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Josh Lyder
The clinical judgment of a nurse is an essential tool that is required of all registered
nurses in the field of medicine. It is what sets the position of RN apart from the technical side of
medicine. Nurses are given more in depth training so they can not only do what they need to do,
but also think as an independent medical caregiver. This puts a nurse in a very specific brand of
care that no other practitioner has. The nurse is involved with the hands on, personal care of the
patient, but is still responsible for the assessing, critical thinking, and clinical judgment of those
same patients.
It is inarguable that critical reasoning within the daily practice of nursing very much
improves patient outcomes. Without these critical reasoning skills not only is the best care not
being provided, but there is also a higher risk for mistakes and malpractice. The foundation of
ones ability to use critical reasoning in nursing judgment is active engagement (Levett-Jones,
Sundin, Bagnall, Hague, Schumann, Taylor, & Wink, 2013). Not only does actively engaging in
the nursing process promote learning, but it also increases the nurses observance of what is going
on around him/her. These factors both very much play a role in the nurses ability to make a
clinical judgment in any given situation. A nurse who is less actively involved with their patients
is less likely to use effective clinical reasoning for 3 reasons. Firstly, without regular interactions
with a patient it is hard for a nurse to have a completely up to date picture of what is currently
wrong, therefore any clinical judgments made could be inaccurate (Levett-Jones, et al, 2013).
Secondly, without any real empathetic relationship with a patient the nurse is much less likely to
take the time to think through and use clinical reasoning. Lastly, not engaging enough with a
patient leads to a lack of communication and a lack of trust from the patient, therefore hindering
One of the major reasons for decreased clinical judgment use among nursing staff
is the mass integration of technology into the daily nursing setting (Graan, Williams, & Koen,
2016). With the power of technology nurses are able to attain much more information on their
patients with much less effort. They are also able to quickly run through assessment and other
documentation requiring far less thought and attention to detail. Computerized medicine has
offered immense help to medical field in both reliability and in efficiency. However, it creates the
opportunity for nurses to do the extent of their obligation without the full interaction and
attention to detail Nurses must prioritize seeing patients and engaging in the care for these
patients in order to be fully suited to conduct clinical judgment concisely and accurately.
Another issue that can hinder clinical judgment is poor teaching or environment
(Cappelletti, Engel, & Prentice, 2014). This can refer to instructors in nursing school, nurses
interacted with in school, orienting nurses, or experienced co-workers. Many experienced nurses
have developed their own ways of doing their jobs on a daily basis. Some of these are good
practices that give adequate patient care while being efficient. However, many of these practices
by certain nurses can be ineffective, irresponsible, and at times even dangerous. If a student or
new nurse is exposed to an environment like this they will have a tendency to adapt to their
environment (Cappelletti, Engel, & Prentice, 2014). This can be detrimental to the nurses
clinical judgment to take on these poor practices that tend to be based in short-cuts and lazy
practices. Judgment is something that must be trained and adopted by every new generation of
nurses and it must be done properly. A nurse can very easily believe that she is using good
clinical judgment, however if it is not based on safe, effective nursing practices it could do more
The benefits, however, to properly developed and carried out clinical judgment
are immense. When a nurse is properly trained and has developed an effective ability to
analyze a situation and make the best, safest, and most efficient nursing decision. These
attributes lead to better patient outcomes, more efficient work, better atmosphere, and
higher patient satisfaction (Graan, Williams, & Koen, 2016). In many medical situations,
advanced practice providers are not always immediately available and at times cannot
even be contacted immediately, in this common situation the nurse must rely on their
foundation of knowledge and judgment based upon that knowledge. This can be as
could also be as complex as picking up on the initial signs of internal bleeding and
To conclude, the impact of clinical judgment on the care of patients in any setting
young nurses to be alert and intuitive about their nursing responsibilities and use critical
thinking at all times. It is also important for experienced nurses to talk to the younger
ones to share insight and help to facilitate proper judgment that will have a benefit on the
nursing process and improve patient outcomes. With properly implemented clinical
judgment; patients are safer, patients are happier, staff works better together, and a
medical facility runs more efficiently. Therefore, developing proper nursing clinical
judgment should be a priority for all nursing personnel whether they are a new nurse
finding their footing or an experienced nurse helping usher in the new generation.
CLINICAL JUDGMENT 5
References
Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic Review of Clinical Judgment and
doi:10.3928/01484834-20140724-01.
Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses' understanding of
doi:10.1016/j.hsag.2016.04.001
Levett-Jones, T., Sundin, D., Bagnall, M., Hague, K., Schumann, W., Taylor, C., & Wink, J.
(2013). Learning to Think Like a Nurse. HNE Handover: For Nurses and Midwives, 3(1).