Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review


Michelle E. Bussard, School of Nursing, Bowling Green State University, 924 Ridge St., Bowling Green, OH 43403, USA. Electronic address:
Mary Ann Jessee, School of Nursing, Vanderbilt University, 461 21(st) Avenue South, Nashville, TN 37240, USA. Electronic address:
Majeda M. El-Banna, School of Nursing, George Washington University, 45085 University Drive, Innovation Hall, Ashburn, VA 20147, USA. Electronic address:
Mary Ann Cantrell, College of Nursing, Villanova University, 800 E. Lancaster Ave., Villanova, PA 19085, USA. Electronic address:
Intima Alrimawi, School of Nursing, Georgetown University, St. Mary's Hall, 3700 Reservoir Rd. NW, Washington, DC 20057, USA. Electronic address:
Nadine M. Marchi, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042-3300, USA. Electronic address:
Lisa I. Gonzalez, College of Southern Maryland, 8730 Mitchell Rd, La Plata, MD 20646, USA. Electronic address:
Keith Rischer, KeithRN, 6417 Penn Ave S, Ste 8, iPMB 1383, Minneapolis, MN 55423, USA. Electronic address:
Michelle L. Coy, Mayo Clinic College of Medicine and Science, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:
Mari Poledna, Arizona State University, 411 North Central Ave, Phoeniz, AZ 85004, USA. Electronic address:
Patrick Lavoie, Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada. Electronic address:

Document Type

Journal Article

Publication Date



Nurse education today






Assessment; Clinical decision-making; Clinical judgment; Clinical reasoning; Critical thinking; Education; New graduate nurses; Nursing; Students


OBJECTIVE: To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN: Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS: Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS: Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION: In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.


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