Nursing Clinical Judgment Examples: 12 Real Scenarios With SBAR Scripts, Charting Tips, and Step-by-Step Thinking

Every nurse knows that clinical judgment is what turns knowledge into action. On any shift, you’ll face moments where a new symptom, an unusual lab result, or even a subtle change in behavior demands quick thinking. How you respond can shape the patient’s outcome — sometimes within minutes.

In this guide, you’ll explore nursing clinical judgment examples drawn from real practice. Each scenario walks you through how to recognize cues, analyze them, and take safe, confident action. You’ll also see how frameworks like the NCSBN Clinical Judgment Model (CJMM), Tanner’s Model, and Lasater’s Rubric support clear decision-making.

What Is Clinical Judgment in Nursing?

Clinical judgment is how nurses think and act when caring for patients. It goes beyond recording vitals or giving medications. It’s about noticing what matters most, making sense of it, and choosing the safest next step.

For example, a blood pressure of 88/50 isn’t just a number on a chart. A nurse sees the risk: the patient could be bleeding, dehydrated, or septic. The nurse decides what to assess first, acts quickly, and then evaluates whether the action worked. That’s clinical judgment in real time.

Models That Guide Clinical Judgment

Because judgment can be complex, nurses lean on proven models that break the process into clear, repeatable steps. These frameworks aren’t just academic — they’re practical tools that help nurses organize their thinking in fast-paced settings.

1. NCSBN Clinical Judgment Model (CJMM)

This is the model behind the NCLEX Next Generation exam. It gives a structured roadmap:

1. Recognize Cues – What’s different? (labs, vitals, patient behavior)
   
2. Analyze Cues – What could these changes mean?
   
3. Prioritize Hypotheses – Which problem is most urgent?
   
4. Generate Solutions – What options do I have?
   
5. Take Action – Carry out the safest intervention.
   
6. Evaluate Outcomes – Did it work? What next?
   

Why it matters: CJMM reflects how nurses must think step by step under pressure. For example, in sepsis: recognize fever + tachycardia, analyze for infection, prioritize risk of shock, act with fluids and antibiotics, then evaluate response.

2. Tanner’s Model

Patricia Tanner’s model is widely used in education for its simplicity:

• Noticing – Picking up key cues.
  
• Interpreting – Making sense of the situation.
  
• Responding – Taking action.
  
• Reflecting – Looking back to learn from the outcome.
  

Why it matters: Tanner’s model emphasizes reflection. Nurses don’t just act — they pause afterward to ask, What did I miss? What would I do differently? This loop builds long-term growth and sharper judgment.

3. Lasater Clinical Judgment Rubric (LCJR)

The LCJR is a tool that measures how well students use judgment in simulations or clinicals. It breaks judgment into four dimensions:

• Noticing (observing cues, recognizing patterns)
  
• Interpreting (analyzing and explaining data)
  
• Responding (choosing and carrying out actions)
  
• Reflecting (evaluating results and adjusting)
  

Each dimension is scored from beginner to exemplary, helping both students and educators track progress.

Why it matters: It turns an abstract skill into something you can measure. Educators use it to give clear feedback, while students use it to see how their decision-making improves over time.

Why Clinical Judgment Matters in Nursing

Clinical judgment isn’t just another skill. It’s the safety net for patients and the backbone of nursing practice. Nurses who use sound judgment catch small changes before they spiral into emergencies. They also deliver care that feels personal, because decisions are based on both clinical data and the patient’s unique story.

Here’s why it matters:

• Patient Safety: Strong judgment helps prevent errors like wrong medications, missed symptoms, or unsafe discharges.
  
• Better Outcomes: Nurses who think critically respond faster, leading to quicker recovery and fewer complications.
  
• Team Trust: Doctors, patients, and families rely on nurses to notice what others might miss.
  
• Career Growth: Clinical judgment is central to the NCLEX Next Generation exam. Employers also look for it when hiring or promoting.
  

Think of clinical judgment as the bridge between knowledge and action. Without it, even the best textbook answers won’t protect patients in real life.

