Running head: Clinical Nursing Judgment 1

Clinical Nursing Judgment

Kailee Engel
Youngstown State University
March 19, 2018
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Endless hours of research have gone into finding what makes a great nurse. Leadership,

intelligence, dexterity, and charisma are all very important components of nursing, but a great

nurse is set apart from a good nurse by the learned ability known as clinical judgment. This

ability is learned through active engagement in practice and reflection (Levett-Jones, Sundin,

Bagnall, Hague, Shumann, Taylot, & Wink, 2013). One of the major reasons for decreased

clinical judgment use among nursing staff is the mass integration of technology into the daily

nursing setting (Graan, Williams, & Koen, 2016). The power of technology has made

knowledge more accessible and information on patients requiring less effort by nurses but that

does not mean that all problems stem from technology.

Another issue that can hinder clinical nursing judgment is poor teaching or environment

(Cappelletti, Engel, & Prentice, 2014). This can refer to instructors in nursing schools, nurses

interacting with the school, orienting nurses, or experienced co-workers. Many experienced

nurses have developed their own ways of doing their jobs daily. Some of these are good

practices that give adequate patient care while being efficient. However, many of these practiced

by nurse can be ineffective, irresponsible, and at times even dangerous. If a student or a new

nurse is exposed to and environment like this they will tend to adapt to their environment

(Cappelletti, Engel, & Prentice, 2014). These poor practices are then continued from one

generation of nurses to the next and can be detrimental to the patient care and outcomes, not to

mention the poor development of clinical nursing judgment. It is easy for nurses to believe that

they are using good clinical judgment, however, if it is not based on safe, effective nursing based

evidence it could mean more harm than good.

My experience with developing clinical nursing judgment started long before I was even

in nursing school. As soon as I decided I wanted to go to nursing school I obtained a job in the
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medical field as a physician’s scribe in an emergency room. This job has provided me with

endless opportunities to observe other nurses, new and seasoned, and formulate clinical nursing

judgment even when at work as a physician’s scribe. Being able to practice forming clinical

nursing judgment throughout nursing school and the additional hours worked in the emergency

room have been helpful in many ways. Trying to pickup on other nurses reasoning has become

second nature at this point but even when I do not understand their reasoning I am not afraid to

ask why they have done the interventions. Working in the medical field, especially the

emergency room, has brought many opportunities to learn that I would not have otherwise had if

I continued to work elsewhere. I think that it would be very helpful for all nursing students and

students entering medical school to be a physician’s scribe. Being able to learn and study with

doctors and nurses has proven valuable and therefore they are teachers in universities, because it

has been proven that experience is the most valuable in clinical judgment.

As I progress through my preceptorship for transitions in the emergency room, I have

had to use my clinical nursing judgment ever second of every shift. We had a patient during one

of my shifts in the emergency room that was experiencing an arterial bleed from a head

laceration. As the trauma surgeon was trying to repair the damage done, the patient was trying to

scratch their nose, move their arms, move their legs, all while fading in and out of consciousness.

As a student nurse I was assessing what the top priority in this case was and because the patient

was not cleared by cat-scan it was very important that we kept them still but even more

important to maintain the airway. In this patient’s case however, they had an arterial bleed so the

most important part of assessment was circulation. With the surgeon maintaining circulation it

was our job as the nurses to maintain the airway and keep the patient as still as possible so that

there was no compromise in the circulation the surgeon was repairing. After the repairs were
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complete, the trauma physician wanted to palpate along the patient’s back to ensure there was no

back injury prior to being taken to cat-scan. As we were about to log-roll the patient onto their

side, they began to have heavy emesis. It was vital to get them onto their side as fast as we could

while maintaining c-spine. It happened so fast, even the more experienced nurses were caught

off guard and nearly forgot to maintain c-spine so that they would not aspirate causing further

complications. This was a turning point in my clinical nursing judgment as I realized that my

patient’s truly do need to come first and sometimes that may mean having to change or even

shower during a shift.

Competent professional practice requires not only psychomotor and affective skills but

also sophisticated thinking abilities. Nurses are responsible for a significant proportion of the

judgments and decisions made in healthcare (Thompson et al, 2004). Even new graduate nurses

are required to make increasingly complex decisions about patients with diverse health needs

(Lasater, 2007) (Levett-Jones, Sundin, Bagnall, Hague, Shumann, Taylot, & Wink, 2013). This

type of strain placed on new graduate nurses is why the development of clinical nursing

judgment while in school is so important.

In conclusion, clinical nursing judgment comes with experience. The experience a nurse

has should be fostered throughout the education of a nurse through methods of concept mapping

and clinical simulation. Student nurses should be given as much time as possible to train in the

clinical setting to better develop their clinical nursing judgment. In the examples given above it

is clear to see that clinical judgment is an important part of the growth and development as a

student nurse. In the end, clinical nursing judgment is based on experience and the more

experience someone has, generally, the better their clinical nursing judgment has been refined to

provided better clinical decisions and outcomes.

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References
Cappelletti, A., Engel, J. K., & Prentice, D. (2014, August 01). Systematic Review of Clinical

Judgment and Reasoning in Nursing. Retrieved March 1, 2018, from

https://www.healio.com/nursing/journals/jne/2014-8-53-8/{adc06fcd-d4a5-4890-be0a-

a25cb723bb12}/systematic-review-of-clinical-judgment-and-reasoning-in-nursing

Graan, A.C., Williams, M.J.,& Koen, M.P. (2016). Professional nurses’ understanding of clinical

judgment: A contextual inquiry. Health SA Gesondheid, 21, 280-293. Doi:

10.1016/j.hsag.2016.04.001

Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C., & Wink, J.

(2013). Learning to Think Like a Nurse. Retrieved March 1, 2018, from

http://journals.sfu.ca/hneh/index.php/hneh/article/view/65/56