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Clinical Reasoning vs. Clinical Judgment: What’s the Difference for Next Generation NCLEX?

Sep 21, 2023, 15:06 PM
<2-min. read> NCSBN's foremost expert on the new (Next Generation) NCLEX discussed the subtle distinctions in verbiage regarding its test to assess clinical judgment.

The following is a transcript of the above video conversation between Philip Dickison, PhD, RN, CEONCSBN, and Sheryl Sommer, PhD, RN, CNE, former Vice President, Chief Nursing Officer, ATI.*

Before deciding that a new version of the NCLEX should be developed, the National Council of State Boards of Nursing (NCSBN) began researching the topic of clinical judgment in the nursing profession. The organization wanted to identify whether an actual need existed for new nurses to have this skill — and, thus, whether the NCSBN had a responsibility to assess that skill using its well-respected exam, the NCLEX.

But how do you define clinical judgment? How is it different than clinical reasoning?

We asked Dr. Dickison to explain.

Q: What’s the difference between clinical judgment and similar phrases, such as clinical reasoning, decision-making, or clinical decision-making?

A: These are words, but they need to be defined, okay? And so what we did was that there's this sort of combination of some new information in the cognitive science.
Decision theory explanationSo, you have a lot of research on critical thinking and you have this new — well, not brand new, but new compared to other lines of cognitive — and it's called decision theory, right? And so we said, let's take a look at the combination of critical thinking and decision theory. And it is out of that that comes this thing called clinical judgment. I would argue that's probably just a name that is clinical reasoning.

If someone is saying clinical reasoning, I generally stop and say, "What do you mean by that?" so I'm sure that we're all talking about the same thing, right? Or somebody says, "Clinicals are critical thinking." What do you mean by that? Because I need to know that we're talking about the same thing. 

Generally, in my world, I would say — and I know that some others won't — but that we're talking about clinical judgment. It may be an umbrella of critical reasoning. I suggest that they're probably just saying it because reasoning requires you to go through the same steps as judgment. 

Clinical judgment = the final decision

Clinical reasoning = the process

Judgment suggests that that's the final decision; reasoning is the process. Maybe, at the end of this, we call it clinical reasoning. I don't know. We have chosen clinical judgment and have established an operational definition for it, so we all know that's what we're talking about.

NCSBN’s operational definition of nursing clinical judgment:

An iterative decision-making process that uses nursing knowledge to:

  • Observe and assess presenting situations
  • Identify a prioritized client concern
  • Generate the best possible evidence-based solutions in order to deliver safe client care.
*This discussion took place at that National Nurse Educator Summit in April 2018 in Salt Lake City.