Chris Tanner Tanner in Las Vegas

Chris Tanner January 14, 2025 -- Another excellent talk at the Educating Nurses: A Radical Transformation 2025 Conference in Las Vegas was by Chris Tanner, PhD, RN, FAAN, professor emerita at Oregon Health and Science University and a luminary of our profession.

She described an essential yet elusive characteristic of expert nurses, clinical judgment. Nurses who demonstrate this, interpret and act upon patients' needs, concerns, and health problems, personalizing standard approaches and improvising new ones according to patients' responses. Quite a mouthful... what does it mean?

Clinical judgment is driven by perceptions and interpretations of changes in patients' conditions over time, enabling clinicians to generate alternatives and choose the most appropriate. The nurse knows the patient and the patient situation, and the nursing unit's culture and common practices.

How do we get there? One helpful process Tanner calls reflecting in practice. She urges novice nurses to consider (quoted from her Powerpoint):

  • What have you already learned about your patient that will shape your assessment?
  • After you've heard the report, what are your concerns? What I would be concerned about are these things...
  • Have you taken care of a patient with this diagnosis before? What do you remember about their care?
  • Let's go take a look at your patient and see what stands out.

During my own clinical rotations, I did much reflection (as journaling) and found it contributive to my growth.

Characteristics of the expert nurse, Tanner tells us, include engagement and curiosity, and notions of good ethics of care and responsibility. Especially valuable is a strong sense of salience; that there is a "discernible order to clinical situations."

Like me, Keith Rischer RN (about whom I will blog later) finds Tanner's model essential for the teaching of clinical judgment. He cites her seminal work, Thinking like a nurse (2006), in which she describes it in detail -- essential reading for growing nurses and educators alike.