Clinical Decision-Making in Critical Care Nurses

In the clinical setting, critical care nurses use decision-making to assemble and determine the nature, value, quality, ability, extent, or significance of information and make judgments, resulting in the provision of patient care (Benner, 1994). Nurses use clinical intelligence to appraise critically and consider in detail the patient’s data in order to establish the connection between the data and the patient’s plan of attention. The nurse’s knowledge of gathering the right information, making necessary considerations, and performing in the patient’s best interest is based on many factors which are:

  • The critical care nurse is compelled to be clinically competent in order to recognize pertinent facts and act accordingly.
  • The critical care nurse must improve or perfect by pruning or polishing their decision-making skills in a variety of institutions, especially in emergency situations.
  • The critical care nurses must be skilled in negotiating many types of relationships during the course of caring for a critically ill patient.

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.

Benner asserted that the critical patient populace sets or introduces a multisystem health problem of an ever-changing severity. The author further stated that critical care nurses are required to command a complex body of knowledge and to utilize a wide variety of technology in the expert care of these patients. Benner also noted that clinical experience affects decision-making ability; therefore, earlier experience with specific clinical cases supports decision-making proficiency in that clinical situation. He further asserted that the nurse then could be an expert in one clinical situation and make appropriate decisions on behalf of the patient; however, that same nurse could be a novice in a different or unfamiliar clinical situation and therefore demonstrate less decision-making proficiency. Clinical and decision-making competencies must be defined and regularly evaluated in both the expert and novice critical care staff nurse groups.

Darr, K., Rakich, J.S. , and Longest, B. B. (2000). Managing health services organizations and systems. Baltimore: Health Professions Press.

In their book, they stated that many legal issues affect decision-making in critical care nursing practice. The power to decide or consent to treatment is a major issue impacting critical care patients. Consent should be of an individual’s own free will or design; done by choice; not forced or compelled. Many critically ill patients are unable to give consent because they are unconscious. In a life-threatening situation in an unconscious patient, consent is implied and treatment is rendered. Darr, Rakich, and Longest also noted that patients having advance directives can specify the extent of medical treatment they want should they be determined as incompetent and in a terminal condition or a state of permanent unconsciousness.

Johanson, W.R. (1990). Making a critical decision before it becomes critical. Heart & Lung, 19(2), 15a.

Johanson stated that doing the right things right is the product of the ideal relationship between leadership and management. It is the result of decisions made with skill and insight. The highly sophisticated environment of the critical care unit demands that such an ideal relationship and decision-making powers exist at all practice levels from the bedside to the board room. They identified five organizational factors influencing independent nursing practice and decision making:

  • Type of hospital-University, community, or municipal
  • Strong top-level administrative support of nursing
  • Type of nursing unit-small, specialized, or critical care
  • Type of nursing practice model used-primary, functional, or team
  • Organizational values of clinical nursing practices.

These organizational factors influence the types of opportunities nurses have to demonstrate leadership and decision-making.

Ellis, J., & Hartley, C. (1991). Managing and coordinating nurse care. Philadelphia: J.B.Lippincott Co.

Ellis, J., & Hartley, C. (1991). stated that the professional nurse seeking positions within maternal child and pediatric specialties should expect and demand aggressive entry-level position requirements and ongoing support to validate clinical competence. This should include a list of clinical behaviors required in the safe delivery of nursing care in the specialty practice setting. These professional nurses, nurse educators, and nurse managers find listing necessary clinical competency behaviors an easy task, however, the corresponding decision-making proficiencies are more difficult to articulate. Rational and competent clinical decision-making skills are essential critical behaviors for successful professional nurse job performance.

Reference list

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley.

Darr, K., Rakich, J.S. , and Longest, B. B. (2000). Managing health services organizations and systems. Baltimore: Health Professions Press.

Ellis, J., & Hartley, C. (1991). Managing and coordinating nurse care. Philadelphia: J.B.Lippincott Co.

Johanson, W.R. (1990). Making a critical decision before it becomes critical. Heart & Lung, 19(2), 15a.