Validation of the Lasater Clinical Judgement Rubric and Predictors of Clinical Nursing Judgement in Simulation

Background. Appropriate clinical judgement is an expectation of safe nursing care (Lasater, 2007). The Lasater Clinical Judgement Rubric (LCJR) is frequently used in clinical judgement assessment in education (Adamson, Gubrud, Sideras, & Lasater, 2012) but there are few clinical studies to illustrate its validity or to identify predictors of higher clinical judgement scores, including the impact of stress on clinical judgement, a common issue in clinical practice and simulation (Bauer et al., 2016; Bong, Lightdale, Fredette, & Weinstock, 2010; Gore, Hunt, Parker, & Raines, 2011; Gouin et al., 2017). Methods. Using a prospective, two-group comparative and correlational design, we studied Expert Nurses (ICU nurses of at least 5 years; n = 15) and Novice Nurses (senior prelicensure students; n = 13) participating in a single simulation to evaluate the validity (ability to discriminate between the groups) and predictors of clinical judgement on the LCJR. Statistical analysis included t-tests and linear regression. Covariates were age, years of nursing experience, prior simulation experience, LCJR scores and of pupil dilation (measure of stress via eye tracker, SMI, Germany) during specific nursing procedures (pupil change from baseline during elevating head of bed, looking at monitor, applying oxygen). Covariates with a p value of < 0.05 in the bivariate analyses were entered into a Linear Regression with the LCJR score as the dependent variable. Results. There were significant differences in the LCJR between groups, with Expert Nurses having higher scores (22.60 ± 3.18) in comparison to the Novice Nurses (15.38 ± 4.31) p < 0.01. On the regression, only years of RN experience was an independent predictor of clinical judgement (F (1, 23) = 10.078, p = 0.004). The overall model fit was R² = 0.305. Conclusions. This study verifies the validity of the LCJR to differentiate clinical judgement. However, unexpectedly, stress did not show a dramatic impact on clinical judgement, only number of RN years. These findings have important implications for the progression of novice to expert nurse: psychological stress was not a significant hindrance or advantage for clinical performance. This study supports the belief that even between expert nurses (ICU nurses), years of experience still significantly affects nursing clinical judgement.