One Educators Transformational Journey
by Tiffany Condren
This section was written by Tiffany Condren, Ph.D., RN, RNC, CHSE, a passionate clinical educator who recognized the need to change. By incorporating the best practices found in this course, she completed her dissertation study, Effectiveness of Clinical Judgment Reflection Prompts to Develop Clinical Judgment in Prelicensure Nursing Students: A Quasi-Experimental Study in 2024 using the KeithRN “Advanced Reasoning worksheet” with 25 clinical reasoning questions to determine if this worksheet used over her clinical course could improve development of clinical judgment, which it did!
Learn more in her own words…
The Need for Change
I remember being a new clinical instructor and feeling frustrated in a busy clinical setting. The usual teaching methods just weren’t working. My students felt overwhelmed and lost. They struggled to develop the clinical judgment skills they needed. Too often, they were seen as “lazy” or “disengaged,” but I knew they weren’t lazy—they just needed guidance and purpose. Something had to change.
A New Approach: Tanner’s Clinical Judgment Model
In my quest for a better teaching strategy, I discovered Tanner’s Clinical Judgment Model (TCJM). This model made sense of my nursing thought process and provided a practical approach to developing clinical judgment. Outlined by Tanner (2006), it’s a research-based framework recognized in nursing education (Dickison et al., 2019). By integrating TCJM into my teaching, students transitioned from merely completing tasks to “thinking like nurses.”
They became more observant, interpreted data accurately, and made confident decisions. Research shows that structured clinical judgment models like TCJM enhance clinical reasoning in prelicensure nursing students (Gonzalez & Nielsen, 2024; Jessee et al., 2023) and improve performance on NCLEX-style questions (Dickison et al., 2019).
KEY TAKEAWAY
Tanner’s Clinical Judgment Model is more than just a teaching method; it transforms education by connecting a practice-informed framework with real-world practice. By matching clinical teaching to Tanner’s four clinical reasoning processes needed to develop the outcome of clinical judgment, clinical educators equip students to successfully transition to today’s challenging healthcare environment.
“Aha” Moment
I’ll never forget when I realized that traditional teaching wasn’t enough. My students needed a framework to guide their thinking, which led me to TCJM. By adapting the Advanced Clinical Reasoning Questions from KeithRN to align with TCJM’s phases—Noticing, Interpreting, Responding, and Reflecting—I provided my students with a structure to enhance their clinical judgment skills. Witnessing their transformation from uncertain learners to confident professionals was incredibly rewarding despite the challenges we faced.
To further integrate structured reflection, our program includes training for clinical instructors each semester, ensuring consistency in using prompts. Instructors learn to lead discussions that challenge and support student growth, fostering a dynamic learning environment. We embed Clinical Reasoning Reflection Prompts into our clinical day at specific intervals, like 9 AM, 12 PM, and 3 PM, serving as checkpoints for reflective discussions. This flexibility allows for seamless integration of conversations throughout the day.
During these discussions, educators move through all TCJM phases based on student responses, promoting deeper exploration and real-time correction of misunderstandings. Tailoring the guidance to each student’s level—providing more support for first-years and encouraging independence in advanced students—is crucial. Emphasizing reflection during every clinical encounter helps students connect theory to practice and learn from their experiences.
Dissertation Study Results
I evaluated this teaching strategy pre and post-test in my PhD dissertation research, using the Lasater Clinical Judgment Rubric to measure clinical judgment and the results were extraordinary!
- Increased Clinical Judgment Behaviors: Pre- and post-test scores on the Lasater Clinical Judgment Rubric (LCJR) (Lasater, 2007) showed students had a significant increase (p < .001) in their clinical judgment behaviors following the use of clinical reasoning reflection question prompts in the clinical setting.
- Increased NCLEX Preparedness: Students statistically improved in their ability to answer NCJMM-based (Dickison et al., 2019) NCLEX-style questions (p <.001) after the use of prompts, demonstrating their ability to translate clinical judgment behaviors into decision-making on NCLEX questions.
- Correlation between developing Clinical Judgment Behaviors and NCLEX Success: Students with higher LCJR scores strongly correlated with first-time NCLEX pass rates (p = .006).
Final Thoughts
We need to change nursing education now, and it begins with us. Tanner’s Clinical Judgment Model is essential for educators who want to prepare future nurses with the skills they need to succeed. This model encourages us to rethink traditional teaching methods, to be bold, and to focus on being intentional and reflective in every learning experience.
If we do this, we can help our students think critically, act confidently, and make a difference in people’s lives. We can’t wait any longer. The time to act is now. Let’s take on this challenge and use model-based teaching as our path forward. Together, we can improve outcomes and reshape the future of nursing!