Why is clinical judgment important

In healthcare, the development of sound clinical judgment takes time. Yet, it's an essential component of the medical profession. Clinical judgment is crucial for both primary care practitioners and their patients in order to inform other clinicians, scientists and healthcare managers of important information.

An advanced Master of Science in Nursing (MSN) degree prepares healthcare professionals with clinical judgment skills to be successful in patient care.

Evidence-based medicine guides practitioners to use relevant scientific evidence, patient values and clinical judgment when treating patients. Some view this practice as a formulaic approach to medicine. But, the appropriate amount of emphasis on a specific study, report, practice alert or clinical practice guideline is not always clear to practitioners.

Because individual patient values vary, clinical judgment requires more significant development through education and experience. Newer practitioners may focus more on the most obvious diagnosis based on limited or structured information.

Helping healthcare professionals understand the nuances of care is why continuing education is so important. Advanced healthcare education fosters more comprehensive assessments and helps practitioners trust their "gut feeling." This skill is vital for nurse practitioners, as their agility in treatment situations relies heavily on their clinical judgment skills.

Nursing educator Dr. Pam Embler credits clinical decision-making skills for one's ability to adapt to changes in patient presentations. The goal is to improve patient outcomes through creative problem-solving. By evaluating what they know and being open to learning something new, professionals may discover a treatment tactic not previously considered.

Clinical judgment goes beyond passing the NCLEX. Real-world application in bedside situations with actual patients is critical. KeithRN notes that critical thinking plus clinical reasoning equals clinical judgment. Developing these skills in an educational environment helps set nurses up for success in critical situations.

Nurses are at the front of patient care. They often have first and most frequent contact with patients. They discover patient concerns, complaints and values that are important to determine the course of treatment. They communicate their observations and assessments from direct experience with patients to other care team members, which influences diagnosis and treatment decisions.

Clinical decision-making missteps and diagnostic errors can be detrimental to patient outcomes. Biases, lack of education and experience contribute to poor clinical judgment. Poor diagnostic decisions can harm patient safety and heighten malpractice risk. Additionally, they can cause reputational harm to individual nurses, facilities and the profession as a whole.

While there is no substitute for years of experience in the field, education provides a strong foundation for developing sound clinical judgment. Pursuing an advanced degree opens up more opportunities to hone clinical judgment skills in a safe environment. Case studies, simulations and labs help nurses gain confidence in examining and presenting cases. The classroom is the right place to make mistakes and learn from them, as curricula prepare students for real-world scenarios.

Working nurses can further develop their clinical judgment through the Master of Science in Nursing - Family Nurse Practitioner (MSN-FNP) program at Arkansas State University (A-State). Through this online program, nurses learn theories and concepts to help guide their clinical judgment.

Coursework covers patient care with respect to diverse populations, so nurse practitioners can present cases that respect the values and concerns of different ethnicities and cultures. Nurses also develop skills like radiological interpretation, telehealth and dental health practices — adding more tools to their patient care toolbox. They gain clinical decision-making and diagnostic evaluation skills before the clinical portion of the degree program.

With a strong educational foundation, real-world experience working with patients and an understanding of individual patient needs, nurse practitioners are ready for a career in a wide variety of settings.

Learn more about A-State's Master of Science in Nursing - Family Nurse Practitioner (MSN-FNP) online program.

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Clinical nursing environment

Cognitive reasoning skills

What is Critical Thinking?  Let us start with what it is NOT.  It is NOT being negative, showing displeasure or disapproval or being emotionally judgmental.  That is the social connotation of the word "critical".  In the academic and clinical practice setting, the phrase "critical thinking" has a positive meaning. 

