Running Head: CLINICAL NURSING JUDGMENT

Clinical Nursing Judgment as Told by a Senior Nursing Student

Alyssa Blosser

Youngstown State University

According to Phaneuf (2008), “The nurse’s judgment is at the heart of care delivery.

Judgment guides action and decisions, not only of the nurse, but also of physicians and other care

providers (p.1).” The critical thinking that nurses do on a daily basis can be referred to as

stacking or in the field of nursing, clinical nursing judgment (Manetti, 2018). It is the

responsibility of a nurse at the bedside to notice the changes patients experience whether they be

positive or negative. It is a nurse’s job to organize, prioritize, and make decisions to benefit the

patient. The American Association of Colleges of Nursing have defined clinical judgment as the

outcomes of critical thinking in nursing practice (AACN, 2008, p. 36). These critical thinking

skills are taught to nursing students by participating in simulations and clinical hours.

Nursing judgment is applying the nursing process to a patient situation by identifying a

problem and then responding with nursing interventions (van Graan, Williams, Koen, 2016, p.

283). Constant assessment is necessary to evaluate patient outcomes and see if more intervention

is necessary. This judgment is what is important in saving lives and and ensuring better patient

outcomes. A useful tool to help develop the necessary ability to critically think as a nurse is

simulation.

A simulation is a technique that is used to produce a situation with outcomes that would

occur in a real clinical environment (Victor, Ruppert, Ballasy, 2017, p. 236). The student’s

performance in simulations should replicate how the student would perform if it was a real

patient. The condition and stability of the patient is constantly changing as the student is

performing different nursing interventions. According to an article in the Nurse Educator (2017),

a quantitative study was conducted in Pennsylvania that tested the differences in and

relationships between clinical nursing judgment development, simulation performance, and

clinical performance. The study found that there is a strong correlation between the performance
CLINICAL NURSING JUDGMENT 3

of nursing students in the simulated scenarios and their clinical judgments when it comes to

managing patient care (Victor, Ruppert, Ballasy, 2017, p. 236). Studies also suggest that when

students participate in simulation-based learning, their clinical judgments are more developed

(Victor, Ruppert, Ballasy, 2017, p. 238).

As previously stated, clinical nursing judgment is important because all other aspects of

care are guided around a nurse’s findings (Phaneuf, 2008, p.1). If the condition of a patient

changes then it is up to the nurse to inform the doctor or consult with other specialties to form a

new plan of action. The nurse can be thought of as the eyes and ears for the other health care

professionals. Another big responsibility that is stressed in nursing school is being an advocate

for a patient. This can be done through numerous different actions such as having to question an

order from a doctor for a medication or asking for different orders to fit the religious or cultural

expectations of the patient. These are just two examples of how nurses advocate for their patients

when in all reality, providing quality care in and of itself is advocating for a patient.

One of my favorite stories to tell from my time in nursing school involves the clinical

nursing judgment I learned as a student and was then able to use as an aide. I pride myself in

checking in on my patients every time I get a free second to ensure that their condition has not

changed for the worse and that they don’t need anything from me. I vividly remember that I was

working a day shift from 3-11:30 PM and there had been a male patient at the end of the right

side of the hallway. Throughout the day I had been in and out of his room and talked to him on

numerous occasions. It was visible that this gentleman wanted someone to talk to but didn’t have

any visitors coming to see him. He was so happy to talk to me and tell me all about his life but

throughout the day he began talking less and less which is when I knew something wasn’t right.
CLINICAL NURSING JUDGMENT 4

I went into the patient’s room around 11 o’clock and found that he had been vomiting and

was doing so for a prolonged period of time. At this point it was just bile being vomited and I

then checked his vitals which were all elevated. I did for him what my mother does for me when

I’m sick, I got wet washcloths to put on his head to cool him down and rubbed his head while he

vomited. I also rinsed his mouth every time he vomited so he didn’t have to taste it and changed

his gown. Within my scope of practice as an aide I prioritized comfort and also advocacy as I did

not feel comfortable leaving him even though my shift was ending at 11:30.

I went to the patient’s new nurse and gave him an update on the vitals and also gave him

a rundown of the assessment I performed. The nurse didn’t seem concerned and I felt as though

he blew me off. That was until I told him that I was not clocking out and leaving until he gave

me the comfort of simply assessing him visually. When he began his assessment, he knew

something was wrong and called the doctor immediately to update him on what was happening.

The nurse then proceeded to compliment my assessment skills and advocating for my patient.

The next day I went back to work and was floated to another floor. Before I left work that

night I went to check on my patient from the previous night and see how he was. My first red

flag was that the patient’s room had been moved from the very end of the hall to the room closest

to the nurse’s station. From personal experience I knew that the patients who need closer

observation take priority for the rooms closest to the nurse’s station. When I asked for an update

I was informed that the patient was found to have an ileus. The ileus could have been missed if

the nurse continued to refuse to assess him when I trusted my nursing judgment and advocated

for my patient.

Clinical nursing judgment lays the entire basis for the profession of nursing and the care

that patients receive. It is important for schools to begin laying the foundation for this by
CLINICAL NURSING JUDGMENT 5

providing simulation-based learning and other clinical opportunities to learn first hand the

importance of critical thinking. Studies have proven that this type of learning helps increase

clinical judgment skills of new nurses and also helps them to better manage patient care. I

personally believe that my education at Youngstown State University has given me this

foundation. This can be evidenced by my ability to stand up confidently to an experienced nurse

as an aide because I knew something wasn’t right. Nursing truly is a work of heart.
 CLINICAL NURSING JUDGMENT 6

References

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,54(1),

102-110. doi:10.1111/nuf.12303

Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession(Tech.).

Retrieved February 27, 2019, from http://www.prendresoin.org/wp-

content/uploads/2013/01/Clinical-Judgement-.pdf

The essentials of baccalaureate education for professional nursing practice. (2008). Washington,

D.C.: American Association of Colleges of Nursing. Retrieved February 27, 2019, from

http://www.aacnnursing.org/portals/42/publications/baccessentials08.pdf

Van Graan, A. C., Williams, M. J., & Koen, M. P. (2016, August 08). Professional nurses'

understanding of clinical judgement: A contextual inquiry. Retrieved February 27, 2019, from

https://www.sciencedirect.com/science/article/pii/S1025984816300047

Victor, J., Ruppert, W., & Ballasy, S. (2017). Examining the Relationships Between Clinical

Judgment, Simulation Performance, and Clinical Performance. Nurse Educator,42(5), 236-239.

doi:10.1097/nne.0000000000000359