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Clinical Nursing Judgement From a Nursing Student Standpoint

Iqra Imran

Bachelors of Science in Nursing, Youngstown State University

NURS 4850: Nursing Capstone

Dr. Randi Heasley

February 23, 2024

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Clinical Nursing Judgement From a Nursing Student Standpoint

A key component in the profession of nursing is clinical nursing judgement. It is an

essential skill that nurses are expected to learn and continue to improve throughout their careers.

Nursing judgement involves various concepts of nursing practice that collectively need to be

utilized in order to appropriately implement and achieve this acquired skill. “Clinical judgement

is the accumulation of knowledge and skills over time, which contributes to the nurse’s ability to

analyze and synthesize the patient presentation, objective and subjective data, and then provide

evidence based nursing interventions to improve patient outcomes” (Embler, 2021). To

summarize, nursing judgement is a guide to safe decision making in favor of patient advocacy

and high quality of care. Over time, with lots of experience and practice, nursing judgement

becomes the subconscious way of thinking and acting.

Research and history confirms the importance of clinical judgement in each and every

health care profession. As mentioned earlier, nursing judgement requires the use multiples kills.

Some of these factors include evidence based practice, experience and knowledge including

critical thinking, and the nursing process. Nurses are expected to work towards becoming

proficient in these areas and make improvements as they progress through their careers. Critical

thinking and clinical reasoning are two extremely vital skills that directly affect clinical

judgement. Using experience can be difficult for new grad nurses because the lack of years of

work to fall back on. However, a nurse should have an open mindset to continuous achievement

of learning from past case scenarios. Nurses in all stages of their career can continue to acquire

knowledge and develop a readiness to implement nursing judgment by continuing their

education, exchanging feedback, and being up to date with evidence based practices (De Tantillo

et al., 2019).
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Through my progression in the nursing program, I have learned and gained an incredible

amount of knowledge both through lectures and clinical rotations. My understanding of and

personal experience with nursing judgement has changed immensely throughout the years. With

the help and observation of professors and instructors, I believe I have improved my clinical

judgement. A great example of when I used nursing judgement is during NCLEX practice tests,

particularly with the case scenarios. The NCLEX is all about applying yourself using everything

you have learned in the past and the information that is provided about the scenario. I have also

utilized nursing judgement in the clinical setting. During my precepting shift, we had a new

admit of a middle aged female who was admitted with acute respiratory failure and DKA. In the

ED she was given 10 units of insulin and an insulin drip was started due to her blood sugars

ranging from late 300s to 500. Upon arrival to the floor, she was able to ambulate to the bed with

a standby assist. I did the initial assessment and took her vitals. With the ED notes and my

knowledge of her diagnoses, I had certain priorities set for her immediately without having any

physician orders. I immediately checked her blood sugar which was 181. I observed and asked

her whether she was still experiencing hyperglycemic symptoms such as polyuria, polydipsia,

polyphagia, blurred vision, headache, feeling nauseous, and such. From her vital signs I knew

she wasn’t tachycardic or tachypneic, and her BP was within normal range. I asked her if she

used oxygen at home and if so what is her baseline, which to that the answer was no she does

not. She came up to the floor with 2L on the nasal cannula but we took her off of it to see how

she manages. With the oxygen, her pulse ox readings were 94-95% and 88% without it so the

oxygen was placed back on. I also recommended to my nurse that we put a fall risk band on her

and put the bed alarm on due to her previous high blood sugar readings and low oxygen

saturation. The shift ended after I completed her blood work. I can make an educational guess
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that the physician would have corrected the acidosis response (if present) with bicarb along with

normal saline fluids. Potassium would also have to be replaced since she was in DKA. She

would be on strict intake and output. Though all of this may seem like common knowledge, I

believe it is still considered clinical judgement. Based off a nursing article, the attributes of

clinical judgment include cognitive process in terms of thinking, perceiving, categorizing which

allow for decision making, observation, assessment, interpretating and prioritizing data,

responding, and reflection (Uppor et al., 2022). I believe I exercised all of those elements.

Nursing judgement is not only about life and death situations. It can be the simple routines you

do on a daily basis without recognizing the true extent of your professional abilities. Another

time I have used nursing judgement is when holding medications. The decision for when to hold

them and for what reason comes down to your judgement. Not all physicians will write

parameters on these medications and typically you cannot get that information in a timely

fashion so it’s up to the nurse to decide whether to administer it or not. There have been

countless times where I have checked a patients vitals and seen that their blood pressure or heart

rate is below normal values, in which case administering the antihypertensive medication would

be inappropriate. With my preceptor, I held the medication and documented the reason for

holding. This action had to be taken because the patient’s BP would’ve definitely dropped even

further with the beta blocker and that itself can lead to other issues.

Many nursing students turn to their intuition and ethics to confidently make decisions.

Experienced and dedicated instructors can guide students by supporting them in a safe

environment that promotes growth and learning. According to American Nurse Journal, nurse

preceptors help to bridge the gap between academic-practice through modeling, questioning,

concept based teaching, reflection and feedback. Nurse preceptors play a vital role in new nurses,
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like myself, in successful transition to the practice (Grube, 2023). I hope to take everything I

have gained from the BSN program, and apply that knowledge to provide high quality and safe

patient care here on out.

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References

De Tantillo, L. & De Santis, J.P. (2019). Nursing Judgement: A concept Analysis. ANS

Advances in Nursing Science, 42(3), 266-276.

https://doiorg.eps.cc.ysu.edu/10.1097/ANS0000000000000245

Embler, P. (2021, March 9). Imparting clinical judgment leading to sound clinical decision-

making and patient advocacy. Wolters Kluwer.

https://www.wolterskluwer.com/en/expert-insights/imparting-clinical-judgement

Grube, T. (2023, July 9). New nurses and clinical judgment. American Nurse Journal.

https://www.myamericannurse.com/new-nurses-and-clinical-judgment/

Uppor, W., Klunklin, A., Vsekul, N., & Skulphan, S. (2022). A concept analysis of clinical

judgment in undergraduate nursing students. Nursing Forum, 57(5), 932-937.

https://doi-org.eps.cc.ysu.edu/10.1111/nuf.12757