Per Dictionary.com, critical thinking is defined as "disciplined thinking that is clear, rational, open-minded, and informed by evidence".  (http://www.dictionary.com/browse/critical-thinking)

Per Rasmussen College,  "Critical Thinking includes identifying a problem, determining the best solution and choosing the most effective method of reaching that solution. After executing the plan, critical thinkers reflect on the situation to figure out if the plan was effective and if it could have been done better."   (http://www.rasmussen.edu/degrees/nursing/blog/understanding-why-nurses-need-critical-thinking-skills/)  Critical thinking applies thinking, reading, writing, listening and speaking.  There are many factors in critical thinking, including gathering, focusing, organizing, analyzing, generating, integrating, and evaluating information.

Critical thinking in research is the method of evaluating all the information gathered, including the sources from which the information is obtained by and determining the value of the information in relationship to the situation.  It means evaluating the sources that you use to find the information to determine the value of the source.  Information from an undergraduate's blog post is not going to have as much weight as information from an article in JAMA. 

For nursing, it also means utilizing the Evidence-Based Practice methodology for determining the quality and strength of the information found.  It means developing the skills to become a critical thinker beyond the classroom.  This practice will allow you to develop deductive and sound reasoning skills and become self-confident in your thought process and your decision making skills.

The characteristic that distinguishes a professional nurse is cognitive rather than psychomotor ability. Nursing practice demands that practitioners display sound judgement and decision-making skills as critical thinking and clinical decision making is an essential component of nursing practice. Nurses’ ability to recognize and respond to signs of patient deterioration in a timely manner plays a pivotal role in patient outcomes (Purling & King 2012). Errors in clinical judgement and decision making are said to account for more than half of adverse clinical events (Tomlinson, 2015). The focus of the nurse clinical judgement has to be on quality evidence based care delivery, therefore, observational and reasoning skills will result in sound, reliable, clinical judgements. Clinical judgement, a concept which is critical to the nursing can be complex, because the nurse is required to use observation skills, identify relevant information, to identify the relationships among given elements through reasoning and judgement. Clinical reasoning is the process by which nurses observe patients status, process the information, come to an understanding of the patient problem, plan and implement interventions, evaluate outcomes, with reflection and learning from the process (Levett-Jones et al, 2010). At all times, nurses are responsible for their actions and are accountable for nursing judgment and action or inaction.

The speed and ability by which the nurses make sound clinical judgement is affected by their experience. Novice nurses may find this process difficult, whereas the experienced nurse should rely on her intuition, followed by fast action. Therefore education must begin at the undergraduate level to develop students’ critical thinking and clinical reasoning skills. Clinical reasoning is a learnt skill requiring determination and active engagement in deliberate practice design to improve performance. In order to acquire such skills, students need to develop critical thinking ability, as well as an understanding of how judgements and decisions are reached in complex healthcare environments.

As lifelong learners, nurses are constantly accumulating more knowledge, expertise, and experience, and it’s a rare nurse indeed who chooses to not apply his or her mind towards the goal of constant learning and professional growth. Institute of Medicine (IOM) report on the Future of Nursing, stated, that nurses must continue their education and engage in lifelong learning to gain the needed competencies for practice. American Nurses Association (ANA), Scope and Standards of Practice requires a nurse to remain involved in continuous learning and strengthening individual practice (p.26)

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgement: A practical approach to outcome-focused thinking. (4th ed.). St Louis: Elsevier

The future of nursing: Leading change, advancing health, (2010). https://campaignforaction.org/resource/future-nursing-iom-report

Levett-Jones, T., Hoffman, K. Dempsey, Y. Jeong, S., Noble, D., Norton, C., Roche, J., & Hickey, N. (2010). The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients. Nurse Education Today. 30(6), 515-520.

NMC (2010) New Standards for Pre-Registration Nursing. London: Nursing and Midwifery Council.

Purling A. & King L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23–24), 3451–3465

Thompson, C., Aitken, l., Doran, D., Dowing, D. (2013). An agenda for clinical decision making and judgement in nursing research and education. International Journal of Nursing Studies, 50 (12), 1720 - 1726
Tomlinson, J. (2015). Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15(103)