Practicing nursing without acquiring critical reasoning skills may stagnate career progression in the field. These skills enhance a student’s problem analysis and problem-solving capabilities, which will prove useful in resolving complicated clinical situations. Private and government establishments prioritize clinical reasoning skills, job experience and higher degrees when promoting nurse practitioners.

Clinical reasoning skills use a dynamic procedure that facilitates core analyses of patients’ health challenges, ensuring safer nursing care. With critical reasoning skills, a nursing student can deliver personalized healthcare to patients.

What are the essential clinical reasoning skills in nursing?

Clinical reasoning in nursing is a process in which a certified or student nurse observes a patient’s health status, processes their status information, understands the patient’s problem, defines and implements interventions, and evaluates outcomes. A nurse must also reflect and learn from the entire clinical process. According to BMJ, the clinical reasoning process in nursing includes:

  • Assessment
  • Diagnosis
  • Outcomes and planning
  • Implementation
  • Evaluation

The importance of clinical reasoning skills in quality and safety, evidence-based practice, and patient-centered care

As a nursing student, you will learn diverse skills related to nursing practices, such as dressing wounds perfectly and starting an IV treatment efficiently. With clinical reasoning skills, however, you can make rational decisions when faced with challenges. These are scenarios where your reasoning skills will become relevant to maintaining high-quality patient care.

As a nurse, you must make diverse decisions, especially when handling patient care. Each decision you make in patient care will directly impact the patient’s quality of care. For example, a nurse will continuously make triage decisions in emergency rooms. In a situation where there is limited staff to handle an overflow of patients, a nurse must evaluate which patient to prioritize ahead of the rest without compromising any patient’s safety and quality of service.

Although nurses will rely on their training to read and evaluate patients’ vital signs and consciousness levels, they must apply critical thinking in analyzing the consequences of delaying treatment in some patients. Regardless of their department, nurses must apply clinical reasoning skills in their everyday routines. The process is not linear, so nurse practitioners will continue to re-evaluate new developments and discoveries while providing a personalized healthcare delivery to patients.

How to develop clinical reasoning skills as a nurse

Nursing programs offer numerous materials to help students master the art of acquiring and implementing clinical reasoning skills. These materials will help you uphold the high standards expected of nursing practices. To become an expert in applying critical reasoning skills, you must go beyond memorizing clinical terms and learn to use an analytical mindset in dealing with various patient healthcare challenges.

One way of implementing clinical reasoning skills is aligning the clinical reasoning process involving assessment, diagnosis, planning, implementation and evaluation with professional practices.

Although there are often multiple correct solutions to a given healthcare-related problem, the purpose of applying clinical reasoning is to choose the most efficient solution that fits the situation.

A student who has acquired clinical reasoning skills should be able to narrow down their options, based on the nursing process, to select the most appropriate solution without compromising quality and safety. It is important to note that the best solution to one particular patient’s problem may not be the best option for every patient in that situation.

What information will you find in the clinical skill checklist?

The clinical skill checklist for nurses is made up of skills categorized into three levels of competencies that a nurse must complete. This checklist is a guide used to evaluate a nurse’s clinical patient handling skills. It has different segments, including three competence levels, to indicate the nurse’s capability.

Level 1 is the highest level and represents complete competence, while level 2 means the nurse requires some assistance. Level 3 is the lowest attainable level on the clinical checklist, which indicates a beginner or no-experience level. Traditionally, a nurse practitioner begins at level 3 and gradually works their way to higher levels. A nurse manager often uses this clinical skill checklist when evaluating junior nurses.

The skills that make up the clinical skill checklist include:

  • Basic skills (blood pressure, temperature measurements, bed making, and wheelchair transfer)
  • Neurological skills (glaucoma scale handling, cranial nerve assessment and motor function assessment)
  • Cardiopulmonary skills (peripheral pulses monitoring, respiratory assessment and sputum collection)
  • Gastrointestinal handling skills (abdominal palpation, calorie counting and stool sample collection)
  • Genitourinary skills (assists with urinary assessment and bladder irrigation)
  • Musculoskeletal skills (muscle and joint palpation measurements and skin traction)
  • Skin handling skills (ulcer risk assessment and care and wound management)
  • Psychosocial skills (therapeutic communication and cultural assessment)
  • Medication handling skills (interpretation of medication orders and medication safety)
  • Intravenous skills (peripheral site assessment and hyper-alimentation handling)
  • Professional role (the ability to communicate with other nurses, critical thinking and client transfer)
  • Self-assessment skills (the ability to communicate assertively and self-confidence in nursing skills)

Acquiring clinical reasoning in nursing through a master’s entry program

To become a registered nurse in the US, you will need to earn a degree from a registered, accredited institution. Before obtaining state licensure, you must pass the necessary exams, including the NCLEX.

Getting advanced training in nursing through a master’s entry program in nursing is one of the most assuring ways to develop clinical reasoning skills. You will need a bachelor’s degree to apply to this program. A master’s entry program is accelerated and offers a quick route to registered nursing licensure.

This is a complete two-year program that will provide the education, practical skills and clinical hours to qualify you to become a registered nurse. It is also an excellent choice for those who have a bachelor’s degree in a field that is not related to nursing. The program is suited to those who want to pursue an accelerated career in nursing practice. With this degree, you can achieve competency in nursing research and use evidence-based nursing delivery, implementation and evaluation in patients’ healthcare.

