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The Nursing Assessment and Clinical Nursing Judgement

Gracey White

Centofani School of Nursing, Youngstown State University

NURS 4852: Capstone

Dr. Kim Ballone and Dr. Wendy Thomas

February 28, 2022

The Nursing Assessment and Clinical Nursing Judgement

Nursing Clinical Judgement is a skill that is developed throughout nursing school and the

skill used the most throughout one’s nursing career. Clinical judgement is the first skill used

when a nurse steps on the floor post-graduation. To me, clinical nursing judgement can be

summed up by going back to the basics of nursing and remembering the nursing process. The

nursing process creates the pillars of nursing and creates the pillars of sound nursing judgement.

With every patient, we assess. After an assessment, we utilize our clinical judgement to develop

a nursing diagnosis. Once we have a nursing diagnosis, we utilize clinical judgement again to

plan our treatment of each patient. Once we have a plan of care, we implement that plan and

finally evaluate our patient to determine if the goals that were set, were met. Clinical judgment is

the glue that holds the nursing process together. It is used every step of the way. That is why “the

National Council of State Boards of Nursing’s (NCSBN, 2018) Strategic Practice Analysis

identifies nursing clinical judgement as being number one of the top 10 high-priority skills for

nurses” (Martin, 2020).

Nurses are required to know a multitude of skills, but the National Council of State

Boards of Nursing argues that clinical judgement is the most important. It is not the first skill that

would come to a nurse’s mind when questioned on the most important skill. However, once it is

defined, nurses realize that clinical judgement encapsulates the entirety of our profession. The

“NCSBN (2018) defines clinical judgement as a ‘skill in recognizing cues about a clinical

situation, generating and weighing hypotheses, taking action and evaluating outcomes for the

purpose of arriving at a satisfactory clinical outcome’” (Martin, 2018). As the medical field

advances, the nursing profession has also become more advanced and clinical judgement has

become of even greater importance. Nurses are given more responsibilities and the “NCSBN
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recognizes the increasingly complex decisions newly licensed nurses make during the course of

patient care” (Martin, 2018). Another article points out that “new graduate nurses face increasing

challenges including staffing shortages and more acutely ill clients” (Dickison, 2019). The

obstacles of good nursing care are becoming greater, so nurses need to be even better prepared

with adequate clinical judgement skills.

Both Martin and Dickison discuss the difficulty of assessing whether new nurses have

good nursing clinical judgement skills. Martin noted students were “not meeting the benchmark

as measured by Educational Benchmarking Inc (EBI), Assessment Technologies Institute (ATI)

and Health Education Systems (HESI) scores” (Martin, 2018). From my career as both a nursing

student and an aide, I have learned that these tests are only a snapshot of the skills it takes to be a

good nurse.

Every semester of nursing school, there has always been a simulation day. But I believe

those were the days I saw both my classmates and my own nursing judgement skills come into

action. Although we know they are plastic mannequins, we were able to treat them as real

patients. They were more than a piece of paper. The thing about nursing clinical judgement is

that it takes more than just someone who is knowledgeable, nursing judgement also takes

compassion. There is something far greater that starts working in the brain of a nurse when there

is a real life on the line and not just a what-if scenario on an exam with hundreds of other what-if

scenarios. We each became nurses because our passion is to care for patients and I’m sure if you

put any nursing student in a simulation room or even a real-life scenario, their performance

would be greater than it would on paper. I won’t lie, I have been worried for some of my

classmates when I hear them talk about their grades, and I have even received a few grades that

made me question whether I would make a good nurse. However, when I see my classmates
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come together in those simulation labs, I have no doubts. The professors always find the most

difficult circumstances and I watch my classmates implement the nursing process flawlessly. The

team effort they use to glide from assessing to diagnosing to planning, implementing, and

evaluating, while using their clinical judgement to progress from one step to the next, reassures

me that they will be prepared for the ever-changing field of becoming a nurse. During one of our

most recent simulation experiences, we had a patient who was having an acute MI. We thought

we were in the clear after stabilizing the patient, but things quickly escalated with our patient,

and we ended up having to code him. I was amazed at how quickly my classmates, who had no

experience in a code situation, assumed positions and started to run this code. Our instructor was

even impressed with how quickly we were able to turn the situation around. Coding a patient is

always one of the most-anxiety provoking situations for me but after being able to experience

something that felt so real, from start to end, my classmates and I were able to walk out of that

room with confidence knowing that we have the amount of clinical judgement and nursing

knowledge it takes to code a patient.

This isn’t just an event I have noticed as a student or in my career as an aide. The Journal

for Nurses in Professional Development created a “review of nine quantitative studies” that

“demonstrated that simulation positively influences [newly licensed registered nurse] self-

perception of skills, competence, readiness for practice, and confidence” (Harper, 2021). The

simulations help students to put each piece of the nursing process together. They are able to

gather information from their assessment and then use clinical judgement to conduct the rest of

the nursing process during the simulation. As professors have taught us about delegation, one of

the strongest indicators of whether something must be done by the RN or whether it can be

delegated to someone with less education is clinical judgement. LPN’s and UAP’s are unable to
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assess because that is a skill that utilizes clinical judgement. Assessment takes applying critical

judgement and therefore cannot be delegated to those with less education than an RN.

Although new graduate nurses are experiencing more difficult patients as well staffing

shortages, I believe that because of the real-life experiences that were created through simulation

training in addition to other forms of education, nurses will be prepared to use their clinical

judgement skills.
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References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State

Boards of Nursing Clinical Judgment Model Into Nursing Educational

Frameworks. Journal of Nursing Education, 58(2), 72-78.

http://dx.doi.org/10.3928/01484834-20190122-03

Harper, Mary, PhD, RN, Bodine, Jennifer, DNP, FNP-C, NPD-BC, CEN, Monachino,

AnneMarie, et al. (2021). The Effectiveness of Simulation Use in Transition to Practice

Nurse Residency Programs: A Review of Literature From 2009 to 2018. Journal for

Nurses in Professional Development, 37, 329-340.

https://doi.org/10.1097/NND.0000000000000787

Martin, B., Greenawalt, J. A., Palmer, E., & Edwards, T. (2020). Teaching Circle to Improve

Nursing Clinical Judgment in an Undergraduate Nursing Program.Journal of Nursing

Education, 59(4), 218-221. http://dx.doi.org/10.3928/01484834-20200323-08