Running head: IMPORTANCE OF CLINICAL JUDGEMENT 1

The Importance of Clinical Judgment in the Midst of the Nursing Process

Blake Veglia

Dr. Ballone - Capstone

Youngstown State University

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Discussion:

Clinical judgment is something that many professionals today call their 6th sense. Once a

medical personnel begins their work day they are stepping into the realm where they must

cognitively think, assess data, decide on interventions, and evaluate the patient's plan of care. As

a nurse, a clinical judgment can happen at any moment and can be implemented throughout the

patient’s time of care. As soon as a patient is presented before a nurse, a nurses mind begins to

run a hundred miles a minute. Without even realizing it a nurse is assessing a patient’s

movements, mood, alertness and mental orientation. From there, nurses are able to use their

clinical judgment to determine the plan of action for their patient’s. We further dive into the

clinical judgment domain when we begin to analyze doctors orders, review lab results and

medications that are to be given. But, these topics are not always interpreted the same way.

What is interesting about clinical judgment is that it varies from person to person. Sometimes a

person sees something one way and another person sees it from a different standpoint. Our

experiences greatly affect the way that we interpret our clinical judgment. As a new nurse we are

walking into a realm that is unfamiliar to us. We are going to be exploring and developing

clinical reasoning for patients that we have not ever encountered before. This is why, as new

nurses, when we take our first steps onto the units it is very important for us to ask questions.

When we see a nurse do something a certain way we should always ask their rationale behind

their actions. This will help us formulate a database and elaborate on our understanding of our

nursing interventions. It is key that we understand our clinical judgment. If we are unable to

understand why we are doing what we are doing, then how are we to know if the intervention

was effective or not. In review, we are going to be discussing the importance of nursing clinical

judgment and how it affects not only the patients but the clinical faculty that are part of the care.
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If we are able to understand clinical judgment before taking a step on the units, we can

drastically change the outcomes for our patients.

Clinical judgment is something that every nurse must be able to achieve. This judgment

allows for positive patient outcomes and also prevents patient deterioration. The main focus in

developing clinical judgment is to ensure that our patients are being taken care of holistically.

This is why our education is very important. As an undergraduate student, clinical judgment was

implemented very early to establish critical thinking skills. There are many different definitions

as to what clinical judgment is. But, the national league identifies clinical judgment as a way

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 (Benner, 2010). This

definition implements the idea of all the detailed components that make up clinical judgment.

The goal of all the nursing clinical judgment definitions is to implement nursing science to

implement safe and effective care.

When a patient presents themselves to you the outward overall manifestations may seem

very overwhelming. Other times, patients are textbook cases and their symptoms are directly

related to what is going on. But, those patients that aren’t as plain as day are the ones that needs

clinical judgment the most. For nurses coming right out of school it is important that we have

these skills in order to perform effectively in the real world. Although new grad nurses, like

myself, have good content knowledge and adequate procedural skills, we frequently lack the

clinical reasoning skills needed to respond appropriately in critical situations. Majority of this

clinical reasoning doesn’t come from a textbook but rather, it comes from real life experiences

and being present during these situations.

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One of the times that I can recall using clinical judgment was during my practicum in the

ER. An eight year old patient presented with respiratory distress. The mother and family

members were uneasy and were not handling the situation well. Although the emotions were

high it was important that I stayed focus and oriented myself to the patient. I did a quick head-to-

toe assessment but centered in on the patient's respiratory status. The main focus of the plan of

care was the patients airway and to ensure that it wasn’t compromised or lost during the time of

his care. I quickly applied oxygen to the patient and immediately contacted the respiratory

therapist. Although the doctor had not seen the patient yet, I knew that some interventions

needed implemented immediately to ensure that my patient didn’t deteriorate. I also took the

initiative to put the patient on the monitor and attached a pulse oximetry to be able to assess for

any subtle changes to my patient’s condition. Once the doctor was able to see the patient and

assess what medications they would need we were then able to administer those effectively.

This situation showed how the team worked together and how they implement a safe and

effective plan of care. Sometimes doctors are not readily available, especially in an emergency

room and nurses and other team members must take action in order for their patient’s to survive.

