Running head: CLINICAL NURSING JUDGEMENT: ITS EFFECTS ON NURSING CARE 1

Antonia Ladd

Clinical Nursing Judgement: Its Effects on Nursing Care

Senior Capstone

Youngstown State University

Clinical nursing judgement is one of the most important aspects of nursing because when nurses

use this skill, they can make good decisions for their patient which leads to better outcomes.

Thinking about why an order was placed or if that medication is okay to give based on how a

patient is doing is something that clinical nursing judgement encompasses, and this is vital to

proper care. In nursing school, one of the first things that we are taught about is the concept of

clinical nursing judgement.

Clinical nurse judgement is defined as “the observed outcome of critical thinking and decision-

making…that uses nursing knowledge to observe and access presenting situations, identify a

prioritized client concern, and generate the best possible evidence-based solutions in order to

deliver safe client care” (Billings, 2019, p. 300). Simply put, by using evidence and good

observation skills we can produce better patient care. This process is vital in order to make safe,

evidence-based decisions which will ultimately impact the outcomes of our patients. This

concept is used in every part of nursing, from medication administration to regularly

repositioning patients in order to preserve skin integrity. In order to provide proper clinical

nursing judgement, one of the tools that helps nurses to make effective decisions is the MEWS

score. “These systems generate an urgent need to attend to the patient deemed to be deteriorating

in health through a track and trigger mechanism, using tools such as the Modified Early Warning

Score (MEWS)..,”(Dalton et. al., 2018). This score looks at vital signs and the psychological

function of the client in order to provide an objective value to determine the severity of the care
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needed. Since nurses work so closely with patients, oftentimes we will pick up on small things

such as a patient not talking quite as much even when family comes or not eating as much as

they usually do when others wouldn’t. Doctors and other medical professionals may not pick up

on these small clues because they spend a very limited amount of time in a patient's room. Since

we spend so much more time in patient’s rooms, it is much easier for us to see changes while

others may only see something when the patient becomes quite critical.

Clinical nursing judgement is very important in keeping patients safe, and on the road to

recovery. Unfortunately, it can be a difficult skill to master. “Recent studies indicate that 23% of

newly employed nurses do not demonstrate entry-level competency and do not make clinical

judgements as effectively as more experienced nurses” (Billings, 2019, p. 300). Therefore, it is

very important for nursing students to start learning and begin practicing clinical judgement

before graduating and taking care of patients on their own. Clinical judgement is developed from

experience. In this manner, nurse confidence is key, and must be utilized when recommending a

course of action or change in treatment due to the small signs others may not be fully attuned to

pick up on. If a medication is not safe to give at a certain point, nurses need to be aware and be

able to use this acquired judgement to determine the correct course of action. “Clinical reasoning

is an integral component of safe medication administration as nurses assess patients and

situations, apply foundational knowledge, plan and administer medications, evaluate patients’

responses to medications and teach patients about taking their medications safely” (Domm, 2018,

p. e403). Many medications have specific parameters that need to be met such as blood pressure,

heart rate and lab work. Nurses need to be aware of these parameters and understand when it is

safe to give a medication. In many ways, clinical reasoning is used to keep patients safe.
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During my precepting, I was given the opportunity to use clinical nurse judgement appropriately.

On one of my precepting shifts, I took the first vitals of the day and I noted that one of my

patients had a heart rate less than 60 but that their blood pressure was above 160/100. During the

8 am medication administration, my preceptor didn’t notice this when we were about to give

hypertensive medications, but I did. I took the initiative and I told my preceptor. We marked the

medications not given with a note and called the doctor. Because of the new information, they

decided to order a different medication that would not affect heart rate. This is just one example

of when I used nursing clinical judgement to give my patient safe and effective care. If I had not,

my patient could have become severely bradycardic and potentially gone into critical condition.

There are many times where I have used clinical nursing judgement in precepting and clinicals

thus far.

All in all, clinical nursing judgement is a very important aspect of nursing. It is a thought tool

that comes with experience and allows a nurse to make good judgements about what is best for

their patient. Since nurses work so closely with patients, they get to build a rapport with patients

and learn many of the characteristics that makes a person unique. So that when a patient starts to

exhibit signs and symptoms that are not their norm, nurses have a greater chance of picking up

on them. Using clinical nursing judgement, nurses can then help to escalate the patient’s care in

order to keep them safe. Throughout nursing school, I have found that clinical nursing judgement

is very useful in keeping patients safe and I hope to continue to build on it as I gain more

experience.
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References

Billings, D. M. (2019). Teaching nurses to make clinical judgments that ensure patient safety.

The Journal of Continuing Education in Nursing, 50(7), 300-302.

doi:http://dx.doi.org/10.3928/00220124-20190612-04

Dalton, M., Harrison, J., Malin, A., & Leavey, C. (2018). Factors that influence nurses’

assessment of patient acuity and response to acute deterioration. British Journal of

Nursing, 27(4), 212–218. https://doi.org/10.12968/bjon.2018.27.4.212

Rohde, E., & Domm, E., PhD, RN, BScN. (2018). Nurses’ clinical reasoning practices that

support safe medication administration: An integrative review of the literature. Journal of

Clinical Nursing, 27(3-4), e402-e411. doi:10.1111/JOCN.14077