Clinical Nursing Judgment

Julia C. Hum

Centofanti School of Nursing, Youngstown State University

NURS 4850: Nursing Capstone

Dr. Randi Heasley

February 27th, 2024

 Clinical Nursing Judgment is an essential asset in the healthcare industry to ensure

quality patient care and the safety of all patients. From the information gathered, I have found

that clinical nursing judgment essentially means the capability of a nurse to be able to make

decisions during their practice as a healthcare worker. It is not a dichotomous term, as it is more

an entire concept and way of thinking that all great nurses demonstrate. It is essentially the ability

for a nurse to see a situation at hand, quickly run through all the information in their head that the

nurse has learned throughout schooling and experience, and then critically think about the

decision at hand, allowing them to make a decision on what to do that will be at the greatest good

of the patient. (Clemette, 2021)

This judgment can be a hard topic to measure or “test” new nurses on. All Registered

Nurses are required to complete an undergraduate program and then pass their written N-CLEX

licensure exam, but there is really no “clinical judgment” exam or standards that are required

before practicing as an RN, even though clinical judgment is the most important thing to ensure

patient safety at the bedside. As nursing students, we rotate through several clinicals during our

time in school. This is an introduction to nursing clinical judgment and how it can be used. We

then hopefully get an extensive on-unit orientation at a job in order to further the introduction to

developing these essential skills. Even with all of these assets that are given to us, developing

these clinical judgment skills takes time and repetitiveness through practice. It takes experience

after experience of making right decisions, and making wrong decisions and learning from those

mistakes, so that the nurse is able to know what to fix next time a similar situation happens.

A nurse can know almost everything about a diagnosis; the pathophysiology, the side

effects, the medications and actions used to treat it, the contraindications, the orders, etc. Even
with all of this knowledge, if something happens with this patient that is not black and white with

the current diagnosis or situation, and the nurse is not able to effectively change the course of

treatment to accommodate, efficient nursing will not be practiced.

Clinical nursing judgment is essential for all nurses to impose for many reasons. One of

the main reasons this is important is during an emergency setting or trauma. Trauma situations

rely solely on nurses and doctors to be able to use their background knowledge and skill at a fast

pace, in order to potentially save patients' lives. As briefly mentioned above, there are two

aspects that are imposed in clinical judgment; knowing the information and being able to apply it

to the current situation. Without a nurse possessing both of these attributes, clinical decisions

cannot be made in a fast manner, potentially putting patient safety at risk. (Dix, 2021)

Healthcare is a continuously changing field, so keeping up with current practices and

standards while also using your own judgment as a nurse can oftentimes be a difficult task. As a

nurse, they are oftentimes the first people to evaluate a patient in an ER once they are admitted

in. If nurses are not able to pick up on signs of respiratory distress, what certain signs and

symptoms can lead to, potential causes for the issues at hand, and knowing what they can do to

ensure airway, breathing, and circulation, lives can be at great risk. (Phil, 2022)

While in nursing school and going to clinicals, I have also worked two hospital jobs as a

tech / extern and got a great view of what being a nurse who imposes clinical judgment is. When

thinking about a time I had to use nursing clinical judgment, I thought about a very specific

situation. This situation happened during my time at the NICU. The nurse and I were assigned a

baby who was on CPAP for respiratory distress due to prematurity and needed respiratory

support. This baby also had an OG (oral gastric) tube in place for supplemental feeding. During

the entirety of the shift, we checked placement by measuring at the lip line and aspirating the
tube with a syringe before each feeding to check for stomach content. Conducting these routine

checks ensures that the feeding is entering the stomach. During our last feed of our shift, we

routinely checked this placement and ensured it was correct, which it was. We then aspirated

stomach contents, and started the feed through the pump. We remained in the room, charting and

hanging new fluids for the baby. The CPAP alarmed that the oxygen saturation was below 88%,

and it started to drop a little bit lower than that. My nurse checked that the CPAP prongs were

correctly in the nostrils and checked the tubes for water, which my nurse discovered there was.

She drained the tube into the canister, yet the baby's oxygen saturation was not coming up.

I then looked at the OG tube and noticed that the OG tube was almost completely out of

the baby's mouth, causing the feed to run into the patient's nose and causing them to choke. The

baby had pulled its hand out of the swaddle, and pulled on the OG tube. I expressed this to the

nurse and we quickly pulled the OG and stopped the feed while also sitting the patient up. This

was thinking out of the normal realm with this patient, because normally with a vented patient

and low 02 saturation, the system we would think needs addressed would be their respiratory

support.

I quickly was able to notice that since this was not what was causing the patient to not

breathe well, it had to be something else causing it. This was essential because if this was not

checked and we had just upped the fi02, the feed would have continued to run into the wrong

location, and the fi02 would still not have benefitted the patient. It was great that we were

remaining in the room and able to find this problem almost immediately before it potentially

caused serious harm to the patient. After we did this for the patient, their 02 saturation came up

to above 93%, and I was then able to insert a new OG. Clinical judgment is not something that is

able to be learned overnight, and I truly believe that the best nurses are ones that have had the
most experience practicing these skills and continue to learn from their mistakes. Nursing is a

field of ever changing education practice, and learning and practicing our clinical judgment

fields is vitally important for patient outcomes.

 Works Cited

Clemette, V. J. (2021, April 8). The validity and reliability of clinical judgement and

decision-making Skills Assessment in Nursing: A Systematic Literature Review. Nurse

Education Today.

https://www.sciencedirect.com/science/article/pii/S0260691721001428?casa_token=FGd

sQYbpZmAAAAAA%3AxFuL2uQEJNo4-VZ0foKR3r8c0o5hI59mNH5XCE8QdvD1Td

GCtQY1uInoPUBkyTNq_WeBNVc9QQ

Connor M. Phil, Justine. (2022, July 25). Wiley Online Library | Scientific Research Articles,

journals, ... Clinical judgment in nursing – An evolutionary concept analysis.

https://onlinelibrary.wiley.com/doi/10.1111/jocn.16469

Dix , S. (2021, January 11). Wiley Online Library | Scientific Research Articles, journals, ...

Effectiveness of neonatal emergency nursing education through simulation training:

Flipped learning based on Tanner’s Clinical Judgement Model.

https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.157