Clinical decision-making processes among graduate nurses, specialist nurses and nurse practitioners A collaborative international study

Abstract

Aim: To explore clinical decision-making by comparing the processes used by threegroups of nurses in the emergency departments of three hospitals: in Norway, Finlandand Ireland.Background: Clinical decision-making in an emergency department environment is acomplex process often occurring in times of crisis. It is an important aspect contributingto the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles.Methods: In accordance with the consolidated criteria for reporting qualitative research,a qualitative and observational study was conducted to explore clinical decision-makingby comparing the processes used by three groups of nurses in the emergency depart-ments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, sixNurse Specialists and six Nurse Practitioners were observed. A total of 40 hours ofobservation was made at each setting according to a structured observation guide-line, followed by clarifying questions. The data material was analysed by means of aqualitative manifest and latent content analysis.Results: Three themes arose: acting in accordance with routines, previous experienceand intuition; considering patient experience; and facilitating new alternatives basedon critical thinking. The Registered Nurses mainly used the first approach, the NurseSpecialists used the first and the second approaches, and the Nurse Practitioners usedall three approaches.Conclusions: The results highlight the differences in decision-making processesbetween these groups. Nurse Practitioners were the only group that facilitated and eval-uated new alternatives using their clinical autonomy, such as stepping up and makingindependent and collaborative decision-making.Implication: The results can be used in countries developing advanced practice nursingeducation and defining their scope of practice to inform stakeholders.