Clinical Judgment
Clinical judgment is the process by which nurses observe, interpret, respond to, and reflect on patient data to make informed decisions about patient care. The NCSBN Clinical Judgment Measurement Model (NCJMM) is the framework used on the NCLEX to evaluate this competency.
Exam Tip
Know the 6 NCJMM steps: Recognize Cues, Analyze Cues, Prioritize Hypotheses, Generate Solutions, Take Action, Evaluate Outcomes. NGN items test clinical judgment through case studies and new item types. Focus on APPLICATION, not memorization.
What Is Clinical Judgment in Nursing?
Clinical judgment is the cognitive process nurses use to identify, prioritize, and manage patient health situations. It goes beyond memorizing facts to applying critical thinking in real clinical scenarios. The NCSBN developed the Clinical Judgment Measurement Model (NCJMM) to assess this skill on the NCLEX.
NCSBN Clinical Judgment Measurement Model (NCJMM)
The NCJMM has 6 cognitive processes organized in a cycle:
| Step | Cognitive Process | What It Means |
|---|---|---|
| 1 | Recognize Cues | Identify relevant information from patient data |
| 2 | Analyze Cues | Organize and connect the information |
| 3 | Prioritize Hypotheses | Rank possible explanations or conditions |
| 4 | Generate Solutions | Identify expected outcomes and interventions |
| 5 | Take Action | Implement the best interventions |
| 6 | Evaluate Outcomes | Assess whether interventions were effective |
Clinical Judgment vs. Critical Thinking
| Clinical Judgment | Critical Thinking |
|---|---|
| Applied to patient care specifically | Broader reasoning skill |
| Uses patient data and clinical knowledge | Uses logic and analysis in any context |
| Results in nursing actions | Results in conclusions or decisions |
| Measured by NCJMM on the NCLEX | Foundation for clinical judgment |
How NGN Tests Clinical Judgment
| NGN Item Type | NCJMM Steps Tested |
|---|---|
| Highlight | Recognize Cues |
| Drop-down Cloze | Analyze Cues, Prioritize Hypotheses |
| Matrix/Grid | Generate Solutions, Take Action |
| Drag-and-Drop | Prioritize Hypotheses, Take Action |
| Bowtie | Multiple steps simultaneously |
| Case Studies | All 6 steps across multiple items |
Exam Alert
Clinical judgment is the core competency tested on the NCLEX-PN through NGN item types. Understand all 6 steps of the NCJMM. Practice recognizing relevant cues in patient data, prioritizing hypotheses, and evaluating outcomes. Clinical judgment questions require APPLICATION, not just recall.
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Related Terms
Nursing Process
The nursing process is a systematic, five-step problem-solving framework used by nurses to provide patient-centered care: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE). It is the foundation of all nursing practice and the organizing framework for the NCLEX.
Computerized Adaptive Testing (CAT)
Computerized Adaptive Testing (CAT) is the testing methodology used by the NCLEX-PN and NCLEX-RN, where the computer adjusts the difficulty of each subsequent question based on the candidate's previous answers to determine competency with 95% confidence.
Delegation (Nursing)
Delegation in nursing is the process of transferring responsibility for performing a specific nursing task to another qualified individual (such as a CNA or UAP) while retaining accountability for the outcome. The five rights of delegation guide safe delegation decisions.
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