Clinical Judgment
While often associated specifically with nursing, the process of developing and using clinical judgment applies to almost any worthwhile endeavor or profession. At SyncSim, we believe that by providing realistic, work-based experiences coupled with live facilitation by field experts, we can cultivate a culture of curiosity and intentional thought. Below, read more about clinical judgment and why it is specifically relevant to the healthcare professions, their patients, and our communities.
What is Clinical Judgment?
The Impact
Why does all of this matter, and why are we seeing a decrease in clinical judgment ability from our new grad nurses? A message from the CEO: Almost 30 years ago, when I was a nursing student, the clinical experience was very regimented. Before each clinical day we were required to go to the clinical site wearing our uniforms and badges and spend hours reviewing charts for our patients, which had already been assigned to us. Patient demographic data, family-medical-surgical-social history, medications, procedures, laboratory and diagnostic testing results, nursing and progress notes, and provider orders. We looked at everything! We took copious notes (no smart devices back then). Then we went home and spent several more hours creating drug cards, researching diagnoses, normal/abnormal lab values, care planning guides, and textbooks. We didn't have the internet to answer it all for us. No AI to tell us everything we should anticipate the following day. Nope - for us it was about preparing. We formed hypotheses in our minds well before we even said hello to our patients. The clinical day for us then became an exploration of what we expected and the headspace to dig in when our hypotheses proved incorrect. The staff nurses and our clinical faculty provided guidance and support. We practiced skills and communication techniques. But all of the learning was layered into our pre-developed knowledge -leaving us free to be curious and investigate. And more often than not, we then had the opportunity to care for the same patients on a subsequent day, learning even more about the evaluation of patient outcomes. ​ Ask any nursing school today to send their students to their clinical site the night before clinicals without their faculty and they will likely look at you as if you are joking. Faculty are expected to be present with the students. Patient assignments can rarely be provided 24 hours before a clinical day due to changes in patient acuity and length of stay. How often do you imagine a student actually gets to take care of the same patient more than once, outside of a long-term care facility? Rules have changed. Healthcare systems have changed. Faculty have changed. Thus, the training we provide for our students has changed.  Students now learn through mimic behavior, which is entirely dependent upon the staff nurse they are paired with. Without the benefit of preparation, each new piece of information is simply captured while simultaneously trying to perform the role of a nurse. Without the ability to interpret meaning and develop independent judgment regarding the patient's condition and care, clinical can be almost as unhelpful as a lecturer at the front of a classroom going through 87 PowerPoint slides. ​ Now I know what will be said. Leila, out there in the real world nurses don't have the luxury of planning. They show up, clock in, get a patient assignment, and get to work. Yes - that is absolutely the case. However, if their time spent in school had been filled with experiences like we had 30 years ago, they would likely be well-prepared to transfer those experiences and associated knowledge into a novel situation. ​ So where does this leave us, and why did I feel compelled to post this note? I don't see us able to change patient turnover, or staffing, or rules related to students showing up at a clinical site. Experiences like the ones I had in school are likely gone forever. I wrote all of this to share why I am so passionate about simulation and why this company was started. It is our goal at SyncSim to recreate, to the extent possible, the kind of learning opportunities that truly stick. Students are not only allowed, but expected to prepare before our clinical days. We encourage, support, and facilitate that vital part of the clinical learning process. Then, we provide intentional, meaningful patient encounters designed to assist students in achieving specific outcomes. And as a bonus, we even get to provide assessment data to the students and their programs. ​ We hope that you find some connection to our mission, and that you will have your students join us during an upcoming clinical experience. Just think of it as an awesome 1995 throwback. ​ Best, Leila Casteel, DNP, APRN, NP-C CEO, SyncSim, LLC