Alicia Leone

Clinical nursing judgment in a formal perspective denotes the ability of one to understand

the pathophysiology behind an illness, and the ability to problem-solve and use clinical judgment

when coming to a resolution. I strongly believe that nursing judgement is backed by experience

and instinct based on concepts learned from the previous years. Nursing assessments are always

documented based on objective data and should be as accurate as possible. In the case of a

patient with a deteriorating status, precise documentation and clinical reasoning allows for the

nurse to detect abnormalities with data and perform new interventions for a patient.

Today, nursing judgment is becoming increasingly important due to higher acuity

patients, a shortage of nurses, and increased workload of the nurse. Employers are expecting the

new graduate to possess ethical decision making and leadership skills to provide a safe and

effective environment for patients (Coram 2016). Nurses are responsible for their own actions, as

well as the STNA and the LPN who also may be providing care for patients. This means nurses

must be aware of the environment, any deteriorating patient conditions, and be able to delegate

based on acuity of care. It is important to keep in mind the status of a patient and be able to

prioritize effectively, so that the RN can utilize time management and resources well.

Nursing judgment occurs everyday subconsciously with a well experienced RN. As for

nursing students, it is of upmost importance to problem-solve before coming to a conclusion on

the status of a patient whether due to, decreased oxygen saturation, decreased/increased urine

output, or changes in vitals. Simple steps to reduce panic and unnecessary treatments may be to

analyze the surrounding environment and to assess the patient first. Rapid changes in vitals could

be fatal, or they could be from something as simple as a cuff not properly fitting the patient.
 Nursing judgement goes far beyond what any school book can entail. Judgment and

competency is learned through technique, observation, and experience. Nursing students may not

have the best judgment as a new graduate, however, by showing leadership and evidence-based

practice skills, one can achieve the best patient outcome. It is especially important to become an

advocate for the patient and provide expertise when needed. Patients are susceptible to

confusion, disorientation, and anxiety due to being placed in a new setting that one is not familiar

with. Care can be delegated to the LPN/STNA, but nurses must understand the status of the

patient and educate as necessary.

In order to provide care in a timely, structured and holistic mannered way, nurses must

work together with other professionals to achieve a desired outcome. “To facilitate and maximize

the integration between team members and optimize the distribution of tasks across the team, it is

important that all team members understand the roles, scopes of practice and competence of each

of the professions which comprise the team” (Halcomb 2017). Not only must nurses be vigilant

when deciding care, but also must coordinate with other members of the team.

Precepting allows upcoming graduates to thoroughly focus on patient care more than

clinical rotation. Shifts of eight to twelve hours coordinates a strict time frame for managed care.

It also allows for interaction and leadership skills between the RN and the nursing student.

Delegation of tasks from the RN to the student promotes leadership and building of trust.

“Effective preceptorship can help the newly qualified nurse adjust to the demands of their new

role. Inadequate preceptorship can leave the newly qualified nurse to feel overwhelmed, and

more likely to consider leaving the profession” (Allan 2017). Today nurses must focus on the

continuity of complex diseases, while also treating acute exacerbations, as well.

 Within the past four years as a nursing student, I have learned skills pertinent to

conditions, comorbidities, labs, diagnostic testing and most important, - humanistic care. Clinical

rotation has allowed me to form relationships with patients and nurses. I have been seen both life

and death, and coordinated patients care in the best of my ability. Very little experience I have

obtained has came from personal decision making. Throughout my nursing career, I have

collaborated with the RN and teachers to make decision regarding patient care. In one case

scenario, I had a chance to make a change in my patient’s comfort level. I collaborated with the

nurse in a timely manner in order to reach a therapeutic goal.

An example of when I used clinical nursing judgment happened in professional nursing,

when I had to be an advocate for a patient with a chronic illness. This patient was a new admit,

and nurses were patiently waiting for doctor’s orders to come back. This patient was in severe

pain and the only medication ordered at the time was acetaminophen 650 mg. After giving the

patient one dose of the medication, I reassessed the pain a half hour later. The patients pain was

still 10/10, and I discussed the situation with the nurse. After about an hour or two of advocating

for the patients’ condition, the nurse finally decided to call the doctor to obtain a new pain

medication. After giving the patient the new medication, morphine, she felt better and was able

to resume normal ADL’s with limited help.

A simple change in pain mediation can improve a patients’ condition. It can improve the

quality of life as well as comfort for the patient. Chronic pain can be debilitating and reduce the

functioning of everyday living tasks. Excoriating pain can increase the nurses time spent with the

patient to help with bathing, positioning, and range of motion. It is very important to monitor the

status of pain, so the nurse can keep it at a minimum before it progresses. Assessment of pain is

one of the most important things a nurse can do to promote comfort care.
 References

Allan, H. T., Magnusson, C., Evans, K., Horton, K., Curtis, K., Ball, E., & Johnson, M. (2017).
Putting knowledge to work in clinical practice: Understanding experiences of
preceptorship as outcomes of interconnected domains of learning. Journal of Clinical
Nursing, 27(1-2), 123-131. doi:10.1111/jocn.13855

Coram, C. (2016). Expert Role Modeling Effect on Novice Nursing Students Clinical Judgment.
Clinical Simulation in Nursing, 12(9), 385-391. doi:10.1016/j.ecns.2016.04.009

Halcomb, E., Stephens, M., Bryce, J., Foley, E., & Ashley, C. (2016). Nursing competency
standards in primary health care: an integrative review. Journal of Clinical Nursing,
25(9-10), 1193-1205. doi:10.1111/jocn.13224