Running head: CLINICAL NURSING JUDGEMENT 1

Clinical Nursing Judgement Scholarly Paper

Selina Nuzzi

Youngstown State University

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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.

Keywords: clinical nursing judgement, critical thinking, decision-making

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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

be held responsible for their actions and patient outcomes.

Defining Nursing Judgement

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
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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.

Importance of Nursing Judgement

Clinical nursing judgement is important because it helps us to determine whether or not

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

reasoning behind their judgement and decision making.

Another reason why nursing judgement is so important is because nurses’ constantly

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,
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“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

variety of patients on a daily basis.

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
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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

fundus because she was in fact having a postpartum hemorrhage.

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

and decision-making skills to make independent nursing judgements.

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References

Lee, D., Abdullah, K., Bachman, R., Ong, S. (2017). An Integrated Review of the Correlation

Beetween Critical Thinking Ability and Clinical Decision-Making in Nursing. Wiley

Journal of Clinical Nursing. Pg. 4065-4067.

Standing, M. (2017). Clinical Judgement and Decision Making in Nursing. Thousand Oaks,

California: SAGE Publications INC.

Thompson, C., Aitken, L., Doran, D., Dowding, D. (2013). An Agenda for Clinical Decision

Making and Judgement in Nursing Research and Education. International Journal of

Nursing Studies. Pg. 1721.