A comparison of the clinical judgment process in experienced registered nurses and student nurses

The purpose of this study was to analyze the clinical judgment process used by registered nurses identified as highly-skilled judgment-makers (HSJMs) and student nurses. Two areas of the clinical judgment process were explored: the type and number of cues elicited, and the judgment process. Thirteen students within a month of graduation, and 13 HSJMs participated in this study. For each participant, the judgment task was the initial assessment of a hospitalized patient. Each nurse reviewed the patient's Kardex, listened to the end-of-shift report and then assessed the patient as if this was the beginning of a workshift. This nurse-patient interview was tape recorded. Each nurse was then asked to review her thoughts as short segments of the nurse-patient interview were replayed. This was also tape recorded. These tapes were transcribed, and three nurse educators rated each transcript using a judgment process rating scale. Results of this study indicated the following: the registered nurses collected significantly more cues than the students, use of each cue type was not the same, students and HSJMs collected cues in the same proportion, and total scores on the rating scale could discriminate between the student and HSJM groups.