Running Head: THE ESSENTIAL CLINICAL JUDGEMENT 1

The Essential Clinical Judgement in Nursing

Kaitlyn Viglio

Youngstown State University

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Abstract

This paper explores what “Clinical Nursing Judgement” is, and the importance it plays in the

healthcare field, specifically in nursing. It is explained why a nurse should practice good clinical

judgement, and the benefits it has on the outcomes of the patients. I used three different sources

in this paper to help reiterate the importance for all healthcare providers to continually improve

their clinical judgement to contribute and not deter from their health and well-being of their

patients. Along with an in-depth conversation to understand what this term means, I explained a

time in my student nursing career in which I used clinical judgement in my preceptorship.

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The Essential Clinical Judgement in Nursing

Clinical judgement in the nursing field is an essential skill that is required for a nurse to

be successful in their career. According to Benner (2010), it is defined as “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” (p. 1). By making clinical judgements in

practice based upon substantial evidence and safe practices, it ensures the best quality of care for

a diverse patient population and their families in collaboration with the healthcare team.

Components involved in clinical nursing judgement include responding quickly to changes in

patient status, collaboration with physicians about the most appropriate course of action

individualized to each patient, accounting to context, and the nurse’s practical experience in the

field. Benner (2010) also states that “making clinical decisions is rooted in the nurse’s theoretical

knowledge; ethical perspectives; relationships with patients, the patient’s caregivers, and the

community; and understanding of the influence of systems on health care outcomes”

(p. 1).

Nurses are significant decision makers in most healthcare systems around the world,

especially in the United States. The importance of clinical nursing judgement according to

Thompson et al (2013) is that “nurses’ judgements and decisions have the potential to help

healthcare systems allocate resources efficiently, promote health gain and patient benefit and

prevent harm” (p. 1720). It is believed that about half of adverse events in the healthcare system

could be prevented due to the them being caused by error on the healthcare providers behalf.

With a promotion in improvement of judgements and decision making by clinicians, errors made

by poor decision-making errors could be greatly decreased. In order for nursing to contribute to
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raising quality through improved clinical judgement in the health care system, we need to know

what interventions are likely to improve judgement and decision processes and outcomes; also,

we need to know more about the judgment and decision options themselves.

Thompson et al (2013) explain that “worldwide, 19 million nurses will exercise their

clinical judgement before making choices with, for and on behalf of patients” (p. 1721). Within

these 19 million nurses worldwide, there is a very high chance to introduce unnecessary harm to

the patient population through poor clinical judgement and decision making. Patients put a lot of

trust in the nurses caring for them to make decisions for them that will benefit their health and

well-being. There are major challenges that nurses must overcome to make decisions for their

patients on a daily basis; these include: ageing populations, rising healthcare cost, promoting

population health through preventative care, and employing evidence based practice to produce

the biggest health gains in the most efficient and acceptable way possible. Healthcare systems

expect nurses to overcome these challenges and allow their clinical judgement and decision

making to contribute and not detract from the quality of care they are providing their patients.

Even as a senior nursing student, I have employed clinical nursing judgement in my

preceptorship during my first 12-hour shift. The patient I am going to share my experience with

was not my assigned patient, so I did not know his background story as to how he ended up in

the ICU. However, I was informed by the charge nurse that he was septic and from an Amish

community. I stumbled upon this case when I was answering a call light while the patient’s

assigned nurse was running down to the pharmacy to pick up a medication for her other patient.

I walked in on the patient who seemed to be in distress. His vitals on his monitor showed his

blood pressure systolically in the 160’s, heart rate well above 100, respirations in the 40’s, and
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pulse ox was normal >92%. His skin was flushed and he was diaphoretic. I attempted to

communicate with the patient, but his mother who was at his bedside told me that he was non-

verbal; therefore, I asked if she was calling due to his declining status, and she said yes. I

stepped out of the patient’s room to get my preceptor and to have her grab a thermometer, which

was the only vital that wasn’t continually being monitored. She was quick in acquiring a

thermometer, and I was able to read his temperature orally, which came back to be 103.2 degrees

Fahrenheit.

My preceptor called the assigned nurse to the case, who was caught up with a mix up in

medications down in the pharmacy, so she gave my preceptor the background situation on the

patient so we were able to treat him immediately. In my mind, I knew we had to quickly get his

temperature down due to the chance of the patient suffering from a febrile seizure. I was

thinking to myself that we needed to get a more accurate temperature reading, and we needed it

to be a continual reading until his temperature was down into a safe range. According to Blum et

al (2010), “development of safe nursing practice in entry-level nursing students requires special

consideration from nurse educators” (p. 1551). My preceptor understood that I needed to

practice my clinical nursing judgement, so I collaborated with my preceptor and we decided to

get a cooling blanket, which is an external blanket that is placed underneath the patient, set to a

specific temperature, and monitors both the patient’s temperature rectally and the blankets

temperature. Also, I realized that the patient did not have an IV site; therefore, he was unable to

get IV antibiotics into his system to help fight the infection that is causing him to be septic. I

pointed this out to my preceptor, and we called the resident physician so he would place a triple

lumen central catheter to being IV antibiotics and IV fluids ASAP on this patient. By the end of
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our shift in the ICU that night, the patient’s temperature dropped a couple of degrees, and he was

no longer in immediate danger.

Based on my knowledge of clinical nursing judgement, I knew that this patient was in

immediate danger, and that I needed to cover all bases to make the correct decision for his course

of care. All nurses should have a clear understanding of how to assess a patient, make an

appropriate judgement call to provide the best quality of care for their patient in all health care

settings; whether it is acute care, intensive care, long term care, or outpatient care, clinical

nursing judgement is essential to decrease errors that can negatively affect the patient outcomes.
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References

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

Radical Transformation. San Francisco: Jossey-Bass.

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), pp. 1720-1726.

Blum, C., Borglund, S., Parcells, D. (2010). High Fidelity Nursing Simulation: Impact on

Student Self-Confidence and Clinical Competence. International Journal of Nursing

Education Scholarship, Volume 7, Issue 1, ISSN (Online) 1548-

923X, DOI: https://doi.org/10.2202/1548-923X.2035.