| Clinical judgement, an essential component of clinical competence, incorporates scientific and practice knowledge, clinical decision making, critical thinking, clinical skills, and moral development. Clinical judgement is a critical element of professional competence, and is necessary for safe effective client care and effective evidence-based practice. Using grounded theory method, I explored the process in which new baccalaureate registered nurses engage as they develop their clinical judgement over their first two years of nursing practice. Twenty-five Registered Nurses with two to three years of experience in acute care clinical nursing practice in Canada participated in semistructured interviews over a period of 16 months of data collection and analysis. Using constant comparative analysis, I explicated a theory that explains the process of developing clinical judgement in nursing practice. This grounded theory is integrated by the basic social process of seeking learning in clinical practice. Pervading themes included new nurses' needs and desires to learn in clinical practice, the importance of the social network for learning in clinical nursing practice, and new nurses' desires to be supported in learning by their employing agencies.; The Theory of Developing Clinical Judgement in Practice, based in experiential learning in clinical practice, details how new nurses use scientific, professional, personal, and ethical knowledge in the process of converting their experience to practice knowledge as the basis for clinical judgement. Five stages are evident in this process; orientating to the practice environment, learning practice norms, developing confidence, consolidating relationships , and seeking challenge. New nurses progress through these stages in a predictable fashion and within general time frames depending on the acuity and diversity of the client group, the supportive learning network in the workplace, availability of learning resources and formal learning opportunities, feedback, and incremental increases in responsibilities. Facilitative factors such as mentoring, continuing education, availability of practice advisors, and a culture that supports learning in the practice setting support new nurses in their development. These findings will assist nursing leadership and clinical educators in supporting new nurses to develop their clinical judgement more efficiently and effectively, ultimately contributing to the quality of health care provided to clients. |
