"Nurses don't make judgments"...do they?

[Darjeeling22]

I'm a first-year student, and we had an interesting question on a test the other day. It asked what was an example of teaching that a nurse can do. One answer (exact wording changed to protect the innocent) was "Your BP is 120/80, which is within normal range". This answer was wrong, as I learned, because calling a BP "normal" was not something a nurse can do. I was told "nurses don't make judgments". Which got me rather down, as I wonder if I'm walking into a profession that is really so tightly restricted.

I can understand why the answer was incorrect. If I read into it and realize there was no information given as to the patient's previously measured BP, 120/80 might indeed not be "normal" for them. And there's always the nightmare looming over my student head that if I say something positive about someone's status and two minutes later they crash and die, it'll be me everyone's pointing fingers at.

I get answers like this, but then on another question asking about a nurse's duty, the correct answer was "to gather and interpret data". Somewhat contradictory. Then I go to my community health rotations and watch a nurse (not a practitioner) help a patient interpret their high AC1 level and some other labs. At LTC rotation, the nurses I observed seemed to be making plenty of judgments as to whether something was abnormal with their patients.

So I'm just curious to hear from working nurses, because as a student I don't feel like I've grasped where the line is yet -- do you feel you make judgments? And where do you feel is the border between the kind of judgments a nurse can make (if any), and where it crosses into medical calls that you can't make? Is it only correct when you're repeating what a doctor has said?

[86toronado, BSN, RN]

I use nursing judgment every day. Just because a doctor doesn't write parameters for a medication, ie: "hold lopressor for SBP of less than 110 mmhg" doesn't mean that I will give the lopressor to a patient with a SBP of 90 mmhg. If you are a nurse, and not making judgments, you will either kill someone, or **** off some doctor for calling him/her for every little assessment finding.

[86toronado, BSN, RN]

There I go getting censored for my potty mouth again... :)

[SitcomNurse, BSN, MSN, EdD, RN]

Nurses who work in LTC generally have a relationship with the population they serve. They are all there... long term. So, I know Mr P. has a b/p of 97/64 every day. If he was 120/80, Id say something was wrong, and start assessing.

And I agree with 86toronado, you need nursing judgement, which comes in the form of knowledge of the patients normal status, the meds you are giving out, and common sense of what is going to happen--which you learn in Nursing School.

You will be valued as a nurse when you use all your faculties to gather information, and tell the doc what it is, after you have yourself well grounded, you will be able to say... This is happening again, and this is what you did last time/this is what the primary doc did last time.

You make judgement calls, as soon as you know who youre dealing with as a Doc, and who the patients are.

A doctor cant order common sense, but they all hope to God we have it!

Good luck in your career!

[Murse901, MSN, RN]

If a nurse *doesn't* make judgments, he or she won't be a nurse for very long.

[Woodenpug, BSN]

I have always believed that critical thinking is fundamental to nursing.

[ukstudent]

Nurses use their judgement all the time. The difference in the test question come from NOT the use of judgement but from then telling a pt a diagnosis of normal blood pressure. To make it clearer, say the BP is 200/110. You can use nursing judgement to give a BP med or call the Dr for a med but you can not tell the pt that they have a medical diagnosis of high BP. Hope this makes sense.

[hockeynpolo]

Nurses make judgments everyday we work. I work in the ICU and with every medication I give, I need to make sure A) it's the right medication for the patient problem B) the patient is stable enough to get the medication (i.e. holding a beta blocker or ACE inhibitor if the systolic BP is below 100, titrating levo to a MAP of 65, etc), and C) the med it compatible with all the other drips that are going (in addition the the 5 rights of medication administration). Also, nurses are with their patients 8-12 hours a day, while the doc round on their patients for 15 minutes and then leave. We have that extra sense and know when our patients aren't doing well. It is then our JUDGMENT to assess the situation, assess the patient, get as much information as possible to figure out the problem, and if we can't resolve it on our own, then we call the docs. Nurses making judgments is a vital role of what we do as nurses. Nurses who don't make judgments aren't good nurses, aren't safe nurses, and aren't performing the duties of what a nurse should be doing.

Keep on making judgments, assessments, and be keen on your patients' conditions and status.

[metal_m0nk, BSN, RN]

Nursing school is full of information that is designed to encourage you to think about patient care/nursing actions in a particular way but that is not intended to be taken literally.

[nursel56]

Darjeeling, without giving any extraneous incriminating details - I'd love to know what the right answer was to get an idea of how the blood pressure answer became so wrong. There are many normal values we inform patients of all the time. I like to see how the person who wrote that question thought.

[MassED, BSN, RN]

you are in school to LEARN about judgments and your own bias. We all make judgments, in whatever we do (we're human). Tthe key is to keep that in your brain and filter it. Allow that to stay in that brain but use it to challenge yourself and look beyond those biases when dealing with patients. I find that my judgments are helpful - and usually those I "peg" a mile away walking in the door is right. So the judgment helps. Just keep it on the down low. While in school, you have to go by the rules to pass the test. The real world relies on judgment, critical thinking, multi-tasking, etc.

[BridgetvdpGN]

Nursing judgement is part of the nursing process..you use your knowledge and experience to assess the situation. So yes, it is of course allowed within your scope of practice