Observed Use of Clinical Judgment Among New Graduate Nurses.

BACKGROUND: Despite the efforts of academic nursing educators to prepare students to make sound clinical judgments, the literature suggests new graduate nurse (NGN) competence with this critical skill continues to decline. This study sought to identify how practicing nurses describe their observations of the use and outcomes of clinical judgment by NGNs in nursing practice. METHOD: A multisite, cross-sectional survey using multiple-choice, Likert scale, and open response items to identify participants' observations of NGN clinical judgment was sent with snowball sampling and resulted in a sample of 314 participants from 19 U.S. states. RESULTS: Practice partners identified a wide discrepancy between how they expect NGNs to use clinical judgment and what they actually see NGNs do, with resultant negative effects on patients and NGNs. CONCLUSION: These results provide a beginning understanding of NGNs' specific challenges with clinical judgment. Efforts to improve clinical judgment across nursing education and practice are needed. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Learning Clinical Judgments With a Lens of Inclusivity.

ABSTRACT: To prepare practice-ready graduates and promote NCLEX® success, many schools of nursing have adopted a clinical judgment model (CJM) to provide a framework for their curriculum and teaching strategies. Missing from most CJMs are clear principles of justice, equity, diversity, and inclusion (JEDI), imperative to prepare a nursing workforce to care holistically for diverse populations. This article describes the curriculum integration of an adapted model with added JEDI principles. By intentionally integrating the language and understanding of a CJM with JEDI principles, nurse educators can promote the clinical judgment development necessary to prepare graduates to care for diverse populations.

A National Report on Clinical Judgment Model Use in Prelicensure Nursing Curricula.

AIM: This study examined US prelicensure nursing program use of clinical judgment models and teaching strategies to promote students' clinical judgment. BACKGROUND: Growing interest in teaching clinical judgment associated with upcoming changes in NCLEX-RN testing warrants exploration of how models and teaching strategies are currently used. METHOD: A cross-sectional survey with multiple-choice and open-ended response items was used to examine programs' use of clinical judgment educational models. RESULTS: Of 234 participants (9 percent response rate), 27 percent reported using a model; 51 percent intended and 20 percent did not intend to start using a model. Tanner's clinical judgment model was the most used, followed by the clinical reasoning cycle. Models were used to inform design of teaching/learning strategies and facilitate clinical teaching and evaluation. CONCLUSION: Clinical judgment model use may increase as programs prepare for changes in NCLEX-RN. Research is needed to understand how model use contributes to measurable differences in clinical judgment skill.

Current Practices for Teaching Clinical Judgment: Results From a National Survey.

BACKGROUND: Safe patient care is closely linked to clinical judgment. Concerns about inadequate practice readiness and the impending inclusion of clinical judgment items on the NextGen NCLEX have resulted in increasing interest and publications about teaching clinical judgment. However, little is known about actual current practices for teaching this skill. PURPOSE: This research describes findings about current strategies to teach clinical judgment used in US prelicensure nursing programs. METHODS: Cross-sectional methodology was used to survey program deans and directors across the United States. RESULTS: Programs are using multiple strategies to teach clinical judgment. The most common strategies used include case studies and simulation. Participants believed strategies have a positive impact on student thinking, practice readiness, and program outcomes. They described insights into implementation of teaching for clinical judgment. CONCLUSION: The results of this research provide foundational data to inform current teaching practices and further research for this essential skill.

New Graduate Nurse Experiences in Clinical Judgment: What Academic and Practice Educators Need to Know.

AIM: The aim of the study was to determine if use of a structured reflection exercise using a clinical judgment framework would result in more practice-ready new graduate nurses (NGNs). BACKGROUND: Clinical judgment is a critical skill for all nurses, yet it is identified as a deficit in NGNs. METHOD: Seventy-four NGNs in two groups participated in this mixed-methods study in their first year in practice. Scores from two quantitative measures were collected for all participants. The Lasater Clinical Judgment Rubric framed the structured intervention. RESULTS: Although the quantitative data showed no significant differences between the groups, use of the reflection exercise indicated a positive impact on NGNs. Qualitative data revealed four themes that present challenges for preparation of NGNs: enhancing communication, finding interprofessional support, responding to complexity of care, and appreciating the role of the nurse. CONCLUSION: Implications provide guidance for academic and practice educators to smooth the transition into practice.