Nursing Judgment

The current ANS featured article is titled Nursing Judgment A Concept Analysis, authored by Lila de Tantillo, MS, BSN, RN and Joseph P. De Santis, PhD, ARNP, ACRN, FAAN. While it is featured you can download this article at no cost, and we encourage your comments and discussion below!  Here is a message that Lila de Tantillo sent for ANS readers:

Lila de Tantillo

Health care as we know it is undergoing a transformation. The importance of technology, the composition of the provider workforce to include increased nurse practitioners, and opportunities for patients to access care are changing dramatically. In this context, the role of a registered nurse in the delivery of health care is critical. The essence of a nurse is the implementation of nursing judgment.  

In this paper, coauthored with Joseph P. De Santis, PhD of the University of Miami, we used the Walker and Avant model of concept analysis to explore the unique role of a nurse within the health care system. Specifically, we identified its uses, determined its attributes, identified antecedents and consequences, and determined empirical referents. The goal was to clarify the concept of nursing judgment and better understand how it can be applied in practice, education, research and policy.

Among the essential uses of nursing judgment, we found to be application in the clinical setting, nursing administration, and education of new nurses. One common thread among these uses was that nursing judgment does not necessarily entail the provision of a certain “right” answer or reaction in a scenario, but the ability of a nurse to utilize reason and expertise to respond to a given situation. We continued to explore this theme within the attributes of nursing judgment, which include critical thinking, prioritization, and discernment. A nurse develops these by building on knowledge, experience, and in some cases even intuition.

What happens when you bring this all together? When a nurse implements nursing judgment in practice, the expected consequences are better communication, enhanced patient comfort, fewer errors, and an improved system of health care. Although nursing judgment is an abstract concept, empirical referents that can be used to evaluate the quality of nursing care include reports from Joint Commission, the Agency for Health Care Administration, and Centers for Medicare & Medicaid Services (CMS). CMS data regarding hospital-acquired pressure ulcers and catheter-associated urinary tract infections can provide particular insight. In addition, health care facilities and policymakers can enhance the ability of nurses to implement nursing judgment by supporting BSN nursing education and enforcing reasonable staffing structures. In the future, more work must be done to better understand the ways that patient outcomes are affected by the concept of nursing judgment.

Thank you for taking the time to read this brief preview of our article Nursing Judgment: A Concept Analysis. We hope you enjoy the article in its entirety.