12 Real-World Nursing Clinical Judgment Scenarios

1. Postoperative Shortness of Breath

A patient returns from surgery and suddenly becomes short of breath. Their oxygen saturation drops to 86%. The nurse must act quickly to stabilize the patient and alert the provider.

Nurse Actions

• Recognize cues: low O₂ saturation, rapid breathing, restlessness.
  
• Analyze: possible atelectasis, pulmonary embolism, or fluid overload.
  
• Prioritize: oxygenation comes first.
  
• Act: raise the head of bed, apply oxygen, call provider.
  

SBAR Example
Situation: Post-op patient with O₂ sat 86%.
Background: Abdominal surgery 2 hours ago.
Assessment: Labored breathing, RR 28.
Recommendation: Immediate evaluation for PE vs. respiratory distress.

2. Chest Pain on the Unit

A 58-year-old male reports sudden chest pain rated 8/10. He is pale, diaphoretic, and clutching his chest.

Nurse Actions

• Recognize cues: severe chest pain, diaphoresis, pale skin.
  
• Analyze: possible myocardial infarction.
  
• Prioritize: treat as cardiac emergency.
  
• Act: call rapid response, start oxygen, prepare for EKG.
  

SOAP Example
S: Patient reports severe chest pain.
O: Pale, sweating, BP 92/60.
A: Possible MI.
P: Oxygen started, provider paged, EKG ordered.

3. New Confusion in an Elderly Patient

An 82-year-old patient who was previously alert becomes suddenly confused and tries to climb out of bed.

Nurse Actions

• Recognize cues: new confusion, restlessness.
  
• Analyze: possible UTI, hypoxia, or medication side effect.
  
• Prioritize: safety and rapid assessment.
  
• Act: check vitals, order labs per protocol, initiate fall precautions.
  

SBAR Example
Situation: Patient developed new confusion.
Background: Normally alert and oriented.
Assessment: Disoriented, temp 101°F, HR 112.
Recommendation: Urine sample and provider evaluation.

4. Insulin Timing Error

A nurse notices a colleague preparing to give insulin, but the patient hasn’t yet received their meal tray.

Nurse Actions

• Recognize cues: insulin due, no food available.
  
• Analyze: risk of hypoglycemia.
  
• Prioritize: delay insulin until food is present.
  
• Act: hold insulin, notify team, educate colleague.
  

Charting Tip
Document that insulin was safely delayed, note the reason, and record that the provider was informed.

5. Postpartum Hemorrhage

One hour after delivery, a patient begins soaking pads rapidly, with blood pooling beneath her. She looks pale and weak.

Nurse Actions

• Recognize cues: heavy bleeding, pallor, weakness.
  
• Analyze: postpartum hemorrhage, risk of shock.
  
• Prioritize: stop bleeding, maintain circulation.
  
• Act: massage fundus, call provider, prepare IV fluids and oxytocin.
  

SOAP Example
S: Patient reports weakness.
O: Heavy vaginal bleeding, BP 84/50.
A: Postpartum hemorrhage.
P: Fundal massage, IV fluids started, provider notified.

6. Pediatric Asthma Attack

A 10-year-old with asthma develops wheezing, retractions, and can’t complete sentences.

Nurse Actions

• Recognize cues: severe wheezing, accessory muscle use, short phrases.
  
• Analyze: acute asthma exacerbation.
  
• Prioritize: airway support.
  
• Act: administer nebulizer, monitor O₂ sat, stay with child, notify provider.
  

SBAR Example
Situation: 10-year-old with severe wheezing.
Background: Known asthma history.
Assessment: RR 32, O₂ sat 89%, speaking in short phrases.
Recommendation: Urgent provider evaluation, continue nebulizer therapy.

7. Sepsis Suspected

A patient with pneumonia spikes a fever (104°F), HR 130, and BP 82/54.

Nurse Actions

• Recognize cues: high fever, tachycardia, hypotension.
  
• Analyze: possible sepsis.
  
• Prioritize: treat as emergency.
  
• Act: call rapid response, draw blood cultures, start IV fluids and prep antibiotics.
  

