A Simple Guide to Tanner’s Clinical Judgment Model for Nurses

Every nurse knows that clinical judgment is at the heart of effective patient care — but how do you actually strengthen it? Tanner’s clinical judgment model breaks down this formerly abstract concept into four clear steps: noticing, interpreting, responding, and reflecting, giving nurses a practical framework they can use in real-world practice.

Tanner’s model is just as relevant in today’s fast-paced healthcare settings as it was when it was first introduced in 2006, helping nurses make sense of complex patient situations and learn from each experience. Let’s explore the model’s key components and why it continues to matter in nursing today.

Tanner’s Clinical Judgment Model: A Snapshot

• Clinical judgment is a process, not a single decision. It’s a dynamic cycle of thinking and doing that nurses engage in as they assess patients, decide on appropriate interventions, and learn from their experiences.
• It begins with noticing. Nurses pick up on important cues — vital signs, patient symptoms, and contextual factors — based on their clinical knowledge and past experiences.
• Interpreting gives meaning to what you notice. Nurses analyze data, connect patterns, prioritize concerns, and formulate educated guesses about what may be happening.
• Responding involves taking action. Nurses implement appropriate interventions, such as administering medications, providing emotional support, coordinating care with other members of the healthcare team, and escalating care when needed.
• Reflecting strengthens future judgment. Nurses review their actions and the patient’s responses — both during the care and after the event — to evaluate outcomes and learn.
• Reflection leads to growth. This ongoing reflection builds deeper clinical reasoning and greater confidence, as nurses integrate what they’ve learned into future practice.

What Is Tanner’s Model of Clinical Judgment? Stages and Framework Overview

Tanner’s model is a research-based framework that explains how nurses think through complex patient situations — not just what decisions they make. Developed by nursing scholar Christine A. Tanner, the model is developed based on a review of nearly 200 studies on clinical judgment, and describes foundational reasoning steps that shape effective nursing practice.

At its core, the model defines clinical judgment as “an interpretation or conclusion about a patient’s needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient’s response.”

Instead of seeing judgment as a single decision, Tanner emphasizes that it’s a dynamic and cyclical process that involves four interrelated phases:

• Noticing is about perceiving what’s clinically imperative in the moment. Here, you’ll need to use your experience and knowledge of the patient to recognize important cues, taking into consideration context, background, and other factors. This might include changes in vital signs, behavior, or anything that doesn’t fit the expected pattern.
• Interpreting involves giving meaning to the information you’ve noticed. This phase involves analyzing, reasoning, and connecting the dots — for example, weighing what a cluster of abnormal symptoms might suggest, or prioritizing which concerns need immediate attention.
• Responding is about planning and implementing nursing actions, which could range from performing a clinical intervention (like administering medication, initiating oxygen therapy, or providing wound care), adjusting the care plan, or even escalating care when needed.
• Reflecting involves thinking critically about the actions taken and the outcomes that followed. It can happen during care (reflection‑in‑action) and after the situation (reflection‑on‑action), allowing you to evaluate whether your response was effective and identify what could be adjusted in the future.

Core Concepts Behind Clinical Judgment in Nursing

Besides its four phases, Tanner’s model highlights several other important ideas that help nurses deepen their clinical judgment:

• Judgment depends on what nurses bring to the situation. Tanner’s original research (linked above) found that clinical judgments are often influenced by the nurse’s knowledge, experience, expectations, and relationship with the patient rather than by objective data alone.
• Knowing the patient matters. Familiarity with a patient’s normal patterns and concerns supports better noticing and interpretation.
• Context shapes judgment. The environment, unit culture, and situation dynamics affect clinical reasoning.
• Nurses use multiple reasoning strategies. Depending on the context, nurses may reason analytically, use intuition, or apply pattern recognition — often blending these approaches as situations unfold.
• Reflection strengthens future performance. Reflection is not just an add-on — it’s central to developing knowledge and improving reasoning over time

Tanner’s Clinical Judgment Model: Nursing Examples

To help illustrate how Tanner’s clinical judgment model plays out in real nursing practice, here are some concrete scenarios showing each phase in action:

Example 1: Recognizing Early Signs of Sepsis

A nurse notices that a patient’s temperature has risen and their heart rate is elevated — even though the patient insists they feel fine. By picking up these subtle cues early (noticing), the nurse considers the possibility of sepsis rather than dismissing the patient’s reassurance. The nurse interprets the vital sign changes as a potential infection, notifies the team quickly, starts appropriate sepsis protocols (responding), and later reflects on what worked well to improve future recognition of similar patterns.

Example 2: Missing Early Hypoxia in a Post-Op Patient

Four hours after a patient has abdominal surgery, their oxygen saturation drops from 97% to 92% on room air. The nurse notes the value but assumes it reflects residual anesthesia and opioid use. A few hours later, the patient’s oxygen saturation falls to 89%. Rapid response is activated. During reflection-on-action, the nurse recognizes that subtle restlessness and shallow breathing were early cues of respiratory compromise. In future situations, the nurse commits to reassessing any oxygen saturation decline from baseline more thoroughly and responding more promptly to even mild abnormalities before they progress.

Example 3: Responding to Fetal Distress

A labor and delivery nurse is caring for a patient receiving oxytocin. During routine monitoring, she notices recurrent late decelerations on the fetal heart monitor, minimal variability, and a rising baseline heart rate. She begins interpreting the pattern as possible uteroplacental insufficiency and fetal hypoxia. The nurse immediately responds by repositioning the patient to her left side, reducing the oxytocin infusion, increasing IV fluids, administering oxygen, and notifying the healthcare provider. After the tracing improves in the patient, the nurse reflects on the event, acknowledging how early recognition of the issue prevented further complications.

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