Making Decisions in Nursing Practice


Nursing decision-making depends on numerous factors to take into account to provide patients with qualified and ethical care. These factors include effective communication, the sustainability of leadership practices, teamwork success, employee personal readiness, and some other aspects. In conditions of constant interaction with the population, nurses should be aware of different approaches and principles of assisting those in need and, thus, always seek to develop individual skills and expand knowledge. For this reason, the current paper seeks to discuss the important aspects that help medical workers to deliver better decisions.

Decision-Making concerning Client-Centered Care

Nowadays, client-centered care is one of the key principles of skilled nursing. This approach dictates the specific conditions of interaction with target patients and determines the nature of decision-making, which concerns many aspects of each case. According to Sanerma et al. (2020), in an individualized care plan, the patient-nurse relationship includes ethical, cultural, spiritual, and some other factors to take into account. For instance, nurses must consider a patient’s background to provide the most effective care, both from a clinical and a moral standpoint. From a decision-making perspective, patients’ religious beliefs or other cultural criteria may be constraining factors for individual care interventions. In this regard, a client-centered approach allows addressing such barriers so that each patient receives individualized attention, which, in turn, leads to greater efficiency and satisfaction.

Decision-making from a client-centered perspective can have not only clinical consequences, such as the rate of recovery but also political implications. Introducing dedicated funding programs can be effective in improving the quality of nursing care and enhancing nursing service coordination and delivery (Sanerma et al., 2020). The timely replenishment of the resource base eliminates any challenges associated with addressing patients’ problems, whether they are physical or psychological disorders. As a result, a client-centered approach is a practice that greatly influences decision-making and correlates with different individual factors of care, which explains the value of this technique in dealing with complex cases.

Intentional Learning and Decision-Making

In the context of nursing education, the concept of intentional learning plays an essential role. The particular value of this type of learning lies in the ability to hone decision-making attainments and make nursing work more credible from a reliability perspective. Epp et al. (2021) emphasize that sometimes, students in this field have “insufficient foundational knowledge to inform clinical judgments” (p. 805). In other words, the lack of theoretical background influences work outcomes negatively and can affect the quality of interaction with patients. Intentional learning, in this case, can become a driver to strengthen a health professional’s decision-making skills and deepen the understanding of how to operate with sufficient evidence for credible and ethically correct nursing practice.

Additionally, intentional learning is associated with medical workers’ increased abilities of self-reflection. Due to increased understanding of oneself, nurses can elaborate a clear model of professional development and identify those areas where improvement is needed. This, in turn, helps to approach decision-making more responsibly as health professionals become aware of their limitations to make unconditionally accurate predictions and nursing diagnoses. Any form of interaction with patients, whether direct communication or care programs evaluation, requires commitment and responsibility. Therefore, intentional learning has become a popular concept among healthcare researchers and managers that helps to minimize mistakes at any of the interaction levels.

Processes of Making Decisions in Nursing

There are a wide variety of processes and approaches to decision-making based on different analytical techniques. Each of them helps to minimize errors and accelerate patient recovery through effective care interventions. As a consequence, a large volume of theoretical and practical bases can improve nurses’ skills in analytical decision-making. According to Nibbelink and Brewer (2018), this process is reliable and efficient due to the logical comparison of specific data and their objective assessment. In other words, no personal beliefs and opinions affect decision-making.

On the contrary, another process that is important to mention in regards to decision-making is based on intuitive practice. Nibbelink and Brewer (2018) describe it as the technique of identifying specific causal relationships based on individual experiences and similarities, which resembles a deductive method. However, the latter process is not suitable for those with little work experience. It is explained by the fact that inexperienced workers do not have the sufficient practical background to draw conclusions regarding patient outcomes based on intuition and to refer to individual views on care outcomes.

Moreover, one of the crucial concepts that unite the approaches mentioned above is naturalistic decision-making. This framework is based on stimulating rapid responses to different situations, including emergencies (Nibbelink & Brewer, 2018). For instance, one can initially research and analyze what is the optimal set of actions under certain emergencies and then simulate the decision-making process several times. As a result, when the emergency occurs in reality, the action plan would already be easily ‘available’ intuitively. Such training is important as medical employees often face situations when much depends on the speed of making the right decision, up to the patient’s life. Therefore, such a process is a valuable practice to develop so that to learn how to work in different conditions and be able to address potential challenges quickly.

Decision-Making concerning Clinical Reasoning and Critical Thinking

Any issue related to patient care requires professional judgment in line with clear rationales for a specific solution. In this regard, decision-making is associated with clinical reasoning as a concept that Macauley et al. (2017) define as “a process of balancing patient interactions, health systems, clinical data, judgment, and knowledge” (p. 64). By combining different aspects of care, including both individual patient data and related circumstances, nurses can achieve high efficiency and the rational use of available resources and intervention techniques. Clinical reasoning corresponds to various manifestations of decision-making, whether it is either an analytical practice with clear reasoning or an intuitive approach based on practical experiences. As a result, nursing diagnostics, selecting communication strategies, and other relevant tasks are successfully solved due to the search for adequate justifications based on clinically reasonable features of each case.

