Clinical Decision-Making in Nursing Practice

A smiling nurse stands at an intake desk.

Clinical decision-making is one of the most important skills that nurses bring to the profession. When nurses have the authority to make evidence-based care decisions that follow best practices, a host of benefits accrue. Patients have better outcomes, nurses have higher job satisfaction, and hospitals benefit by improving their patient care metrics and reducing their risk profile.

Therefore, nursing education coursework and practicums should teach both critical thinking and clinical decision-making in order to prepare nurses for their role as leaders in patient care quality.

What Is Clinical Decision-Making in Nursing?

Nurses are the experts in patient care. They have a more in-depth understanding of a patient’s current condition than doctors and hospital administrators do. They’re the first to recognize that a patient is in pain or that a patient’s condition is deteriorating. That’s why nurses need to be problem-solvers and decision-makers with regard to patient outcomes.

Clinical decision-making in nursing is an active approach to assessing a patient’s condition and basing care decisions on the evidence. It’s a collaborative approach, with a team of health care providers weighing in and determining the best course of action. Clinical decision-making also includes patients and families in the process, which recognizes patients as their own best advocates and experts on their physical and mental health needs.

Critical thinking skills, teamwork, communication, collaboration, and knowledge of best practices are all essential parts of the clinical decision-making process. Nurses, colleagues, and patients keep the lines of communication open, make sure that everyone is on the same page with regard to decisions, and follow the evidence when caring for patients.

Examples of clinical decision-making by nurses include the following:

COVID-19 Interventions

During the pandemic, the health of hospitalized patients infected with COVID-19 could deteriorate quickly. Experienced nurses combined their knowledge of patient care and their analysis of COVID-19 patients whom they’d already treated to identify patients who were in the most danger of requiring rapid response. Nurses often followed their intuition and experience rather than relying on rules-based decision-making, allowing them to respond to complex and rapidly changing information more quickly.

Catheter-Associated Infections

Boston Medical Center identified Foley catheters as the source of 9% of hospital-acquired infections in its patients, according to a BMJ Open Quality article. The medical center set up a task force, including nurse managers, nurse educators, urologists, and other stakeholders. This team identified the issues and created education programs to prevent infections. The initiative resulted in an 83% reduction in catheter-caused infections between 2013 and 2017.

Patient Falls

Falls are a common source of inpatient injuries. In a 2021 study published in the Journal of Medical Internet Research, researchers analyzed the effectiveness of a data analytics tool for preventing falls among elderly and other patients. The data showed that use of the data analytics tool increased nurses’ awareness of fall risk and decreased the number of falls overall. Studies such as these become part of the evidence that support clinical decision-making.

Why Should We Care About Clinical Decision-Making?

Clinical decision-making has a number of advantages for hospitals, patients, and nurses. At its core, the process is rooted in science and the scientific method (hypothesis, test, repeat). It allows nurses to use all of their clinical experience, education, and professional knowledge of patient care, rather than following a set workflow or checklist. Nurses are clinicians; therefore, they should make clinical decisions. Health care organizations that support nursing judgment and critical thinking benefit in the following ways:

Patient Outcomes

The above examples show how clinical decision-making can improve patient outcomes. Nurses assess their patients, work with their colleagues, communicate with patients and their families, and identify patient health requirements. They can base their decisions on research and data. They can use critical thinking skills to identify when a patient’s treatment needs to be adjusted. The research increasingly shows that clinical decision-making by nurses can improve quality of care and patient satisfaction.

Hospital Advantages

As health care payment models move from fee-for-service reimbursement models to value-based care, patient outcome metrics have become more important. That’s because hospitals and doctors will soon largely be reimbursed based on the quality of the care they provide rather than by procedure. Medicare is using data such as hospital-acquired infections, falls, and readmissions to penalize hospitals. As a result, allowing nurses to use their clinical judgment can help boost hospital revenues.

Job Satisfaction

The nursing shortage has worsened under pressure from COVID-19. Nurses report that when their employers give them authority to make clinical decisions, they are more likely to be satisfied in their jobs. They may be less susceptible to burnout and more likely to stay in the profession. When employers treat nurses as clinicians, they are more likely to retain staff, which can help stem the nationwide nursing shortage that the health care system faces.

Multidisciplinary Care

By its nature, clinical decision-making is a multidisciplinary process. Health care providers can apply it at the patient level, because it accounts for the views of all professionals involved in a patient’s care plan. It also applies at the organizational level, as leaders can incorporate the knowledge and experience of all clinical and administrative staff members when making operational decisions.

Coordinated Care

The coordinated care pathway is a hallmark of clinical decision-making at the patient level. It connects health care providers (doctors, nurses, and support staff) and makes sure that everyone communicates through transition points, such as when patients are handed off to specialists or other care teams or throughout the length of their medical condition.

Organizational Decision-Making

At the organizational level, nurses, nurse managers, physicians, administrators, and chief nursing and chief medical executives are part of the decision process. This was found to be especially effective during the pandemic. According to the American Association of Critical Care Nurses, direct care nurses, nurse leaders, and organizational leaders came together to support clinical care best practices at all levels, starting with the nursing process (assess, diagnose, plan, and evaluate).

A Comprehensive Nursing Education for Your Future

The future of nursing is in the hands of clinicians who are just now coming into the workforce. This is a time of great change in health care. Hawai‘i Pacific University’s online Bachelor of Science in Nursing to Doctor of Nursing Practice program prepares nurses to excel in this new world with a curriculum that supports clinical decision-making and critical thinking. Take the first step into your future today.

Recommended Reading:

The Importance of a Nurse’s Role in Patient Safety

What Is Evidence-Based Practice in Nursing?

Nursing Advocacy: The Role of Nurses Advocating for Patients


Agency for Healthcare Research and Quality, "Chapter 2. What Is Care Coordination?"

American Association of Critical-Care Nurses, Effective Decision Making

American Association of Critical-Care Nurses, "Effective Decision-Making During the Pandemic"

American Association of Nursing Colleges, "Hospitals Innovate Amid Dire Nursing Shortages"

BMC Nursing, "Shared Clinical Decision-Making Experiences in Nursing: A Qualitative Study"

BMJ Open Quality, "Catheter-Associated Urinary Tract Infection Reduction in Critical Care Units: A Bundled Care Model"

JMIR Publications, "Clinical Impact of an Analytic Tool for Predicting the Fall Risk in Inpatients: Controlled Interrupted Time Series"

Nursing-Writing, "Clinical Decision Making in Nursing Scenarios"

PLoS One, "Identifying Factors That Nurses Consider in the Decision-Making Process Related to Patient Care During the COVID-19 Pandemic", "Critical Thinking in Nursing: Decision-Making and Problem-Solving"