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Clinical Nursing Judgement
Clinical Nursing Judgement
Morgan McAllister
Clinical nursing judgement is an essential key to nursing. Margot Phaneuf came up with
her own definition of clinical nursing judgement as, “a concept which is critical to the nursing
profession as a result of its outcomes.” Essentially, clinical nursing judgement is when there is a
situation related to a patient. It is the nurse’s responsibility to use clear judgement and opinion in
order to make the best decision for the best possible outcome. This can be difficult for some
nurses, especially those who are just starting their career, because much like any other time when
a decision is being made, you may be torn in different directions as to what is the best decision.
Understanding of the situation and being knowledgeable on what is at hand is a must. In order to
make the best judgement, it requires close observations to identify the situation and have the best
outcome.
To obtain a nursing license, it takes multiple years along with many clinical hours.
Nurses receive an extended amount of training and education in order to become a great nurse.
With many years of experience, making sound decisions may be easier than those who are just
starting out. Mary Cazzell (2018) says in a recent journal the gap between nursing education and
practice will not be bridged until baccalaureate curricula address the complexities and rapid
changes in nursing practice (p. 1). There may be times where decisions are obvious and by the
textbook, but a nurse will not always run into a clear-cut situation. Sometimes, no matter how
many years of experience and education a nurse has, they will have to make decisions based of
their intuition and knowledge to the best of their ability. That is what we call clinical nursing
judgement.
When it comes to caring for a patient, nursing judgements are being made every day. In
Manetti’s (2018) journal over nursing judgement, she says bedside nurses must notice subtle
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cues and changes in a patient’s condition to prevent complications and detect problems as soon
as possible (p. 102). As a nurse, obtaining vitals, performing assessments, and bed side care are a
part of their daily routine. When they sense something is off, it is key for their nursing judgment
to be used. A patient may have a fever, sore throat along with a rash while in the process of
receiving blood. A clinical nursing judgement would be for the nurse to recognize these
symptoms as an allergic reaction to the blood transfusion and stop the treatment.
When it comes to transitioning from nursing school to life as an employed nurse, it can
be hard for new graduates who don’t have very many opportunities to use their judgement due to
assignments being much smaller and having focus on only one or two patients in the clinical
setting. As a senior nursing student from Youngstown State University (YSU), our professors
and clinical instructors do everything they can to teach us about making clear, educated decisions
and using nursing judgement when in the clinical setting. I have been taught in many clinicals
how to prioritize patients and their illnesses in order to give the best care I can. Critical thinking
is a huge part of making clinical nursing judgements and in nursing school it is a large part of the
education. At the beginning of the program at YSU, a critical thinking test is to be taken as a
brand-new student to see how sound your judgements are before starting the program and being
educated. At the end of the program, before graduation as a senior, you take the critical thinking
test again to see how far you have come with the educational background to make better
judgements.
With simulations, clinical experience, case studies, and exams to test critical thinking,
YSU’s nursing program conditions us for using clinical nursing judgement in our future careers.
In a recent study, Lavoie (2019) states how important debriefing is after clinical simulation to
understand how the student interpreted the simulation and how well it was understood. In his
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CLINICAL NURSING JUDGEMENT
study, students went to simulations with different scenarios and cases. Randomly selected
students reflectively debriefed afterwards while others only self-debriefed. Situational awareness
was measured for clinical nursing judgement. The students who did not debrief did not perform
as well or retain the knowledge they were supposed to receive out of the simulations. Those who
understand changes in patients and the recognition of abnormalities (p.514). This study proves
how important it is to have students experience a clinical situation and learn from it through
reflection and understanding changes to bring that bridge together between being a student nurse
to a registered nurse.
In my time as a nursing student, I have been challenged to make my own judgement calls
in order to give the best possible care to my patients. An example of a time I used clinical
nursing judgment was when I was at Akron Children’s Hospital. A teenage girl came through the
emergency room due to suicidal ideations. My nurse and I did an assessment but could not calm
her down to talk to us. She was extremely distraught and breathing fast. My nurse became easily
frustrated and wanted to wait for the doctor. Due to knowledge of psychiatric patients, I used my
education to perform milieu therapy with the patient to prevent harm to herself. Sitting with the
patient and allowing her to talk when she was ready and calm was what she needed. She asked to
hold my hand because she was scared and instead of leaving the room and giving up on her when
she wouldn’t talk, I sat patiently with her and recognized her feelings, so she felt safe and heard.
I never left her alone because of the risk of harming herself. This quickly calmed the patient
down where if I would have left, she may have felt even more panicked, scared and would not
because your patients well-being and lives depend on it. Without nursing judgement, we put
many patients at risk. Having excellent judgement makes a world of a difference in the type of
nurse you will be. I am thankful for my experiences at YSU in order to prepare me to be the best
Cazzell, M. (2018). The Impact of Critical Thinking on Clinical Judgment During Simulation
http://dx.doi.org/10.5480/15-1553
Lavoie, P., Pepin, J., Cossette, S., & Clarke, S. P. (2019). Debriefing approaches for high-
Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession. Journal
http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement–
An_Essential_Tool_in_the_Nursing_Profession.pdf
doi: 10.1111/j.1365-2648.2007.04583.x