The first years of work as a nurse are critical to the development of clinical skills and expert nursing judgment. These early years serve as a foundation for building the competency, confidence, and decision-making abilities required to deliver safe and effective patient care. I was excited to begin my career as a nurse and overjoyed to be able to define myself as a professional nurse. But soon after starting my practice, I was overwhelmed by the knowledge and expert action of my more seasoned colleagues. They seemed to possess an “other-worldly” ability to predict the future, to anticipate patient needs and to prepare for events that were yet to happen. In my eyes, they were magical! I felt like an imposter. What was I thinking to believe that I could be like these incredible nurses? But held up by the fact that I needed to make a living to support my children and also by a little bit of ego, I put my game face on and stepped up to the plate. If they could do it, I could do it.
In nursing education, we gain valuable theoretical knowledge and learn fundamental clinical skills in a controlled environment, such as a nursing school simulation lab or clinical rotation. However, I soon found that the realities of working on the front lines of nursing differ in several key ways. Clinical practice introduces nurses to the nuances of patient care that cannot always be fully anticipated in textbooks or simulated scenarios. The first years of professional practice are vital for bridging the gap between theoretical learning and the complex, unpredictable nature of real-world patient care. Patient and family demands, patient load with diverse needs, dynamics of the healthcare environment with minute to minute interruptions, coupled with the requirement to “get it right”.
Clinical judgment refers to the nurse’s ability to assess, analyze, and make decisions based on their clinical knowledge and the context of the patient’s needs. It involves a blend of critical thinking, experience, intuition, and evidence-based practice. In the first few years of a nursing career, nurses hone these skills through the regular application of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. Gradually, these processes and the continual acquisition of knowledge through experiences evolves into an innate process that becomes the responses of the expert nurse.
Developing strong clinical judgment is a gradual process that involves actively seeking out and reflecting on clinical experiences. It is through practice that nurses learn to recognize subtle changes in patient conditions that could signal a need for intervention, as well as when to collaborate with other healthcare professionals or escalate concerns. My preceptors and mentors aided my development by pointing out the need for intervention and reinforcing my decision making and guiding the development of skills and knowledge.
The changing landscape has resulted in an abbreviation of this kind of mentorship and support and novice nurses may not have the same opportunity to learn and grow. We must focus on enhancing these experiences and placing importance on the support and intentional early development of skills and judgement.
Placing a spotlight on nursing stories is an evidence-based strategy to both identify the value of nursing intervention and to educate others about the impact of quality nursing care. With this in mind, we will be reviving our annual conference (formerly the FNA Clinical Excellence Conference) in 2025 during National Nurses Week (May 6-12). Guidelines will be disseminated in December to allow nurses and state institutions to prepare to submit to this much celebrated event. Please stay alert for the official announcement before the end of the year. A toast to Florida’s Magical Nurses!
P.S. In the end, according to my mentees I also became a Magical Nurse.
In the Spirit of Caring,
Willa Fuller, RN
Executive Director,
Florida Nurses Association
