Thinking Like a Nurse: The Research-based Clinical Judgment Model

Contributor: Christine A. Tanner, PhD, RN, ANEF

First published – 2006

Major Concepts

Clinical reasoning, clinical judgment, clinical decision-making, expertise in nursing practice, perceptual grasp, background for practice, knowing the patient, engagement, ethic of care and responsibility

Typology

This is a model, drawn from an integrative review of over 200 studies and rooted primarily in the phenomenological tradition. Often referred to as the Tanner Clinical Judgment Model (TCJM) it has been widely adopted for use in nursing education and as a framework for research on simulation. It is among the most cited models in nursing education. An update of the model has been submitted for publication, along with several manuscripts which describe its use in nursing education for assessment and clinical coaching

Brief Description

October 2026 –The updated version of the Tanner Clinical Judgment Model (TCJM) has been submitted for publication

Educational applications of the original model have focused on four visible aspects— Noticing, Interpreting, Responding, and Reflecting—while its foundational background dimensions and philosophical grounding have received comparatively little attention. Drawing on Benner and colleagues’ research on nursing expertise and the phenomenological tradition that underpins the model, TCJM was updated through theoretical synthesis and illustrative narrative accounts.\

The updated TCJM articulates the foundations that distinguish situated clinical reasoning from cognitive models; explicates the Nurse’s Background, Knowing the Patient, and Context as foundational to clinical judgment and elaborates aspects of clinical reasoning evident in expert practice.

Conclusion: The TCJM offers nurse educators a theoretically grounded, practice embedded framework for understanding, teaching, and assessing clinical reasoning and judgment in their full complexity.

Primary Source

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04

Application Sources

Chan, G. K., Benner, P., Burns, E. M., Orozco, R., Bowman, M., Escobedo-Wu, E. L. G., & Vallejo, E. (2025). Establishing the “North Star” for clinical education to accelerate practice readiness: Implications for leaders, faculty, educators, nursing professional development practitioners, and preceptors. Nursing Administration Quarterly, 49(3), 206.

Chen, Y., Bai, F., Luo, Y., Bai, J., Liu, H., Xu, W., … & Yin, H. (2025). Effects of reflective writing on critical thinking, clinical decision making, empathy, and communication skills of nursing students and nurses: A mixed methods systematic review. Nurse education today, 106948.

Cross, L., & Salguero, R. (2026). Introducing a model for competency-based nursing education to make habits and attitudes explicit. Journal of Professional Nursing.

Dong, J., Sui, W., Gong, X., Wang, L., Ni, Q., Yan, R., … & Zhuang, Y. (2026). Impact of Nurses’ Knowledge, Self‐Efficacy and Clinical Reasoning Competency on Difficulties in Caring for Patients With Delirium in the Intensive Care Unit: A Cross‐Sectional Study. Journal of Clinical Nursing, 35(2), 729-746.

Lamichhane, G. (2025). Shaping professional nursing practice using Benner’s novice to expert theory. British Journal of Nursing, 34(22), 1133-1137

Mendivil-Perez, M., Choperena, A., Salas, V., Chocarro-Haro, M., & Oroviogoicoechea, C. (2025). Interventions to develop clinical judgment among nurses: A systematic review with narrative synthesis. Nurse education in practice, 84, 104300.

Moreira Ferreira Teixeira, J., Ray-Barruel, G., Mosca Teixeira, G., Durao, C., Bastos, C., & do Rosário Pinto, M. (2026). Bridging Theory and Practice in Emergency Nursing: A Discussion Paper on Peripheral intravenous catheter Management Using Tanner’s and Chinn & Kramer’s Models. Sage Open Nursing, 12, 23779608261433137.

Wang, Q., Xu, M., Wu, M., Wu, L., & Xu, B. (2026). From Intuitive Concern to Safety Action: A Qualitative Meta‐Synthesis of Nurses’ Experiences of Recognising Patient Deterioration. Journal of Clinical Nursing.

Author

Christine Tanner is professor Emerita at Oregon Health & Science University. During her years at OHSU, she taught in pre-licensure, masters and doctoral programs, was one of the leads in the development of the Oregon Consortium for Nursing Education, (OCNE) facilitated the development of the high-fidelity simulation capacity in OCNE campuses.

Her lifelong work was the study of clinical reasoning in nursing, beginning with her doctoral studies in educational psychology in 1977. She did post-doctoral work with Patricia Benner, conducting a large study of expertise in nursing practice. Throughout the 80’s and 90’s she continued her research and writing about clinical reasoning in nursing, culminating in the development of the Clinical Judgment Model, based on an integrative review of nearly 200 studies published in 2006. She retired in 2014, and began work in the community co-founding a non-profit that built and operated micro villages serving the most underserved of Portland’s unsheltered population.

She served on its Board of Directors until 2023, when she retired again.

But not for long. Most recently she has worked with Pat Kyriakidis and a group of professional development nurses in creating education materials that support use of the Tanner Clinical Judgment Model which were recently submitted for publication.