Introduction
Clinical judgment is an essential emphasis in modern nursing education. We discuss the importance of prioritization, early recognition of patient deterioration, timely intervention, and safe decision-making. And we absolutely should.
However, there is something even more fundamental that must come first. Before a nurse can think like a nurse, they must care like a nurse.
When clinical reasoning lacks compassion, it becomes mechanical. Similarly, critical thinking without moral grounding turns into a task-driven approach to patient care.
The foundation of nursing has always been character because nursing is never just a technical job. It is, and always has been, a calling rooted in the sacred worth of human life.
The beginnings of our profession
Over 2,000 years ago, the early Christian church established caring for the sick as a ministry grounded in Jesus’s teachings, recognizing human life as sacred and created in the image of God.
This belief transformed how the sick were treated, leading to the creation of hospitals and organized nursing through caregiving orders associated with St. Francis of Assisi and St. Benedict, emphasizing compassion.
Centuries later, Florence Nightingale advanced nursing by insisting on the importance of moral character alongside technical skills. She believed that nursing excellence stemmed from personal virtue, highlighting the need for nurses to think critically, disclose errors, advocate courageously, and act decisively based on strong character.
Let’s explore five timeless virtues Nightingale valued for her probationer nurses, which are still relevant today.
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Truthfulness
Honesty is essential to patient safety. A student who takes shortcuts by cheating will likely find it difficult to admit to a mistake in their practice. Transparency is not optional in nursing; it is a crucial element that protects lives.
Questions to ask your students:
- Am I honest even when it might have negative consequences for me?
- Would I report a mistake immediately, or would I hesitate to protect myself?
Clinical judgment and professional identity formation require moral courage, and moral courage relies on truthfulness.
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Integrity
Integrity means that the person you are in private aligns with the person you show to the public. In nursing, integrity is reflected in accurate documentation, ethical decision-making, and the prompt disclosure of mistakes.
Student reflection questions:
- Are my actions consistent with my stated values?
- When I make a mistake, do I take full responsibility for it?
Patients are safest when cared for by nurses whose inner character matches their professional behavior.
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Compassion
Compassion is at the core of nursing and remains the primary virtue ethic of our profession. Benner and Wrubel (1989) describe caring as a nurse by recognizing that the patient and their experiences truly matter to the caregiver. Compassion goes beyond sentimentality; it involves entering into another person’s vulnerability with intent and action.
This compassionate approach enhances clinical judgment. When you genuinely care, you:
- Notice subtle changes that others may miss
- Listen attentively
- Take action more promptly
- Advocate more assertively
A nurse who truly cares pays closer attention.
Consider these questions for your students:
- Have I become distant from suffering?
- Am I allowing myself to be moved and touched by the suffering of others?
In her seminal clinical judgment theory, Chris Tanner recognized that what the nurse brings to the situation (caring, compassion, engagement) is more important than what she knows (Tanner, 2006). Put another way, you cannot truly think like a nurse if you do not first care like one.
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Humility
Humility protects patients and enhances critical thinking. A humble nurse:
- Asks questions.
- Seeks clarification.
- Recognizes their limitations.
In contrast, arrogance can delay intervention, while humility fosters accelerated learning.
Have students reflect on these questions:
- Am I comfortable admitting what I don’t know?
- Do I find fulfillment in serving others?
The strongest clinical thinkers are often the most teachable.
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Gratitude
Gratitude reshapes our perspective. Entitlement says, “I deserve this,” while gratitude says, “I am entrusted with this.”
In many parts of the world, education is a privilege that students must fight for. This perspective significantly influences how one approaches learning.
Scripture reminds us: “In everything give thanks” (1 Thessalonians 5:18). We are called to be grateful not because everything is easy, but because gratitude anchors us in contentment.
Consider the following questions for student reflection:
- Do I approach nursing education with a sense of entitlement or stewardship?
- Am I willing to put in the hard work that growth requires? Gratitude cultivates resilience — something every nurse needs.
Clinical judgment is enhanced when it is based on compassion, integrity, humility, honesty, and gratitude. You cannot separate a nurse’s thought process from their character.
To think like a nurse, one must first care like a nurse.
My Journey
When I first wrote this blog about ten years ago, I sensed a shift in nursing education. We were increasingly focused on measurable outcomes, such as exam scores, predictive test scores, and NCLEX pass rates.
Over time, I have become more convinced that clinical judgment and character are inseparable. When compassion diminishes, vigilance declines. When integrity weakens, documentation suffers. When humility is absent, safety is compromised.
When we observe breakdowns at the bedside, we often look for knowledge gaps. However, the deeper issue may be related to professional identity formation grounded in the character of the nurse.
How much attention are we currently placing on this metric in nursing education?
To help students think like nurses, we must focus on who they are becoming, not just what they are learning. For educators, this involves:
- Integrating virtue-based reflection into case studies.
- Asking not only “What is the priority?” but also “What does caring require in this situation?”
- Demonstrating humility when you do not have an answer.
- Discussing ethical considerations when reviewing clinical errors.
- Connecting clinical reasoning to the inherent dignity of the patient.
Case-based learning can be an effective way to combine critical thinking and character development, as real-world scenarios demand not just decisions but also strong values. We do not need to overwhelm students with more content; we need to prioritize formation that blends compassion with sound judgment.
As you reflect on your program and teaching philosophy, consider the following questions:
- Where are virtues explicitly modeled and emphasized in my content?
- Do students observe caring and integrity in me?
- Are questions that emphasize compassion and humility incorporated into simulation debriefs?
- Are we focused on shaping professionals, or merely preparing students to pass tests?
Character formation does not occur by chance; it happens through intentional actions.
Closing Thoughts
These virtues do not come naturally; human nature tends to focus inward on the self. Character transformation requires intention and, historically, a spiritual foundation.
Regardless of individual beliefs, the nursing profession is built on transcendent values: service, sacrifice, and love for one’s neighbor.
Nursing emerged from the belief that all human life is sacred and that serving those who suffer reflects the heart of God.
If these foundations erode, technical and clinical judgment skills alone will not sustain the profession. However, if we nurture nurses who both care deeply and think critically, we enhance not only our graduates’ clinical judgment competency but also patient safety.
Recommended Resources
References
Benner, P., & Wrubel, J. (1989). The primacy of caring: Stress and coping in health and illness.
McDonald, L. (1999). Nightingale’s spirituality: The faith of Florence Nightingale.
Tanner, C. A. (2006). Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing. Journal of Nursing Education, 45, 204-211.
Woodham-Smith, C. (1951). Florence Nightingale.
Keith Rischer – Ph.D., RN, CCRN, CEN
As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…
The Ultimate Solution to Develop Clinical Judgment Skills
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