Running Head: SCHOLARLY CAPSTONE PAPER 1

Scholarly Capstone Paper

Paige Bandera

Youngstown State University

SCHOLARLY CAPSTONE PAPER 2

Nursing as a profession has evolved rapidly since the nineteenth century. Florence

Nightingale recognized that nurses had to be more than caregivers. She realized that as medicine

advanced so must nursing. Advancement, in nursing, is rooted in the concept of clinical nursing

judgement. This paper will expand on the concept of clinical nursing judgement. First, by

defining the concept and then by explaining the concept’s importance. Finally, I will share a

personal experience in which I employed clinical nursing judgement so that the topic may be

thoroughly understood.

According to Seidi, Alhani and Salsali (2015) clinical nursing judgment “is mainly based

on nurses’ knowledge and experience as well as their reasoning, intuition, clinical thinking, and

evidence-based practice skills” (p. 1). To put it simply, clinical nursing judgement is when the

nurse uses everything she has learned, everything she has observed and every skill she has

obtained to provide her patients with the best care. Clinical nursing judgement is putting all the

pieces together which will result in “nursing diagnoses, effective clinical decision-making,

problem solving and the improvement of care quality” (Seidi et al., 2015, p. 1).

As aforementioned, clinical nursing judgment is how nurses advance as professionals.

Advancement of the nursing profession through the utilization of clinical nursing judgement is

important because it enables the nurse to function at their best. Williams et. al. (2016) envision

an “individual RN who was knowledgeable about and accountable for the applicable standards

and scope of practice; educated and committed to engaging in a journey of lifelong education;

and accountable for and able to articulate his or her professional value” (Process, para. 6).

It is important for a nurse to function at the highest professional level possible because it

improves patient outcomes. To function at the highest level possible nurses must rely on their

clinical judgment. They strive to be professionals because they are caring for the life of another
SCHOLARLY CAPSTONE PAPER 3

human being. Nurses cannot afford to simply utilize clinical skills without consulting their

knowledge base and experiences. For example, Wallis (2016) summarized the “the benefits of

higher education levels in nurses” (p.14) while comparing three reports that linked professional

nurses to improved patient outcomes. Clearly, nurses can no longer function at a vocational or

technical level: they must function as professionals.

Clinical nursing judgment is the key component of professional nursing and subsequently

of improved patient outcomes. Seidi et al. (2015) noted “that education enhances nurses’ clinical

judgment skills” (p.2) after discussing how it was integrated into nursing curriculums. To

become a nursing professional, one must learn nursing clinical judgement. To be a nursing

professional, one must utilize and build upon their clinical judgment daily. Patients do not need a

skilled caregiver. Patients need a professional, a nurse, who is consistently employing clinical

judgement.

The concept of clinical judgment has been explained and its importance validated. Now it

is time to look at it from a personal perspective. How has my education, at Youngstown State

University, prepared me to be a professional nurse?

From day one of health assessment, we, nursing students, have been instructed on how to

“put the pieces together”. We were not taught to simply observe “the patient has cyanotic nail

beds”. We were taught to observe the nail beds, question the origin of cyanosis, treat it within

our scope of practice and determine what the next best action would be because it never ends

with simply treating a problem.

I believe that our instructors have done an excellent job of getting us to use clinical

judgement, from day one, of our clinical rotations. Therefore, I think it would be most helpful to

talk about my first patient on a hospital floor. My first patient was a drug overdose; however, she
SCHOLARLY CAPSTONE PAPER 4

was not admitted under that diagnosis. While doing my clinical paperwork I realized that my

patient had attempted to kill herself, upon talking to her I learned that it was because her mother

had died two weeks prior to that.

The patient was in stable condition except for extremely high liver enzymes. I had to look

at the big picture when determining nursing diagnoses for this patient. I had to use my clinical

nursing judgment to understand that this patient no longer needed physiological diagnoses but

that she need psychosocial diagnoses.

Once I gathered three psychosocial diagnoses for the patient I was able to use my care

plan book to determine the best interventions based on each diagnosis. All my interventions were

psychosocial. To this day I believe that I helped that patient in ways that a less involved nurse

would not have.

Had I not employed my nursing clinical judgement and instead focused on the medical

diagnosis of my patient then none of my interventions would have been effective. I had to look at

her history, her labs, her vitals and assess that the problem was no longer physical. I had to

utilize nursing clinical judgement to provide her with the care she needed.

I learned that day that nursing clinical judgment is what separates a nurse from a nurse’s

aide and even a doctor. It is what makes a nurse a professional. Nursing is a profession because

nurses have special insight that no other member of the healthcare team has access to. It is our

duty to utilize that insight, that judgement, each time that we interact with a patient. Nursing

clinical judgement is the only way a nurse can provide their patient with the best care.
SCHOLARLY CAPSTONE PAPER 5

References

Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses’ Clinical Judgment Development: A

Qualitative Research in Iran. Iran Red Crescent Medical Journal, 17(9), 1-8. Retrieved

March 13, 2018.

Wallis, L. (2016). Data Again Show Nurse Staffing Improves Outcomes in a Variety of Settings.

American Journal of Nursing, 116(3), 14-14. Retrieved March 13, 2018.

Williams, T., Baker, K., Evans, L., Lucatorto, M., Moss, E., O'Sullivan, A., . . . Zittel, B. (2016).

Registered Nurses as Professionals, Advocates, Innovators, and Collaborative Leaders:

Executive Summary. The Online Journal of Issues in Nursing, 21(3). Retrieved March

13, 2018.