How is Clinical Judgement Used in Health Care initiatives in the Practice Setting?

Locate and describe a health care initiative (not related to your DNP project idea) in your
practice setting or community designed to improve patient populations or health systems
outcomes that demonstrate advanced levels of DNP clinical judgment.
What role did clinical judgment play in this initiative, and how was this evident?
What were the patient and population health outcomes?
Clinical judgment is crucial for DNP-prepared nurses because it can separate
monumental life-saving decisions from routine, banal clinical ones. DNP-prepared nurses are
always required to possess exquisite critical thinking and self-reflection skills crucial in making
decisive choices. They are required to collect, examine, and use evidence to create advanced,
objective judgments; use their knowledge and experience, clinical thinking, intuition, and
evidence-based practice skills; and integrate interprofessional teams to find logical solutions.
Through their training, DNP-nurses acquire leadership skills, research and analytical skills, and
clinical-based expertise that they can use to make informed decisions when faced with ethical
dilemmas and challenging situations (Benner, Hughes, & Sutphen, 2008).

Health Care Initiative

In 2020, the local clinic I worked for contemplated introducing electronic health records
across all departments, from the billing to the laboratory to the physician offices to the nursing
section. The complaint was that previous paper-based charts were tedious, time-consuming,
erratic, and inaccurate, hampered communication among clinicians, and delayed decision-
making at the point of care. As a result, critical sections like the emergency department did not
just register higher medication errors, morbidities, and mortalities but also negatively impacted

CLINICAL JUDGMENT 3
patient experiences, increased hospital stay, and skyrocketed the cost of care. In 2020, the facility
was operating ineffectively and inefficiently, clinicians complained of burnout, and the patient
walk-in traffic was at its lowest. Therefore, the facility’s leadership required clinical judgment to
determine whether EHRs would reverse the situation. The core objective was to improve the
safety and quality of patient care, enhance clinician communication and flow of data required to
make critical treatment decisions, and reduce medication errors and mortalities. Ideally, the
management needed to urgently make an advanced level of DNP clinical judgment to save the
facility from liquidity. Ultimately, the facility opted to roll out a comprehensive EHR system in
December 2020 after the Board approved the decision proposed by the management.

Role of Clinical Judgement

Personally, clinical judgment was practical because it promised to integrate evidence-
based knowledge and practices with interprofessional collaboration and interdisciplinary teams
and nurse experiences and skills to improve patient outcomes, nurse collaboration, and revive the
facility’s fortunes. From the beginning, managers used DNP advanced-level research and
analytical skills to examine the evidence about the industry-wide implementation and success of
EHRs from government websites and peer-reviewed article databases. For example, a National
Health Statistics Report revealed that nearly 26 percent of healthcare facilities in residential
areas used EHRs, representing an increase from 20 percent in 2012 (Caffrey, Cairns, & Rome,
2020). This was evident in the management’s attitude and tone towards the program from when it
was first proposed to when it was voted. Clinical judgment helped managers convince the Board
about the potential of the EHR redeeming the ailing facility by answering the why, how, when,
and who questions using evidence-based data.

Patient and Population Health Outcomes

CLINICAL JUDGMENT 4
Within three months after implementation, the clinic reduced mortality and morbidity
rates by 50 percent, lowered hospital stays by an average of 1 day per patient, increased patient
walk-in traffic by 5 percent, and improved revenues by 10 percent. Evidence has linked EHR use
to better collaboration and communication among clinicians and patients, lower medication
errors, and improved patient safety and quality of care (HealthIT.gov, 2019).

CLINICAL JUDGMENT 5

References

Benner, P., Hughes, R. G., & Sutphen, M. (2008). Chapter 6: Clinical reasoning, decision-
making, and action: Thinking critically and clinically. In Hughes R.G. (ed), Patient safety
and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for
Healthcare Research and Quality.
Caffrey, C., Cairns, C., & Rome, V. (2020). Trends in electronic health record use among
residential care communities: United States, 2012, 2014, and 2016. National Health
Statistics Reports, 140, 1-10. https://www.cdc.gov/nchs/data/nhsr/nhsr140-508.pdf
HealthIT.gov. (2019, June 4). Improved diagnostics & patient outcomes.
https://www.healthit.gov/topic/health-it-and-health-information-exchange-
basics/improved-diagnostics-patient-outcomes