Clinical judgment skills are the basis of how nurses apply their knowledge and experience to real-world situations. Strong clinical judgment leads to appropriate nursing diagnoses, optimal care, and positive patient outcomes.

Current curricula are guided by industry standards offered via BSN Essentials, QSEN, CCNE, and ACEN frameworks—however even these fall short in cultivating new graduates’ abilities to leverage clinical judgment effectively in real-world settings. Nurses surveyed as to why they were negligent or untimely with care note issues like: staffing shortages, insufficient time, bad habits, poor task delegation, or even the belief that particular tasks are beyond their scope. This illustrates the lack of adaptability of extant nursing education to real-world settings and clinical care.

Passive pedagogical approaches to clinical judgment are, quite simply, not working as effectively as they need to be to serve patients.

Admittedly, teaching clinical judgment skills can be difficult. Each learner has their own pace of development, which does not always coincide with the availability of clinical placements or classrooms. From nursing students through professional nurses seeking to expand their skill set, the development of clinical judgment skills relies on the promotion of learning and confidence.

That confidence component has proven historically challenging to instill in a classroom setting, or on any sort of rigid schedule. There is also a widespread issue of extremely limited access to direct care clinicals, combined with a mounting need to effectively address the growing nursing shortage.

To try and develop an approach to tackle the challenge of clinical judgment skills in nursing education, research has been done to measure the efficacy of different methods. Recent studies have been demonstrating, more and more, a statistically significant increase in learners’ clinical judgment ratings following the use of virtual nursing simulations.

These findings help illuminate a potential solution addressing several core issues in the industry, such as how only 10% of newly-licensed nurses score within an acceptable competency range via performance-based testing. This solution can yield significant results for nursing prioritization of patient care, as well as delegation and management of care.

Led by Amber Kool, Arizona College recently completed a study showcasing the effectiveness of virtual nursing simulation with statistically significant increases on perceived clinical judgment scores across all nursing student participants.

Measuring Positive Clinical Judgment Scores

Kool sought to use a quantitative approach to assess tangible impacts of virtual simulation on clinical judgment.

A sample of n = 42 pre-licensure accelerated BSN students in their senior semester was used for this study, higher than the 34-student minimum required by the Power Analysis for statistical significance.

From there, the ten-question SCJS tool—validated by American Sentinel University—was used to gauge subjective and objective data around prioritization of care as well as delegation of care. The tool centers around a four-point Likert Scale, meaning that resulting scores could range from 10 to 40. There was a statistically significant increase in perceived clinical judgment scores from pre-intervention with virtual nursing simulations (M = 32.17 and SD = 4.178) compared to post-intervention (M = 34.10 and SD = 4.992). This indicates a mean increase in perceived clinical judgment scores of 1.929.

These numbers may have been even higher, but one unanticipated outcome was that a couple of participants rated themselves higher in their pre-simulation survey versus their post-simulation one. A post-study survey revealed this may have been because they thought their skills were stronger, but the virtual nursing simulations showed them that they needed improvement—while also specifying exactly where.

As Kool noted in a recent presentation on her research, “Based on the results of this study the VS provides an effective pedagogy to bridge the gap between direct patient care, [and] traditional simulation…”

Virtual Nursing Simulations Augment Direct Care Clinicals

Virtual nursing simulations give learners maximum opportunity for experiential learning, which allows for the development of skills in all areas—including critical thinking. Sentinel U simulations are designed to address all four stages of experiential learning theory:

Stage One: The presentation of a clearly defined experience
Stage Two: Individual reflection on the experience
Stage Three: Synthesis of experience outcomes into conclusions
Stage Four: Application of this experience to future experiences

A central idea that emerges from experiential learning theory is that exposure to real-world situations in learning environments allows for the type of active experimentation and reflection that makes learning effective for all types of learners: divergent learners, assimilators, convergers, and accommodation learners alike.

Anything that can be done to render learning more effective is critical in today’s nursing world. The gap that exists in nursing education—both foundational and continuing—can be filled by virtual nursing simulations:

  • The shortage of clinical sites that could allow learners direct patient experience
  • The further restriction of clinical experiences due to the COVD pandemic, natural disasters, and other emergencies
  • The limited supply of high fidelity patient simulation opportunities
  • The need for nurses of all skill levels—even newly licensed—to come prepared to make increasingly complex decisions

It’s not just nursing students that benefit from virtual nursing simulations. Even credentialed nurses seek out educational opportunities, whether for continuing education needs or even entry into new specializations. Some common circumstances in which we have witnessed virtual nursing simulations provide particularly useful include:

  • Standardization of skills as part of clinical agency orientation
  • Skill development for nursing continuing education and nursing competency
  • Practice exposure to high-risk patient environments at no risk to actual patients
  • Where nurses are seeking highly specific courses to prepare them for training goals

Here at Sentinel U, we are continuing to see more hospitals, nursing facilities, and schools adopt virtual nursing simulations to replace, augment, and enhance their programming. This number will only continue to grow as virtual nursing simulations continue to evolve, and the benefits of virtual nursing simulations become more apparent.


See how virtual nursing simulations could elevate the confidence and clinical judgment of your nurses or students. Book a demo today!