Clinical judgment is a hot topic in nurse education right now! The NCSBN’s NCSBN’s Next-Gen Clinical Judgment Measurement Model (CJMM) is the new standard for safe clinical practice. The NCSBN research found that nursing students and newly licensed nurses may lack clinical judgment, a true cornerstone of safe practice.
According to Hoffman, “The two most common reasons that new graduate nurses are disciplined are (1) failure to notice changes in patient status and (2) failure to act when a patient is deteriorating” (2024, 3). This is a sobering report. How can the CJMM help students and newly licensed nurses enter with steady intention into their careers with confidence and competence? The answer is curiosity.
There are five components of clinical judgment in the CJMM: recognize cues, analyze cues, prioritize hypotheses, take actions, and evaluate outcomes (NCSBN, 2019). When addressed in an orderly fashion, these elements can help the nurse make better clinical decisions. Let’s ask ourselves three simple questions to guide us through this model: What? Why? How?
As a nurse educator, I ask students, “Why?” more frequently than they wish, I’m sure. The more they answer that question, the more they make connections between the what, or subject matter, and the how or the actions that may address those findings. This vital principle of connection allows decisions based on understanding and leaves little room for assumption. I have created a graphic using the five domains of the CJMM to help us ask some critical questions and lead us toward good clinical decisions.
Curiosity Invites Connection
A seasoned nurse knows through experience the cues of a deteriorating patient, but unfortunately, we cannot transfer our knowledge to our students, peers, or mentees. We can, however, thoughtfully unravel the process by which we understand that a patient has had a status change. For a novice nurse, this process may take more time and require confirmation by another. For a well-experienced nurse, this could take mere seconds. What happened? Why did it happen? How do I address it?
Curiosity Keeps Us Cautious
Using these three simple words to begin each series of questions can be a guide to any nurse who needs to gain confidence and competence in clinical decision-making. At their most simplistic, these questions can keep us moving forward in decision-making rather than being stuck in indecision. We notice systematically that the what leads to the why, and the why guides us to the how. We cannot forsake any step in this process lest our patients receive incorrect treatment or unsafe nursing actions.
Curiosity Helps Us Care
Identifying the gap in clinical judgment offers an opportunity for students, educators, and all nurses to examine our processes and practices of inquiry. Learning this process, like any other, requires repetition and intention. You can make better choices when you ask better questions. Whether you are a student, a staff nurse, or an educator, I hope that the What? Why? How? of clinical judgment will help you as you continue forward in your nursing career. Keep learning.
Stay curious!
References
Hoffman, Janice J., and Nancy J. Sullivan. “Foundations for Medical-Surgical Nursing.” Essay. In Davis Advantage for Medical-Surgical Nursing: Making Connections to Practice, 3rd ed. Philadelphia: F.A. Davis Company, 2024.
Daily Nurse proudly honors Scott Stewart as our Nurse of the Week.
“This textbook is the first in the field that has been written by VAD coordinators for VAD coordinators,” says Stewart, who has a decade of experience as a VAD program coordinator. “It’s designed to be a primer for new or seasoned VAD coordinators, including those looking to start a VAD program.”
The textbook includes chapters written by Hackensack University Medical Center cardiac care experts, including:
“Temporary Mechanical Circulatory Support,” by Kanika Mody, M.D., Medical Director of LVAD Service and Advanced Heart Failure Cardiologist, and Andrea Stuart, Chief PA of Cardiothoracic Surgery.
“Surgical Implantation of Left Ventricular Assist Devices,” by George Batsides, M.D., Surgical Director of the VAD program.
“Mechanical Circulatory Support in the Era of COVID-19,” by VAD coordinator Christina Silva, RN, MSN.
“Our Mechanical Circulatory Support Program provides life-saving — and life-changing —care for patients with advanced heart failure,” says Mark Anderson, M.D., Chairman of the Department of Cardiac Surgery at Hackensack University Medical Center. “Our entire team is proud of Scott’s recent publication and his contributions to the field of mechanical circulatory support.”
Mechanical Circulatory Support Program Receives National and International Recognition
Hackensack University Medical Center’s Mechanical Circulatory Support Program has also received national and international recognition for excellence and comprehensive care. The program has had seven abstracts accepted for publication at the International Society for Heart & Lung Transplantation annual meeting to be held in April 2023.
Stewart has also been elected to the Board of Directors at the International Consortium of Circulatory Assist Clinicians (ICCAC) — the only organization for VAD coordinators in the U.S.
