Decision-making in nursing practice: An integrative literature review.
Christine W Nibbelink, Barbara B Brewer
PMID 29098746WHAT IT FOUND
In medical-surgical nursing, experience shaped decisions most strongly: nurses used pattern recognition, confidence, colleague advice and unit culture.
But experience did not consistently improve decisions, and nurses sometimes chose colleague advice over evidence-based protocols.
Key findings
01Experience was the most common theme in nurse decision-making, but years of practice alone were not consistently associated with effective clinical decisions.
02Nurses preferred information from experienced colleagues or their own experience over other sources, and described colleague information as more applicable to patient care than protocols.
03Nurses worried about how others would perceive them when deciding whether to activate a rapid response team, and informal unit rules influenced escalation and information sharing.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It searched only PubMed and CINAHL, included English-language nursing research, and excluded simulation, education, student and advanced-practice studies. It included only 17 articles, and participant samples in those studies ranged from 12 to 150. It did not test an intervention or measure patient outcomes; it synthesized themes about how nurses make decisions. Quality appraisal used different tools and no single standard existed for the review.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that experience, colleague consultation or protocol use improves patient outcomes. The review did not test an intervention or measure patient outcomes; it summarized themes about how nurses described decision-making.