F.A. Davis Teaching Clinical Judgment to Nursing Students

Table A: Questions to Connect Scientific Understanding and Clinical Judgment The clinical instructor is helping a beginning student empty a foley catheter bag, which is filled with dark, concentrated urine. Questions the instructor might ask the student, at the appropriate time, include:

1. How would you describe this urine?

2. What is the physiological reason for the appearance?

3. What other information about this situation should you collect?

4. What nursing action(s) should you take?

References Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., Hiatt, H. (2004). Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. 1991. Quality & Safety in Health Care. 13, 145-151. Saintsing, D., Gibson, L. M., & Pennington, A. W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19, 354–359. Smith J. & Crawford L. (2002). Report of findings from the 2001 Employers Survey. National Council of State Boards of Nursing, Chicago, IL. Tanner, C.A. (2006) “Thinking like a nurse”; a research-based model of clinical judgment in Nursing. Journal in Nursing Education. 45(6) 204-211. Van Graan, AC, Williams, MS, Koen, MP (2016) Professional nurses’ understanding of clinical judgment: A contextual inquiry. Science Direct. Elsevier. 280-293. About the author Susan Sportsman, PhD, RN, ANEF, FAAN , is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas. Although this is a simple situation to which a new clinical student may know the answers, these types of questions provide a framework by which the student can connect scientific knowledge to clinical judgment. As students care for more complex patients, this format can be used for more difficult questions. Sufficient evidence exists that many novice nurses are not prepared to assume the role of an RN or LPN/LVN at the time of graduation without further assistance. The NCSBN has revised the licensing exams to more fully evaluate test-takers’ clinical judgment competencies. Nursing faculty must make changes to prepare students for the NGN Exams and safe practice at the time of their graduation. Let’s commit to using every available resource and best practice to prepare students for this challenge.