SOAP Example
S: Patient reports chills.
O: Temp 104°F, HR 130, BP 82/54.
A: Sepsis suspected.
P: Blood cultures drawn, IV fluids started, antibiotics pending.

8. Stroke Symptoms in the ER

A 70-year-old suddenly develops slurred speech and right-sided weakness.

Nurse Actions

• Recognize cues: facial droop, slurred speech, arm weakness.
  
• Analyze: possible stroke.
  
• Prioritize: time-sensitive emergency.
  
• Act: activate stroke team, check glucose, prep for CT scan.
  

SBAR Example
Situation: 70-year-old with slurred speech and right-sided weakness.
Background: No prior stroke history.
Assessment: FAST positive.
Recommendation: Immediate stroke team activation.

9. Hypoglycemia After Insulin

A diabetic patient becomes sweaty, shaky, and confused shortly after receiving insulin. Blood glucose is 52 mg/dL.

Nurse Actions

• Recognize cues: diaphoresis, tremors, confusion, low glucose.
  
• Analyze: hypoglycemia.
  
• Prioritize: rapid glucose correction.
  
• Act: give oral glucose if alert, IV dextrose if not, then recheck glucose.
  

SOAP Example
S: Patient reports dizziness.
O: BG 52, sweating, disoriented.
A: Hypoglycemia.
P: 15 g oral glucose given, BG recheck planned.

10. Fall in the Hospital

A patient is found on the floor after trying to walk unassisted. They report hip pain.

Nurse Actions

• Recognize cues: fall, hip pain, possible fracture.
  
• Analyze: risk of injury, need for imaging.
  
• Prioritize: safety and assessment.
  
• Act: check vitals, assess injury, notify provider, reinforce fall precautions.
  

SBAR Example
Situation: Patient found on floor with hip pain.
Background: Known fall risk.
Assessment: Guarding right hip, vitals stable.
Recommendation: X-ray, pain management, update care plan.

11. IV Infiltration

During IV medication administration, the nurse notices swelling, coolness, and pain at the IV site.

Nurse Actions

• Recognize cues: swelling, blanching, discomfort.
  
• Analyze: infiltration.
  
• Prioritize: prevent tissue damage.
  
• Act: stop infusion, remove IV, elevate limb, apply compress.
  

Charting Tip
Document: “IV site swollen and cool to touch. Infusion stopped, catheter removed. Limb elevated, cold compress applied. Provider notified.”

12. Medication Allergy Reaction

Minutes after IV antibiotics, a patient develops hives and shortness of breath.

Nurse Actions

• Recognize cues: hives, wheezing, shortness of breath.
  
• Analyze: allergic reaction, possible anaphylaxis.
  
• Prioritize: airway and emergency treatment.
  
• Act: stop infusion, call rapid response, give epinephrine, support airway.
  

SBAR Example
Situation: Patient developed hives and SOB after IV antibiotic.
Background: No prior allergy noted.
Assessment: Wheezing, O₂ sat 88%.
Recommendation: Epinephrine, airway support, provider at bedside.

Common Mistakes in Clinical Judgment (and How to Avoid Them)

Even experienced nurses can slip up when making clinical judgments. The good news? Most mistakes follow predictable patterns — and once you spot them, you can avoid repeating them.

1. Missing Subtle Cues

Example: Ignoring mild confusion in an elderly patient that later turns out to be early sepsis.
Fix: Slow down. Always compare today’s behavior or vitals with the patient’s baseline. Small changes often point to big problems.

2. Jumping to Conclusions

Example: Assuming chest pain is indigestion instead of ruling out a cardiac emergency.
Fix: Keep an open mind. Rule out life-threatening causes before minor ones.

3. Poor Prioritization

Example: Giving pain meds before addressing an oxygen saturation of 82%.
Fix: Use the ABCs (Airway, Breathing, Circulation) and Maslow’s hierarchy to decide what matters most.

4. Weak Communication

Example: Saying, “The patient isn’t doing well,” without giving details.
Fix: Use SBAR or SOAP so your message is clear, structured, and actionable.