“I’m excited to be a part of the leadership team at ICCAC and look forward to participating in their mission of developing best practices for VAD care, creating networking and mentoring opportunities for VAD professionals, and promoting research,” says Stewart.
“Our program is a national leader in VAD care,” says Dr. Mody. “Scott’s work has contributed to our program’s excellent reputation and has made a huge difference in the lives of our patients.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Nursing has always been an essential, trusted and well-respected career. In light of the Covid-19 pandemic and many nurses seeking retirement, nursing education have become an even more critical part of the healthcare system to train new nurses to fulfill this urgent gap in the healthcare system.
Nurses are more than just healthcare workers; they provide care and treatment for sick patients while providing support for patients and family members during challenging times.
As the nursing industry evolves, there has become a greater demand for healthcare services due to an aging population and shifting technologies. With the need for hospitals and other organizations to maintain the best care for patients, nursing has also become a highly sought-after role in an in-demand field.
“From an educational standpoint, nursing has seen a demand for BSN educated nurses as the minimum entry into the professional degree,” said Nick Carte, PhD, AGNP-C, APRN and faculty lead in the nursing program at Southern New Hampshire University (SNHU). “Nursing continues to be the highest and most respected profession because nurses adapt to change and the environment they need to work in.”
Your first step is to decide your career goals within the nursing field, as different degrees are required for different nursing types. Once you know where your goals lie, you can begin your degree program.
While nursing requirements vary state by state, you will need to complete either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) at a minimum. During your BSN, you will explore healthcare management, ethics in healthcare, leadership, and more.
If you choose to advance your nursing degree from there, you can go on to complete your Master of Science in Nursing (MSN).
During your MSN, you can choose to focus your degree on a more specialized career.
There is no one job in the nursing field that is the best, but one position may be the best for you. Many nursing professions extend outside of a traditional hospital experience. For example, many nurses work in family practices or clinics, home healthcare services,
Before beginning your nursing career or nursing education, create goals for yourself and do your research to explore all your options. Ensure you learn about what it’s like to be a nurse in your desired role to know if it is the right fit for you.
Some popular nursing positions include:
Certified Nursing Assistant (CNA): A CNA works as a part of the healthcare team under the supervision of a registered nurse. They provide basic care from motoring vitals to cleaning, bathing, and caring for patients. The education requirement is often a state-approved education program with on-the-training required. The Bureau of Labor Statistics (BLS) reports, in 2021 the median salary of a CNA was $30,290, and as a projected job growth of 8% through the year 2030.
Registered Nurse (RN): As an RN, you will assess patients, administer medications and treatments, provide emotional support to patients and their families, and more. The education required to become a nurse is typically an ADN or a BSN from an accredited university. In 2021 the median salary for an RN was $77,600, with a 9% projected job growth from 2020 to 2030, according to BLS.
Nurse Practitioners: A nurse practitioner’s role is to serve as a primary care provider to deliver nursing services to patients. They manage a patient’s health and discuss ways to incorporate a healthier lifestyle where necessary. Most nurse practitioners hold at least a master’s degree in a nursing program. According to BLS, in 2021 nurse practitioners earned a median salary of $120,680 and the field is expected to grow by 52% through 2030, which is a much faster average than most occupations in the field.
Nurse Educators: Nurse educators are mentors and teachers who work in nursing schools and teaching hospitals to prepare the next generation of nurses through their own skills and knowledge. While the pay for a nurse educator can vary depending upon your certification, skills and the number of years in your profession, the average salary for a nurse educator in 2022 is $103,448, according to Salary.com.”As long as we maintain the profession of nursing, we will need highly capable educators to provide new education, as well as ongoing education, to nurses everywhere,” said Kimberly Gibbons, DNP, CNM, RN, CNL, CNE, a clinical faculty member in the nursing program at SNHU.
Many nursing specialties are in high demand as the pandemic created a need for more professional, clinically skilled nurses in hospitals and medical centers.
There are many nursing jobs for you to consider and it’s a field that will always be needed. We saw this more than ever over the past couple of years.
“Nurses stepped up and we cemented our place in healthcare,” said Carte.
Boredom: “not something nurses find…”
A day in the life of a nurse depends upon the type of nursing role you choose to build a career in. Even in your specific role, your days may look different as you work with various patients who have different needs.
“I believe boredom is not something nurses find,” said Gibbons.