Developing clinical thinking in nursing

Nursing professionals who have years of practice and experience believe that classroom training and critical mind development are essential in cultivating strong clinical skills. Nursing students are encouraged to continue to develop their critical analysis skills in their workplace during every shift.

To develop clinical skills, experts recommend that you emulate the mindset and actions of an experienced nurse around you. You can achieve this by analyzing and understanding how an experienced senior nurse came to different conclusions in different scenarios. This will give you insight into the types of approaches you can take to develop your own attitude and response to similar or different scenarios.

It is also possible to develop clinical skills through the chain of command within the nursing environment. In the nursing command chain, younger nurses consistently report to nurse managers. The more you study and understand the contents of the command chain, the better you will be able to use your knowledge of deploying clinical skills in patient care.

How clinical reasoning skills are useful in nursing practice

Clinical reasoning involves the application of expertise and knowledge to create a solution that will improve patients’ wellbeing. There are several forms of this reasoning with various applications and merits. All forms of clinical reasoning involve procedures of cognition and meta-cognition. In most cases, you must think aloud and verbalize your reasoning steps.

Checking your clinical procedure’s accuracy and reliability is one way you will use your clinical reasoning skills. The procedure for checking accuracy and reliability will include assessing, analyzing, diagnosing, implementing and evaluating the results that are obtained. This means that developing and using your clinical reasoning skills is an ongoing process; you must keep re-evaluating your results until you arrive at the best-quality delivery.

Registered nurses must apply clinical reasoning skills in simple and complex clinical practices. The clinical reasoning process always begins with assessing a patient’s health situation and ends with improved wellbeing within the standard regulations.

A skilled nurse must use clinical reasoning skills to deliver a cyclic patient care process rather than a linear routine. A cyclic clinical process will deliver the best suitable interventions in the most accurate and timely manner.

Master’s entry program in nursing (MENP) highlights 

The Master’s entry program in nursing at Elmhurst University is an accelerated two-year, full-time program that features the following components, among others:

  • Clinical simulation classes that combine the curriculum with high-tech devices.
  • Clinical partnerships with health facilities and local communities.
  • Leadership roles and team-building skills training.

After MEPN training, you will be prepared to take the NCLEX for registered nurses. You will also become eligible for the public health nurse certification. You will earn a master’s degree in nursing and be prepared for research and practice-oriented doctoral programs in nursing.

The MEPN curriculum also provides high-quality education for safety improvement and the integration of clinical skills in health policymaking and advocacy. It trains students on health promotion and disease prevention.

Why you should upgrade your nursing certification

According to 2022 statistics released by Nursing Process, the starting yearly salary for a graduate nursing practitioner with a minimum of a bachelor’s degree was $81,380 in 2022. This amounts to roughly $38.21 per hour or around $6,620 a month.

Since most nursing practitioners in the US will enter into residency or fellowship, salaries will increase sharply with an increase in academic qualifications and experience. A nurse practitioner with an advanced degree like a master’s certificate can expect to earn around $118,000 annually. If a higher wage motivates you to become a better nurse practitioner, you should pursue an advanced degree.

According to the US Bureau of Labor Statistics, nurse practitioners’ average salary will rise by 16.27% within the next four to six years. This increase in average wages is attached to growing demand for certified nurse practitioners, especially in the primary care sector.

The average income for nurse practitioners also depends on the sector in which they work. For example, the average total package for a practitioner in the private sector is $168,051, and one who works in a government establishment may earn up to $188,788.

Nurse practitioners who work in the offices of practitioners may earn between $79,000 and $153,000. Those who work in hospitals may earn up to $163,800, while those who work in outpatient care centers may earn up to $169,710. Nurse practitioners working in educational institutions such as colleges and universities may earn up to $131,000.

It is also important to consider average salaries based on each state. Nursing practitioners with advanced degrees like an MEPN and some years of experience may earn up to $208,000 in California, while New York nursing practitioners may earn up to $168,000. States like Florida, Tennessee, Missouri, Georgia, Indiana, North Carolina, Alabama, Kentucky and Wisconsin offer lower salaries than New York and California.

Clinical reasoning skills are needed to attain nursing leadership and management positions

Government and private establishments only promote nursing practitioners who possess the best clinical reasoning skills. Good nurse managers can manage hospital administration, budgets and policy schedules flawlessly. This means that the application of clinical reasoning skills goes beyond patient care.

As a nurse leader or manager, you may occasionally have to contend with staff shortages. Your clinical skills will allow you to develop a way to prioritize your workload and organize your tasks before deploying strategies to prevent work burnout. You will understand the problems and their full implications with strong clinical skills. Handling issues such as how staff shortages will affect patients’ care and getting nurses from other departments to help are part of the clinical reasoning processes.


Clinical reasoning skills are essential in upholding the quality and safety of inbound and outbound patients through evidence-based practice and patient-centered care services. Although experts can teach these skills through classroom and device-based simulation environments, nursing practitioners will sometimes face situations that are very different from what they experience in the classroom. Nurse practitioners must constantly evaluate the results of crises arising from patient care.

Posted by Virginia K. Stockstill

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