5. Incomplete Documentation

Example: Writing “patient better” instead of “O₂ sat improved from 86% to 95% after 2 L NC oxygen.”
Fix: Document with measurable data. Ask: Would another nurse know exactly what happened from my note?

6. Skipping Reflection

Example: Moving on after an error without reviewing what went wrong.
Fix: Take a few minutes after critical events to reflect. What cues did you miss? What could you change next time? Reflection sharpens judgment over time.

How Clinical Judgment Is Tested in Nursing Education

Nursing programs and exams now put heavy weight on clinical judgment. The NCLEX Next Generation is built around it, using case-based questions that look and feel like real patient scenarios.

For example, you might see a patient profile with labs, vitals, and progress notes. Instead of one multiple-choice question, you’ll work through steps such as:

1. Recognize the most important cues.
   
2. Decide which problem matters most.
   
3. Pick the safest action.
   
4. Evaluate if the plan worked.
   

This mirrors what nurses actually do at the bedside and shows how closely the NCLEX is tied to the NCSBN Clinical Judgment Model (CJMM).

In school, judgment is also tested through:

• Simulation labs where you practice scenarios with mannequins or standardized patients.
  
• Case studies that require you to explain your reasoning and actions.
  
• Rubrics like Lasater’s, which grade how you notice, respond, and reflect.
  

By the time you graduate, you’re not only tested on knowledge. You’re tested on how well you think like a nurse.

How Students and Nurses Can Strengthen Clinical Judgment

Strong clinical judgment doesn’t appear overnight. It’s built through practice, reflection, and the right tools. Here are six proven ways to sharpen your thinking:

1. Practice with Case Studies and Simulations

• Why it helps: They mimic real scenarios without putting patients at risk.
  
• How to apply: Work through cases step by step using the CJMM framework. Ask: What cues matter most? What action should I take first?
  

2. Use Structured Frameworks

• Why it helps: Tools like CJMM, Tanner’s Model, and Lasater’s Rubric give you a roadmap when situations feel overwhelming.
  
• How to apply: Get in the habit of running through Recognize → Analyze → Prioritize → Act → Evaluate after major events.
  

3. Strengthen Communication Skills

• Why it helps: Even good judgment can fail if communication is weak.
  
• How to apply: Practice SBAR or SOAP handoffs in school or on the unit. Role-play with classmates or coworkers to make it second nature.
  

4. Reflect on Your Decisions

• Why it helps: Reflection turns experience into growth.
  
• How to apply: After each shift, ask yourself: What cues did I catch? What did I miss? How did my choices affect the patient? Keep a journal to track insights.
  

5. Seek Feedback and Mentorship

• Why it helps: Experienced nurses often spot blind spots you can’t see.
  
• How to apply: Ask a preceptor, mentor, or charge nurse to review your reasoning and documentation.
  

6. Stay Current with Evidence-Based Practice

• Why it helps: Outdated knowledge can cloud good judgment.
  
• How to apply: Read clinical guidelines, join nursing forums, and attend workshops. Connect your daily decisions to current best practices.
  

Conclusion: Turning Judgment Into Confident Action

Clinical judgment isn’t just a test skill — it’s the backbone of safe, effective nursing. Every day, nurses are asked to notice subtle changes, act quickly, and explain their reasoning. The 12 scenarios in this guide show how judgment unfolds in real life: recognizing cues, deciding what matters most, acting in time, and documenting clearly.

If you’re a student, these examples prepare you for NCLEX-style questions and clinicals. If you’re already practicing, they serve as reminders of the split-second choices that protect patients and build trust.

Key Takeaways

• Clinical judgment saves lives. Missing cues or misprioritizing can change outcomes.
  
• Frameworks guide thinking. Use CJMM, Tanner’s Model, or Lasater’s Rubric to stay organized.
  
• Communication is critical. SBAR and SOAP keep the whole team on the same page.
  
• Reflection builds skill. Learn from each case, even the tough ones.
  

By practicing, documenting, and reflecting consistently, you’ll not only strengthen your own judgment but also help create safer, stronger care for every patient you meet.