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HealthJuly 15, 2021

How to best develop nursing students’ clinical judgment skills

By: Heather Swift, MSN, RN
Critical clinical judgment skills are imperative in the field of nursing. These skills do not happen overnight and isn’t reiterated throughout a person’s education like it should be.

Let’s focus on what we can do to remedy this with our nursing students and novice nurses through different ways to best develop their clinical judgment skills.

Hospital management professionals, including CNOs, unit managers, and educators, regularly find that new graduate nurses do not meet the clinical judgment expectations required for entry-level nurse positions. When asking students and/or novice nurses what the definition of clinical judgment/thinking skills is, the overwhelming response given is “to provide good nursing care.” That response is incorrect and the starting point for us educators to develop a remedy.

Creating educational opportunities to build clinical judgment

Clinical judgment skills can be defined as the relationship between nursing knowledge and the application of that knowledge through intervention, management, and evaluation. We must provide students with the opportunities to think critically and make decisions on their own in a controlled environment. Students learn best by using the knowledge as they acquire it. This can be as simple as rotating clinical groups more frequently to allow all students to encounter a patient population while covering it didactically. It may mean leaving the clinical unit earlier than expected to allow for additional time for reflection, question and answers, coping skill discussions, and debriefing to allow everyone to learn from each other.

Make sure to provide active learning activities for students. A reverse case study, for example, promotes problem-solving skills that allow the student to become dynamically involved by building on previous knowledge and applying concepts to a new set of information - leading to the development of clinical judgment skills. Our goal must be to have well-prepared nurses that know how to apply concepts, think critically, prioritize, and organize a plan of care. Shifting how we deliver nursing concepts, will in return help our students be less shocked and better prepared for their first nursing job.

Fostering deep critical thinking in nurses

Another way to facilitate a deeper level of thinking is using a technique of the muddiest point. During the last portion of class, ask the students to write down what was “muddy” in the lecture, class content, or clinical day - what still doesn’t make sense? This allows for a more thorough discussion allowing the professor or instructor to gauge understanding of content and any misconceptions or confusions on the content. On the flip side, you can also have students write down what is crystal clear from the content. Pairing students together based on what is crystal clear and muddy can facilitate deep discussion and more active learning.

To successfully develop clinical judgment skills in our nursing students and to bridge the gap from academia to profession, educators must consistently allow for application and self-reflection of concepts. It is a priority and needs to be tightly integrated in all areas of curriculum.

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Heather Swift, MSN, RN
Expert Insights Contributor for Wolters Kluwer, Nursing Education
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