What, Why, How of Clinical Judgment


Clinical judgment is a hot topic in nurse education right now! The NCSBN’s NCSBN’s Next-Gen Clinical Judgment Measurement Model (CJMM) is the new standard for safe clinical practice. The NCSBN research found that nursing students and newly licensed nurses may lack clinical judgment, a true cornerstone of safe practice.

According to Hoffman, “The two most common reasons that new graduate nurses are disciplined are (1) failure to notice changes in patient status and (2) failure to act when a patient is deteriorating” (2024, 3). This is a sobering report. How can the CJMM help students and newly licensed nurses enter with steady intention into their careers with confidence and competence? The answer is curiosity.

There are five components of clinical judgment in the CJMM: recognize cues, analyze cues, prioritize hypotheses, take actions, and evaluate outcomes (NCSBN, 2019). When addressed in an orderly fashion, these elements can help the nurse make better clinical decisions. Let’s ask ourselves three simple questions to guide us through this model: What? Why? How?

As a nurse educator, I ask students, “Why?” more frequently than they wish, I’m sure. The more they answer that question, the more they make connections between the what, or subject matter, and the how or the actions that may address those findings. This vital principle of connection allows decisions based on understanding and leaves little room for assumption. I have created a graphic using the five domains of the CJMM to help us ask some critical questions and lead us toward good clinical decisions.

what-why-how-of-clinical-judgment

Curiosity Invites Connection 

A seasoned nurse knows through experience the cues of a deteriorating patient, but unfortunately, we cannot transfer our knowledge to our students, peers, or mentees. We can, however, thoughtfully unravel the process by which we understand that a patient has had a status change. For a novice nurse, this process may take more time and require confirmation by another. For a well-experienced nurse, this could take mere seconds. What happened? Why did it happen? How do I address it?

Curiosity Keeps Us Cautious

Using these three simple words to begin each series of questions can be a guide to any nurse who needs to gain confidence and competence in clinical decision-making. At their most simplistic, these questions can keep us moving forward in decision-making rather than being stuck in indecision. We notice systematically that the what leads to the why, and the why guides us to the how. We cannot forsake any step in this process lest our patients receive incorrect treatment or unsafe nursing actions.

Curiosity Helps Us Care

Identifying the gap in clinical judgment offers an opportunity for students, educators, and all nurses to examine our processes and practices of inquiry. Learning this process, like any other, requires repetition and intention. You can make better choices when you ask better questions. Whether you are a student, a staff nurse, or an educator, I hope that the What? Why? How? of clinical judgment will help you as you continue forward in your nursing career. Keep learning.

Stay curious!

References

Hoffman, Janice J., and Nancy J. Sullivan. “Foundations for Medical-Surgical Nursing.” Essay. In Davis Advantage for Medical-Surgical Nursing: Making Connections to Practice, 3rd ed. Philadelphia: F.A. Davis Company, 2024. 

NCSBN. Clinical Judgment Measurement Model. Accessed January 23, 2024. https://nclex.com/clinical-judgment-measurement-model.page.

Megan Pittman
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