Running head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Christopher Ross

Youngstown State University

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Clinical Nursing Judgment

I have grown somewhat interested in the rapidly expanding and potentially problematic

field of automation; the process by which occupations once manned by humans are now left to

machines. When discussing the topic with friends employed in areas other than healthcare, I

have been told that my field of interest- nursing- is one that will likely succumb to automation in

the near future. While I guess it is impossible for me to exactly know the future of nursing, I am

rather sure this will not be the case for one major factor; clinical nursing judgment. In many

ways, clinical nursing judgment resembles the inner workings of machines such as calculators

and computers; they determine solutions based on various inputs. Clinical nursing judgment is

no different. It is a process of gathering information and data and then determining what to do

based on said pieces of evidence.

Lee, Abdullah, Subramanian, Bachmann, and Leong (2017) describe clinical judgment as

such: Clinical nursing judgment refers to the cognitive processes involved in making judgments,

which includes making sense of data and cues and is defined as an interpretation of patient’s

needs, concerns, or health problems followed by a determined course of action. Clinical nursing

judgment allows for nurses to operate professionally in their field. This definition and the skill of

developing nursing judgment is one that must be acquired by nurses in every level of practice,

for a nurse’s judgment is at the core of providing meaningful nursing care to patients. Also, as

with many things, the act of watching more qualified individuals performing certain tasks

increases the confidence of those viewing. According to Coram (2016), when studying the role

modeling effect on nursing students, “the expert faculty reviewer mean scores indicated a novice

rating for the control group and a developing rating for the treatment group.” That is to say, in
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plainer terms, the group provided visual instruction performed better- in the eyes of the master’s

prepared nurses- than those without. Throughout any nursing preparation, observation is

undoubtedly a key aspect of substantive learning. Interestingly, reinforcement achieved by

debriefing has also been found to have a positive impact on nursing judgment. One particular

study found that, after a simulation, students found debriefing further elaborated their framework

by reviewing what they had observed and described their expanding framework by making

logical connections between the patient’s pathophysiology and observation (Lavoie, Pepin, and

Cossette, 2016).

Nurses are tasked with the responsibility of their patients’ well-being, keeping carefully

annotated documentation, and maintaining strong interdisciplinary communication. All of this

can be achieved by having a strong clinical nursing judgment. However, this skill does not come

readily, nor without practice. In a sense, clinical nursing judgment encapsulates the day-to-day

proceedings that dictate a nurse’s actions. As nurses are often the first line of defense, they must

observe the different types of information they can glean from their patient, make an educated

conjecture, provide that information clearly to the physician when necessary, and then use

evidence-based practice to determine how to treat the patient. Many sources describe clinical

reasoning as the most important function of a nurse’s skill set because, without a strong clinical

reasoning skill set, patient care certainly suffers. Clinical nursing judgment is paramount to safe

nursing practice. It is a career-long skill that takes continual practice and learning. There are

seminars, workshops, continuing education services that are focused on helping to polish this

skill. The amount of services dedicated to this alone provides a strong argument of why clinical

nursing is an important part of nursing practice.

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Now that I am nearing the end of my nursing career, the capstone classes have been

revolving around the theme of clinical nursing judgment, I have realized that each class in my

nursing career, not just the capstone class have been cultivating strong clinical nursing judgment.

Indeed, every source that I have come across in regard to clinical nursing judgment states in one

way or another how crucial it is for new nurses to possess and improve upon their critical nursing

skills. Without even noticing it, I have been practicing clinical nursing judgment skills during my

clinicals by using sound clinical judgment skills to provide strong patient care. There is a specific

incident which comes to mind when I think of a time that I used clinical nursing judgment.

I had a clinical rotation in the Intensive care unit, and I was taking care of a patient who

suffered a cardiac arrest and was effectively braindead. He was receiving isotonic fluids through

a triple lumen catheter in his groin at one hundred milliliters an hour. There were orders to run

Zosyn, an antibiotic, at a slower rate. I went into the patient’s room, ready to hang the other bag.

My nursing preceptor asked whether I thought I should hang the IV bag as a piggyback or by

itself. Knowing that the isotonic fluid was helping to keep the patient’s blood pressure stable due

to the brain damage the patient sustained, I knew that it was crucial to run the IV antibiotic

through a separate line, in order to maintain intravascular volume. In this instance, I had to make

a medical decision on the spot and was able to make the correct decision for a critical patient

using my nursing judgment.

Being a nurse brings with it a great deal of responsibility. New nurses, especially, are

often overwhelmed with being in charge of an assignment, having to learn and refine their

judgment. The basis for determining how best to do one’s job is rooted in the concept of clinical

judgment. A nurse’s judgment is a culmination of experiences and information collected and

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honed over a period of years, at least in most cases. It is a fluid process, capable of being altered

or added to as the nurse is exposed to new information. The process of arriving at the point of

making a decision is one that will see little change, but the determination of what to do based on

the aforementioned information will vary with understanding. As said before, as of this time,

human beings are the only entities, organic or mechanical, capable of making sound judgment as

it relates to nursing. So nursing as a profession seems safe from the threat of automation, at least

for the foreseeable future.

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References

Coram, C., PhD, RN, CNE. (2016). Expert Role Modeling Effect on Novice Nursing Students’

Clinical Judgment. ​Clinical Simulation in Nursing, 12(​ 9), 385-391. Retrieved January 28,

2019, from https://www.nursingsimulation.org/article/S1876-1399(16)30026-3/fulltext.

Lavoie, P., Pepin, J., & Cossette, S. (2016). The Contribution of a reflective debriefing to nursing

students' clinical judgment in patient deterioration simulations. ​Nurse Education

Today,50​, 51-56. Retrieved January 28, 2019, from

https://www.sciencedirect.com/science/article/pii/S0260691716302982?via=ihub.

Lee, D., MA, BN, RN, PhD Candidate, Abdullah, K., Associate Professor, Head of Department

of Nursing Sciences, Subramanian, P., Bachmann, R., PhD, MSc, Associate Professor, &

Leong, S., BNSc, PhD, Candidate. (2017). An integrated review of the correlation

between critical thinking ability and clinical decision-making in nursing. ​Wiley Journal of

Clinical Nursing,26​, 4065-4079. doi:10.1111/jocn.13901