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We Need a New Way to Teach Nursing Thinking and Clinical Judgment

April 1, 2021
April 1, 2021

This blog post is the second in a series about improving clinical judgment in newly hired nurses.

Educating new nurses to become better thinkers who can make sound clinical judgements isn’t easy. This was one of the focus areas during a recent HealthStream webinar, Improving Clinical Judgment in New Nurse Hires to Improve Patient Outcomes. The presenters for this webinar were Dr. Linda Caputi, a nursing education consultant, and Elease Caracci, Senior Product Manager at HealthStream. Caputi has over 30 years of teaching experience at all levels of nursing education. She is a certified nurse educator and a fellow in the NLN's Academy of Nursing Education. Having published numerous books, articles, and book chapters, Caputi’s latest work is Think like a Nurse: A Handbook, published in 2018. Elease Caracci joined HealthStream in 2016 with our acquisition of NurseCompetency and is now a senior product manager. Caracci's background in healthcare staffing, educational planning, and curriculum development, along with her management expertise, have made her a multi-faceted performer within the healthcare industry.

We Need a New Approach to Teaching Clinical Judgment

According to Caputi, “What we have been doing in nursing schools and what we have been doing after graduation, it just isn't working.” She offered that the literature shows that we have to figure this out, because “nurse-client care and nurse errors can be improved by enhancing clinical judgment skills in novice nurses.” The overall goal for improving thinking is “for the nurse to compile a holistic picture of the patient's condition, to recognize emerging clinical patterns, and to know when to intervene.”

What Is Lacking Is a System

Caputi described the typical approach to teaching the thinking part of clinical judgment as “Each faculty member teaches thinking in their own way using their own verbiage and their own way of asking questions.” She attributed successful learning to serendipity, and whether the nursing student was lucky enough to experience the right teacher and teaching method. Some standard instructional strategies “involve using case studies, simulations, discussion of patient's situation, and others.” While this can be a good way to go about it, Caputi advised, “They're only most helpful after the students have learned a thinking framework.” In other words, students may get to a stage where they are asked to apply clinical judgment without first learning what clinical judgment is. Caputi cautioned, “Therein lies the weak link.”

A Uniform Thinking Framework

Nursing students need to learn a “thinking framework that is taught at the beginning of the program, then use that framework.” Rather than allowing every member of the faculty to make individual choices about teaching, they need to be consistently and coherently using the same language for teaching critical thinking and clinical judgment. That way, nursing students will learn a uniform vocabulary. Ultimately, Caputi recommends that “It is best to incorporate a thinking framework or a model into your nursing residency or orientation program.” Once that model is learned, preceptors can use its same language, and so can orientees, which will make expectations and communication about thinking competencies work far more successfully.

Access the Webinar recording here.