This is when clinical judgment plays a huge role. If we didn’t get the patient on oxygen and

placed on the monitor the outcome might not have been the same. Clinical judgment is crucial is

stressful situations. As a new nurse we are going to encounter many situations that we are not

comfortable with, and this is normal. We must always remember to stay calm and think critically

about what actions we should implement next.

Clinical judgment is one of the biggest avenues that needs explored by nurses especially

new graduated nurses. This topic is not going unnoticed by hospitals and nursing schools across

the country. Many hospitals are transitioning to nurse residency programs. As stated in the
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Journal of Nursing Administration these programs are to “transition-to-practice programs are

designed and implemented by hospitals, more consideration needs to be given to the support for

newly licensed registered nurse preceptors… these preceptors will have the time to spend

assessing, guiding, and evaluating each newly licensed registered nurses; and have few

concurrent preceptees” (Blegan). For an example, at Akron Children’s Hospital they are

requiring all newly graduated nurses to be in their residency program. The program’s aim is to

enhance the knowledge and skills learned in the hospital’s traditional nursing orientation

program while focusing on helping newly graduated nurses with the transition from student

nurse to a professional role. It seems as though many hospitals across the country are

transitioning towards this model.

Nursing schools across the country are also taking note to new grad nurses having the

ability to use their clinical nursing judgment. Schools are trying their best to ensure that their

students are able to transition independently when they get their first job. Nursing schools across

the country are implementing more simulation scenarios into their curriculum. The reason that

these schools are stressing this importance is due to the fact there is a dire need for well-educated

nurses who are skilled in evidence-based practice and comfortable using nursing outcomes data

to improve patient safety. “Competent nurses who gain expertise through experience are needed.

Nurses routinely have the most frequent and intense contact with patients; and it is the nurse who

must be able to recognize changes in patient condition that require early collaboration with other

members of the healthcare team” (Abersold). Research is being used to determine the

effectiveness of the real life scenarios they are implementing through the universities. The

outcome and results are staggering and show how important the simulations are to the

development of the new grad nurses. Here at Youngstown State the feedback from the scenarios
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has been very positive and it truly helps bring together the skills in order to make clear clinical

judgment. I think the implementation of high fidelity scenarios can better prepare any nurses for

the potential real life experience.

Conclusion:

In conclusion, nursing clinical judgment is a necessity when transitioning from a student

to a registered nurse role. Although sometimes you may feel hesitant to speak up and take action,

one must do so to ensure their patient’s safety. Nursing judgment defines a nurses role in the

clinical care setting. A doctor isn’t able to be in every patients room at once. This is why doctors

say that nurses are their eyes and ears. This statement couldn’t be more true. Without nurses

functioning independently and effectively the patients care may be compromised. This seems to

be a common trend that is occuring on a national scale and the dire need to stress the importance

of developing nursing clinical judgment is evident. Although a newly graduated nurse has a load

of responsibility it is important for us to be reminded of the basic things that we were taught

during our courses. We must seek new experiences and never settle for something just because

we are comfortable with it. We must always strive to improve our judgment not only for our own

knowledge but for the safety and care of our patients.

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References:

Abersold, M., PhD, RN, & Tschannen, D., PhD, RN. (n.d.). Simulation in Nursing

Practice: The Impact on Patient Care. Retrieved March 06, 2018, from

http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/T

ableofContents/Vol-18-2013/No2-May-2013/Simulation-in-Nursing-Practice.html

Benner, P., Sutphen, M., Leonard, V., Day, L. (2010). Educating Nurses: A Call for

Radical Transformation. San Francisco: Jossey-Bass.

Blegan, M. A., PhD, RN, Spector, N., PhD, RN, FAAN, Ulrich, B. T., EdD, RN,

FAAN, Lynn, M. R., PhD, RN, Barnsteiner, J., PhD, RN, FAAN, & Silvestre, J.,

MA, RN. (2015). Preceptor Support in Hospital Transition. Retrieved March 6,

2018, from

https://www.ncsbn.org/Blegan_Preceptor_Support_in_Hospital_Transition_to_Pr

actice_Programs.pdf