirations were

shallow and tachypneic. She was in a state of fluid overload and her lungs were not functioning

as well as they should have been. The nurse I was working with and I were very concerned that if

they put her under anesthesia that she would not make it off of the ventilator. We called the

surgeon and updated him on the patient’s condition in which he said he was still going to take

her to surgery. At that point my nurse and I knew that we had to use our nursing judgment and

advocate for our patient. We called the anesthesiologist, surgeon, and hospitalist to come and

visually assess the patient before deciding to take her to surgery. The hospitalist came first and

validated our concerns for our patient. She agreed that this patient was not appropriate for
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surgery at that time. The anesthesiologist insisted still that the patient would be okay for surgery.

After about an hour of trying to convince the anesthesiologist to come see the patient, he finally

arrived on the unit. He went into the patient’s room to assess her and when he walked out he said

the same thing that my nurse and I had said earlier in the day, she would not make it off a vent if

they put her under anesthesia. This experience taught me how important clinical nursing

judgment is and how using this judgment could save a patient’s life.
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References

Holm, A. L., & Severinsson, E. (2016). A Systematic Review of Intuition—A Way of Knowing

in Clinical Nursing? Open Journal of Nursing, 06(05), 412-425.

doi:10.4236/ojn.2016.65043

Rohde, E., & Domm, E. (2017). Nurses’ clinical reasoning practices that support safe medication

administration: An integrative review of the literature. Journal of Clinical Nursing,

27(3-4), 402-411. doi:10.1111/jocn.14077

Practical/Vocational Nursing Program Outcome: Nursing Judgment (2014). From

http://www.nln.org/docs/default-source/default-document-library/nursing-judgment-

final.pdf?sfvrsn=0

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