For Gibbons, who worked as a nurse-midwife at the beginning of her career, days were filled with taking care of women and families in outpatient offices, along with hospital rounds and round-the-clock care for patients giving birth or with medical concerns.
Her days look much different now. Having spent over three decades in nursing and completing several degrees, Gibbons now works remotely as a nurse educator teaching master’s students.
While Gibbons’ day to day has changed working in her various roles, her days have always looked different from Carte’s, who works as a nurse practitioner at a family practice, providing care for those with acute and chronic illnesses.
A day in the life as a nurse will be different for everyone depending upon your job. Still, no matter your job, your role will include communication, organization, critical thinking, and compassion and provide opportunities to contribute to healthcare and improve the lives of others.
“My day begins with the understanding that I can make a difference in someone’s life and work to keep my passion alive through the rewards of positive health outcomes seen with many of my patients,” said Carte.
Is a Nursing Degree Worth It?
There are several pathways you can take to become a nurse. With different nursing degrees, certifications, and licensures available to you, achieving your nursing degree can benefit you and your career growth.
Earning your bachelor’s degree will help to open new doors for your career. For example, if your goal is to become a labor and delivery nurse, you will need to have achieved your ASN or your BSN to gain the proper knowledge for your career.
Your bachelor’s degree is also essential in advancing your career as it prepares you for your master’s. In addition, a master’s is necessary for certain positions. For example, if you hope to take your career further and become a nurse educator, you will need at least an MSN degree.
According to the American Association of Colleges of Nursing (AACN), about 41% of employers require at least a BSN for new hires, while over 77% of employers prefer to hire BSN graduates.
The AACN also found during a 2021 survey that 76% of BSN students and 75% of MSN found employment by the time they graduated.
Nursing is a complex field that grows every year. There will never be one path best to become a nurse with many job opportunities for you to explore.
Your nursing degree will provide you with the knowledge and skills necessary to provide the best care for your patients and prepare you for whatever nursing career path you decide is the right fit for you.
“Take the risk to go back to school and learn new skills if the skills you currently have are not leading you to work that is gratifying,” Gibbons said. “No one can ever take your education away, so it is truly the path to gain new opportunities,” said Gibbons.
Whether you are focused on being a clinician, an educator, in shaping health policies—or a combination of these—earning a Doctor of Nursing Practice (DNP) degree helps you gain the skills and assemble the tools you need to be a force for change in 21st-century nursing practice. As one DailyNurse contributor, recent DNP grad Patrick M. Nobles, DNP, FNP-BC, CNL, sees it, “My thoughts on having a career as a nurse include how versatile and applicable the [DNP degree] is to many career paths. The DNP degree echoes that versatility and can be utilized in many different career settings.”
While 13% of nurses currently hold a master’s degree, fewer than two percent are estimated to have a doctoral degree. The DNP is the highest practice degree in the nursing profession—and more nurses are enrolling in DNP programs every year. DNP students learn to care for patients at a practitioner level as they acquire a firm grounding in policy and leadership, a combination of skills that prepares the DNP nurse to contribute to the advancement of healthcare policies, and improvement of health outcomes for entire systems or communities as well as for individuals.
Here are three ways in which DNPs are acting as agents for change in healthcare and helping to steer the future of nursing:
1. As Nurse Scientists and Policy Makers
A good DNP program will train you in theoretical and scientific approaches utilized by behavioral, social, and organizational scientists so you can learn to evaluate evidence not only at the single patient/client and discipline-specific level, but to also to address issues at population, organizational, and systems levels.
Most DNP curricula provide a firm grounding in public health issues, policies, and legislation. Master’s-level APRN programs prepare students to function as effective clinical practitioners but do not train them to participate in the advancement of health policy or public health legislation. However, as a growing number of nurses want to help improve healthcare on a larger scale, the DNP was designed to provide them with the tools to develop their expertise on clinical and systematic levels.
2. As Chief Nursing Officers and Executive Leaders
A DNP can equip you to step up and add your vision to the “Big Picture” of the nursing profession and to the advancement of the profession in myriads of ways. Institutions such as Baylor University’s Louise Herrington School of Nursing offer a special DNP program designed for aspiring executive nurse leaders. Baylor’s online DNP-Executive Nurse Leadership (DNP-ENL) degree program is designed for working nurses and trains students to navigate the fiscal/business aspects of healthcare and develop their executive acumen. The Baylor DNP-ENL program, which revolves around the Adams Influence Model, prepares medical and health services managers, CNOs, and CNEs to effect change at system and organization levels in improving health outcomes on a large scale.
