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Carly Greenwood
NURS4852 – Serroka
In the health care system, there are a variety of different professionals who are involved
in the care of one individual. A health care team could consist of, but is not limited to,
physicians, residents, nurses, dieticians, physical therapists and respiratory therapists. Although
each health care professional has a different task at hand during their care, they each have a
common goal: improving the health of their patient. It is because of this common goal that the
team collaborates their work while completing their individual job to provide holistic care for the
patient. Nurses spend a vast majority of their time caring for their patients within the hospital;
they are responsible for completing assessments, implementing doctor’s orders and initiating
proper interventions, making clinical nursing judgement an important quality to have. Clinical
nursing judgement can be a hard concept to understand, as it is an important process gained with
experience that nurses use every day to decide what is best for their patient during that time.
Bussard defines clinical judgment as “the ability of a nurse (or nursing student) to gather
patient data, make sense of that data and then evaluate both the patient’s and one’s own actions.
Self – reflection has been identified as a key component to developing clinical judgment and
should be incorporated throughout the curriculum.” (Bussard, 2017, p.1). Nurses use clinical
judgment to provide proper and safe care to their patients while they are in the hospital by
prioritizing what is most important and then implementing the proper interventions. They look at
what data they have available such as the patient’s chart, their assessments and the patient’s
appearance to identify what the problem is and then what they can do to fix it. As a quick
example, imagine a nurse walking into her patient’s room to administer his morning medications
and she notices that his oxygen stats are down to 85% when they are typically in the mid 90’s.
Interpreting the data she has available, she knows that the patient is most likely having difficulty
breathing. She could raise the head of the bed, apply oxygenation, check the pulse oximeter and
Clinical Nursing Judgement 3
assess his heart and lungs before administering any medications, since the patient’s airway is of
higher priority.
making it important for nursing students to gain enough experience to have this skill developed
upon licensure. There was a study completed in one nursing school to determine whether there is
progression in clinical judgment using high-fidelity simulations measured by the Lasater Clinical
Judgment Rubric. Seventy students were included in the four simulations and at the end of the
first scenario, the mean score was 24.10 compare to the mean score of 40.17 at the end of the
fourth scenario which signified that there was progression in clinical judgment (Bussard, 2017,
p.2). In addition to this theory, Benner had created a hierarchy in nursing starting with a novice
nurse, which would be a new grad, to an expert nurse, one with more than five years of
experience. He concluded that the novice nurse would have very limited knowledge and
experience which would make clinical judgment more difficult, but the expert nurse has more
experience, self-confidence and better intuition which develops better clinical judgment (as cited
in Phaneuf, 2008, p. 4). While both studies prove that clinical judgement is something that is
gained with more experience, it doesn’t explain it’s importance and how it pertains to nursing.
Clinical nursing judgement is an important tool for nurses in order to provide the safest
and most effective care for patients. By using clinical judgement, nurses gather vital information
and assessment data to prioritize patients based on their severity and come up with proper
nursing interventions. It is also a way to reflect upon previous situations and improve on what
could be done differently so that there could be a better outcome. The best way to understand
fatigue, excessive thirst and urination; he tells the nurse he is a type 1 diabetic and recently
started to feel very sick. Considering that the patient has type 1 diabetes and is showing signs of
hyperglycemia, the first thing the nurse did was take a blood sugar. While taking the patient’s
glucose and touching his arm, she noticed that his skin was very dry and dehydrated. The result
of his blood sugar was 565, he is becoming less oriented since first arriving and his respirations
are at 26 per minute and labored. Using clinical nursing judgement, the nurse would anticipate a
doctor to place orders for 0.9% NaCl and an insulin drip as first priority, since the patient is
presenting signs of diabetic ketoacidosis. The patient would need to have cardiac monitoring
since there is IV insulin running, glucose would need checked hourly along with urinary output
and level of consciousness. This scenario shows that by gathering all of the information possible
quickly, the nurse can determine what is best for the patient and how important it is to provide
In conclusion, as a student nurse who is about to graduate from nursing school, I have
come to learn the importance of clinical nursing judgment and how to implement the process.
Since I have now completed multiple clinicals, simulations and also my preceptorship I have had
different experiences to help contribute to my formation of clinical judgement. Nurses are with
the patient’s the most throughout the day and by assessing their patients they can determine the
abnormal findings and significant changes in data to determine their current health status and
interventions that could implement to help their patient. This interpretation of data and the
interventions used is the process of clinical nursing judgement which is important to providing
safe and proper care and is the kind of care every patient has the right to have.
Clinical Nursing Judgement 5
Work Cited
Bussard, M.E. (2017). Evaluation of Clinical Judgment in Prelicensure Nursing Students. Nurse
Educator. 00(0), 1-3.
McNiesh, S. (2007). Preceptors Perceptions of New Graduate Nurses. Holistic Clinical
Judgment. 72-78.
Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession.
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