The concept of critical thinking is another approach that also intersects with decision-making in nursing. According to Macauley et al. (2017), this practice is rather individual than group, but it is valuable since its basis is a “purposeful self-regulatory judgment that results in interpretation, analysis, evaluation, and inference” (p. 64). Decision-making can be complicated by circumstances that require a quick response, a combination of theoretical and practical skills, and other conditions. Critical thinking helps nurses quickly find an approach to each case by assessing such situations adequately. Therefore, both clinical reasoning and critical thinking are necessary to ensure the highest quality of the provided healthcare.

Decision-Making and Leadership

Even though honing decision-making skills as important attainments acquired during education is a critical aspect of nursing staff training, the effective application of these skills is largely controlled by department heads. The extensive scholarly literature suggests that the primary purpose of a competent leader is to stimulate colleagues’ productive work, not just communicate relevant tasks to them and ensure that they are completed timely (Giddens, 2018). Moreover, for productive decision-making, working at different levels should be taken into account. For instance, Salvage and White (2019) state that many leadership promotion programs focus primarily on organizational management. This means that, at the clinic level, relevant proposals are accepted to improve work performance and stimulate employee initiative, including collaborative activities and individual incentive practices.

At the same time, leadership in local environments addresses broader issues that, nevertheless, also concern decision-making but at a more general level. Salvage and White (2019) provide an example of local campaigns aimed at educating nurse leaders, thereby creating a background for productive leadership at the organizational level. In a global context, leadership concepts are conveyed by international agencies, such as the World Health Organization (WHO), whose purpose is to promote policy decisions and then disseminate them to lower levels. Ultimately, in all environments, decision-making is one of the fundamental concepts to drive through actionable leadership practices.

Use of Technology in Decision-Making

While discussing effective communication, which is an important aspect of productive decision-making, one should also mention the tools used to interact with different stakeholders in the care process. McDonald et al. (2018) consider different remote communication tools, for instance, social media, to deliver information to target patients timely and clearly. This practice is particularly valuable in the current context of the COVID-19 pandemic, when, due to social constraints, communication with patients is often remote.

To target patients to understand the essence of care and the importance of appropriate interventions, healthcare professionals should be aware of potential challenges associated with interaction with the population and the ways to overcome them. Regardless of the technology available, patients have the right to understandable and accessible explanations of diagnoses and care courses. About communication with colleagues, decision-making can be based on teamwork, which also implies productive interaction. Yet to ensure communication success, nurses should become familiar with the mechanisms of conflict prevention in the workplace, numerous theories of effective interaction, and algorithms for group practice in a multitasking environment. As a result, understanding the principles of communication with the public and colleagues can significantly improve the decision-making process.

Quality Improvement and Error Prevention Practices

In a multitasking and dynamic work environment, establishing an efficient and error-free nursing process is a challenging task to implement in nursing practice. In this regard, one of the important topics is medication management and creating conditions for patient safety. According to Kavanagh (2017), an effective care plan with error and hazard prevention strategies inherently includes “preparing, calculating, checking and administering medications,” as well as “educating patients about their medications” (p. 159). In addition, to meet all cultural competencies, nurses should address the aforementioned principles of client-centered care and promote participation and empathy as the essential aspects of skilled care, including psychological support. Such an environment is conducive to recovery and enhances productive patient-provider interaction.

From a quality improvement perspective, there is a wide range of competencies required to improve individual nursing skills and address different care outcomes. Phillips et al. (2018) argue that quality improvement, which is the constant development of professional capacity and the creation of conditions for optimizing the care process, is one of the six core competencies. They are quality improvement, client-centered care, collaboration and teamwork, safety, evidence-based practice, and informatics (technologies) (Phillips et al., 2018). Combining all these conditions is a powerful approach to creating a safe care environment in which the problems of the target audience are addressed through adequate interventions and effective intra-team communication mechanisms.

Team Collaboration as Part of Decision-Making

As mentioned above, team collaboration is essential to an effective decision-making process. As such, colleagues’ help and support can be highly valuable for the individual who can actively listen to others and accept their support. Moreover, collaboration is not only associated with uniting team members together, but also it has a positive effect on the quality of care. According to Emich (2018), “positive consequences of collaboration in nursing include improvements in patient safety, patient satisfaction, patient care, and decreases in error rates, patient mortality, patient length of stay, and healthcare staff turnover rates” (p. 569). All these benefits are direct evidence of the important role of team communication.

Furthermore, health promotion among the population is one of the critical advantages of working in a nursing team. As a member of the group, collective assistance programs aim at engaging with target communities and integrating modern care approaches. Alone, these tasks would be impossible to accomplish due to the limited workforce. Moreover, from a decision-making perspective, individual solutions may be biased. Teamwork, conversely, reduces the risk of misjudgment of challenges and facilitates the search for adequate solutions designed to address different patient problems and gaps in care.


In summary, the current paper discussed various aspects of the decision-making process within the healthcare sphere. On the one hand, it analyzed how such factors as intentional learning, critical thinking, clinical reasoning, and collaboration within a team can help to improve the decisions that healthcare professionals deliver. On the other hand, the importance of a good decision-making process with a personal approach to achieving client-centered care was considered. Moreover, the paper examined various decision-making processes and approaches, which included analytic, intuitive, and naturalistic models. Furthermore, the role of technology was viewed from the perspective of communication with clients and colleagues. Finally, the practices that help to improve the quality of care and prevent errors were presented.


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