Clinical Judgement in Baccalaureate Pre-Licensure Nursing Students

Good clinical judgement is an essential component of clinical competence to ensure the delivery of quality, safe nursing care.  Health care administrators and experienced nurses have voiced concerns that novice nurses lack the clinical judgement necessary for entry into practice.  Therefore, nurse educators have the responsibility to foster clinical judgement development in nursing students and to assess its adequacy.  There is a lack of evidence-based tools to evaluate students’ clinical performance and more specifically clinical judgement.

            This descriptive, comparative study described and compared the clinical judgement of junior and senior baccalaureate pre-licensure nursing students in the clinical setting using the Lasater Clinical Judgment Rubric (LCJR).  Tanner’s Integrative Model of Clinical Judgement (IMCJ) provided the theoretical foundation for this study and the development of the research instrument.  The clinical judgement of 75 junior and 61 senior baccalaureate, pre-licensure nursing students was assessed by clinical faculty using the LCJR in the medical-surgical clinical setting at the end of one semester.  Statistical methods used to analyze the data included descriptive statistics, independent t-tests, and multivariate analysis of variance.

Senior baccalaureate, pre-licensure nursing students were found to have significantly higher total and subscale scores of clinical judgement on the LCJR than junior baccalaureate, pre-licensure nursing students.  Additional analyses revealed that both junior and senior students with health care work experience had higher clinical judgement scores than students not working in healthcare. 

The findings of this study contributed to the growing body of nursing knowledge about clinical judgement, Tanner’s IMCJ, and Lasater’s LCJR.  Utilization of findings could guide teaching-learning strategies to foster clinical judgement development in nursing students and ultimately produce better prepared novice nurses for the practice setting.  Findings from this study provide nurse managers valuable information about the level of clinical judgement of the new graduate nurse.  This information can provide direction as to the content and length of mentored preceptorships programs and the type of unit a novice is best suited.