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Selina Nuzzi
Abstract
Clinical nursing judgment is a critical thinking and decision-making skill that nurses use during
their shifts. Nurses are independent and use their knowledge and experience to make quick
decisions and actions. Nursing judgement is a characteristic of a RN that gets better with time
and clinical practice. It’s important for nurses to have this skill because the lives of patients are
placed in nurses hands and are held accountable for their patient outcomes. Nurses are placed in
difficult patient situations at times and not all choices and decisions go as planned. They learn
from experience and figure out what could have be done differently or better. This scholarly
paper looks into defining what clinical nursing judgement is, how and why it’s important in
nursing practice, and an example of a personal experience using nursing judgement as a student
nurse.
As I near the end and look back at the beginning years of nursing school and compare it
to where I am now, there is so much knowledge and skills that I have gained that I will take with
me as I begin my career as a registered nurse. In nursing school, everything you learn builds onto
one another. Once you understand the normal and healthy body system, you can begin applying
all the skills and knowledge to ill patients in clinical practice. One important key component of
nursing school and clinical rotations includes making clinical nursing judgements. This is a skill
that begins developing as a student nurse through exams, simulations, and at clinical settings.
This skill is crucial as a RN for he/she must make judgments and critical think on their own and
Clinical nursing judgement involves both critical thinking and decision making. In
nursing, critical thinking can be defined as a way of thinking about a patient situation or problem
and effectively solving it by examining ideas, principles, and beliefs. Critical thinking is a form
of purposeful thinking that involves reflecting upon reasoning before coming to a clinical
decision (Lee et. al, 2017). On the other hand, clinical decision making can be defined as
weighing the pros and cons between alternative choices to determine which option will provide
the most beneficial outcome for the patient (Lee et.al, 2017). Together, critical thinking and
decision making in the clinical practice form a nursing judgement. It takes time and practice to
critical think and make a quick decision. I think it’s something that student nurses become
proficient at faster in the exam setting compared to in the clinical setting. Personally, as a student
it’s scary when your patient is deteriorating right in front of you, because it’s not something you
are used to nor become accustomed to overnight. A beginner student’s first instinct is to turn to
the cover nurse and/or instructor for help and guidance; however, as you become more exposed
CLINICAL NURSING JUDGEMENT 4
to different patient cases, it becomes less frightening and you began to gain confidence in
yourself to apply your knowledge and critical thinking skills to make an independent nursing
judgement.
our care is beneficial to the patient. If the outcome from our judgement doesn’t go as planned,
we can analyze what went wrong and what could have been better for next time. According to
Clinical Judgement and Decision Making in Nursing, nursing is a profession that provides
continuous practice-based care; therefore, anything we do for a patient will affect their health
and outcomes. Two of the many duties of nursing include providing effective care and
maintaining a safe environment for our patients at all times. Nursing judgements and actions
need to be evidence-based and considerate to the individualized care each patient requires to
recover from illness (Standing, 2017). Nurses are continuously making rounds on their patients
and at the bedside providing care frequently; therefore, they are typically the first person to see,
hear, and/or notice a change in their patient. Patients can deteriorate very fast in front of the
nurse’s own eyes, so it’s crucial the nurse has the capability to think and make a decision quickly
so the patient has the most beneficial outcome. Nurses also are held responsible and accountable
for the quality of care they provide, and that requires being able to explain and defend the
critical think and decision make throughout their entire shift. Patients’ rely on nurses and trust
them with their lives. This is why nursing is one of the most trusted professions. According to An
Agenda for Clinical Decision Making and Judgement in Nursing Research and Education,
CLINICAL NURSING JUDGEMENT 5
“Acute care nurses face a decision or task every 10 minutes and critical care nurses every 30
seconds” (Thompson et. al 1721). This is a significant deal of nursing judgement in an eight or
twelve hour shift. On top of the long shifts, nurses can be caring up to eight patients on an acute
care unit. It can be very exhausting and stressful caring for all these patients and sometimes
nurses’ are put into life and death circumstances with their patients. A nurse’s judgement may
not always be the best option, mistakes can happen, and a patient death may be inevitable. A
nurse learns from previous situations and experiences. Nurses’ use their knowledge and skills to
provide the most holistic and beneficial approach, but what works for one patient may not work
for another. This is why critical thinking and sound judgement is so important when caring for a
Postpartum Hemorrhage
A time when I had to use clinical nursing judgement was during my OB clinical rotation.
I was assigned to take care of a postpartum patient on the mother/baby unit and the new mother
begin experiencing signs and symptoms of postpartum hemorrhage. The patient was 12 hours
post-vaginal delivery and had her call light on because she stated that she could feel herself
bleeding heavily while lying in bed, as well as experiencing dizziness. She appeared pale and
diaphoretic. I assessed her bleeding and could see a large blood clot about the size of a lemon
and a steady trickle of blood now running down her leg. I palpated her uterus and it felt boggy.
From these signs and symptoms I immediately thought of postpartum hemorrhage. I used my
own judgement and begin massaging her fundus and called for help. The cover nurse and several
others all came in. Her nurse took over massaging and I got a set of vitals. Her blood pressure
was 90/50 and heart rate was 120. The crash cart was brought in just in case and the doctor was
called in. A STAT hematocrit and hemoglobin was ordered, as well as fluids, a straight
CLINICAL NURSING JUDGEMENT 6
catheterization, and a Pitocin drip. The cover nurse was able to pass the rest of the blood clots
and the bleeding stopped after we straight catheterized her and got the Pitocin infusing. It was
definitely a scary experience but my nurse told me I made the right call to begin massaging her
Conclusion
In conclusion, critical thinking and decision making form a clinical nursing judgement.
As a nurse, you are exposed to patient cases that require rapid actions. You gain knowledge and
skills through nursing curriculum and clinical practice and apply it to individualized patient care
when you begin functioning as an independent RN. It’s highly important to have excellent sound
judgment and decision-making skills, because nurses are constantly having to make a judgement
call throughout a typical shift. Nurses use a holistic approach to determine the most beneficial
outcome for their patients. Personally, my most remarkable clinical nursing judgment thus far
was a postpartum hemorrhage patient. I used my skills and knowledge I learned from class and
clinical and made a judgement I thought was most appropriate for my patient. In a few short
months, I’ll be functioning as a registered nurse and I’ll continue to broaden my critical thinking
References
Lee, D., Abdullah, K., Bachman, R., Ong, S. (2017). An Integrated Review of the Correlation
Standing, M. (2017). Clinical Judgement and Decision Making in Nursing. Thousand Oaks,
Thompson, C., Aitken, L., Doran, D., Dowding, D. (2013). An Agenda for Clinical Decision