Clinical nursing judgement is an essential skill and key concept when it comes to the
profession of nursing. Clinical judgement pertains to the outcome of utilizing clinical thinking or
clinical reasoning to arrive at a decision. It involves a sequence of actions such as observation,
reflection, and analysis of objective or subjective information. The process of clinical judgement
includes evaluating evidence, relying on one’s intuition, and recognizing patterns to make a well-
informed clinical decision (Grann, Williams, 2018). It is critical for nurses to be able to use good
clinical judgement when performing individualized patient care.
As the healthcare system continues to change and evolve it becomes increasingly
intricate, and nurses are expected to adapt with it whilst being reliable decision-makes. They are
now tasked with performing safe and effective nursing care in these healthcare settings that
demand elevated clinical and cognitive skills compared to previous decades (Connor, 2022).
Nurses do work very closely with a whole multidisciplinary team, but overall perform
autonomous practice and are expected to take full accountability and responsibility for their
actions, making it crucial for them to master the skill of clinical judgement. The decisions,
judgements, and actions nurses take ultimately impact the safety and outcome of the patient,
making it one of the most important nursing skills.
Without the practice of good clinical nursing judgement, many patients would be at risk
for safety concerns and negative outcomes. Enhancing the quality of nursing care and,
consequently, patient outcomes relies on nurses giving priority to the growth of their decision-
making and judgement skills. Nurses are expected to possess and advanced scope of practice and
be capable of providing comprehensive support to their patients. In situations where they cannot 3
fulfill a specific need, it is expected that they can seek assistance from someone else who can
address these needs effectively.
During my last few years in nursing school and my experience working in the hospital, I
have encountered numerous instances of good clinical nursing judgement. One particular
example stands out prominently in my memory, leaving a lasting impact on my nursing career.
This example occurred while I was working as a tech in the Akron Children’s Neonatal Intensive
Care Unit. The nurses I work with at this facility are truly remarkable, and I aspire to emulate
their excellence when I enter the nursing profession. In this notable situation, one of the
oncoming dayshift nurses identified a significant error, potentially preventing a life-threatening
situation for the patient. This nurse was assigned as the resource nurse for the day, with the
responsibilities of supporting the other staff, optimizing patient care, and being helpful whenever
needed. She was doing her morning rounds and laying eyes on all of the babies on the unit when
she walked into one of the rooms and noticed something was not right. On a very small 30-week-
old infant’s vent setting, she noticed a PEEP of 15, when yesterday the PEEP was set to 5. The
nurse knew this couldn’t be correct considering the babies condition and size, so she
immediately reported the finding to respiratory therapy. This error was quickly corrected, and
extensive assessments were done on the infant to ensure no damage was done. This error could
have led to extensive barotrauma or reduced cardiac output which would put this infant at an
extreme risk for mortality. Without the knowledge, attention to detail, or clinical judgement of
this nurse, this infant could have been in an extremely life-threatening situation. Even the
smallest of errors in these infants can put them at such a high risk due to their size and
prematurity. These infant’s organs are not fully developed or ready to work on their own, so any
minor alteration in function can be a life altering concern. These nurses know exactly what to 4
look for and when to report an unexpected finding, due to the extensive risk put on these infants.
I am so grateful and honored to be able to work next to these nurses each and every day and am
proud to call them my coworkers. I am very excited to be able to learn from them and improve
my own personal clinical nursing judgement based on their example.
The Neonatal Intensive Care Unit (NICU) is an extremely specialized environment where
very ill neonates necessitate comprehensive nursing expertise for important monitoring of life-
sustaining interventions (Letcher, 2017). Without this form of clinical judgement knowledge or
skills, these neonates would be at tremendous risk. NICU nurses nationwide frequently encounter
situations where they need to have extensive knowledge in all areas such as cardiology,
pulmonology, and neurology. That knowledge and required extended experience in neonatal care
play a crucial role in obtaining good clinical nursing judgement within this field. This contributes
to better patient outcomes, improved patient safety, and reduced morbidity and mortality rates.
Overall, clinical nursing judgement is significant in the quality and outcome of safe and
effective patient care. Clinical judgement is the skill of apply clinical thinking or reasoning to
make an informed decision. It’s crucial for nurses to be able to observe, analyze, and reflect on
available information to come to these decisions. The process involves assessing evidence,
trusting intuition, and identifying patterns in order to obtain good clinical judgement. When
performing individualized patient care and making decisions for each specific patient, it is
important to use good clinical judgement. The safety and outcomes of patients are significantly
affected by the decisions, judgements and actions taken by nurses, highlighting the importance of
these skills in nursing. And with a mastery of these skills, comes good clinical nursing
judgement and improved patient care.
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References
Connor, J. (2022, July 25). Clinical judgement in nursing – an evolutionary concept ... Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/jocn.16469
Graan, A. C. van, & Williams, M. J. S. (2018, February 21). A conceptual framework to facilitate clinical judgement in nursing: A methodological perspective. Health SA Gesondheid. https://www.ajol.info/index.php/hsa/article/view/167212
Letcher, D. C. (2017, April 29). Simulation-Based Learning: Improving Knowledge and clinical judgment within the Nicu. Clinical Simulation in Nursing. https://www.sciencedirect.com/science/article/abs/pii/S1876139916301360