“If I am going to spend my time to obtain a DNP, I want it to mean something… At Baylor, every class has been relevant to my day-to-day role as a CNO.”
This DNP program track in Executive Nurse Leadership appeals to nurse leaders who want to implement change on an institutional level. One current Baylor DNP-ENL student, Chief Nursing Officer Tami Taylor, MSN, MBA, RN, NEA-BC, speaks for many when she says, “If I am going to spend my time to obtain a DNP, I want it to mean something… At Baylor, every class has been relevant to my day-to-day role as a CNO. I have been able to take what I have learned and apply it at work.”
After being disappointed by another online DNP program, Baylor’s program is helping Taylor to reach her career goals: “I want to continue to be the best CNO I can be and help our nurses take great care of patients through evidence-based practice and knowledge. I want to also make a more significant impact through health care policy and professional organization leadership.”
3. As DNP Nurse Practitioners
Nobles, who is an FNP as well as a DNP, also notes, “The Nurse Practitioner / DNP pathway is increasingly popular and hopefully will become the standard degree for Advanced Practice Registered Nurses. Most nursing programs have phased out their Master’s programs for nurse practitioners and moved into a DNP NP program model.”
DNP programs train NPs who can implement better health outcomes on both a “micro” and “macro” level. With Baylor’s online DNP- Family Nurse Practitioner (DNP-FNP) degree program, for instance, students hone their clinical nursing skills and abilities as leaders and innovators, study the issues facing underserved populations, seek ways to implement new treatment methods, and improve patient outcomes for individuals, families, and entire communities across the lifecycle.
“Most nursing programs have phased out their Master’s programs for nurse practitioners and moved into a DNP NP program model.”
—Patrick M. Nobles, DNP, FNP-BC, CNL
Baylor’s online DNP – FNP degree program is academically rigorous and aims to train nurses in leadership, policy change, and holistically prepare them for what they will experience as practitioners in the field. DNP-FNP students combine advanced courses in pathophysiology, assessment, informatics, and pharmacology with healthcare policy and business, ethics, epidemiology, and servant leadership. A DNP-FNP degree can transform your future and prepare you to grow a thriving practice in family primary care or advance your career track as a public health program director, health policy specialist, patient services head, and other positions from which you can effect positive changes on a large scale.
Additionally, Baylor University offers online DNP tracks for Nurse-Midwifery, Pediatric Nurse Practitioners, and Neonatal Nurse Practitioners who want to take on leadership roles in their specialties. If you want to give back to the nursing profession and play a part in steering the future of nursing, a DNP degree can prepare you to take healthcare to the next level and enjoy a more fulfilling, lucrative, and influential nursing career.
The March of Dimes recently granted their Rising Star Award to clinical nurse leader Jenna Mason, MSN, for her array of leadership initiatives achieved in a short period of time after graduating from Seton Hall University’s Clinical Nurse Leader (CNL) program in 2015.
Mason began her career as a staff nurse with Hunterdon Medical Center in Flemington, NJ. She now works as a clinical nurse leader thanks to a promotion in her second year. Mason has utilized her practical experience to inform the administrative direction for the 30-bed, inpatient surgical floor, where she has served during her three-year tenure at the Center. In her role, she is responsible for staff and patient education, supporting the nursing staff with clinical expertise, data collection, and various areas of evidence-based research.
The March of Dimes Rising Star Award nomination came from Mason’s colleagues who recognized her for the development and implementation of multiple significant initiatives that have greatly improved patient outcomes and increased elements of safety for both patients and staff. One of her greatest accomplishments was a project design that successfully decreased the colonization rates of bacteria in high risk patients from December 2017 to May 2018, subsequently leading to an initiative which will reduce $30,000 of budgetary spending per year. The March of Dimes Rising Star Award was also attributed to Mason’s involvement on multiple committees throughout the hospital, embodying strong leadership skills, facilitating positive change, and demonstrating true dedication to her work.
When asked what it was about the program that attracted her, Mason was quick to observe that nursing requires the ability to work both collaboratively and independently in an environment that necessitates critical thinking. As someone who embraces the opportunity to enhance her leadership skills, she tells SHU.edu, “You need to be the one to enact change. I ended up exactly where I wanted to be. Seton Hall set me up for success.”
To learn more about clinical nurse leader Jenna Mason and her recent Rising Star Award designation from the March of Dimes, visit here.
