1. Education Does education alone make a difference in CDM? YES - Nurses with advanced degrees (Masters level or higher) are significantly better at CDM than those without such preparation (F 2, 48 = 13.83, p < 0.001) (Girot, 2000). No difference was found in those without advanced degrees yet greater years of experience. NO – Higher levels of education are not associated with better decision-making (R2 = 0.019, p =.609) (Hicks et al., 2003). Experience and not education level increase the quality of CDM (Ferrario, 2003). Experience Patricia Benner’s “From Novice to Expert” (1984) – Five levels of proficiency – novice, advanced beginner, competent, proficient, and expert. Decision-making ranges from limited cue recognition and analytic thinking (novice) to comprehensive understanding and intuition (expert). Nurse practitioners do not use one comprehensive CDM method yet rely heavily on experience and recognition of previously seen patterns. (the Experiential Learning Model) (Offredy, 1998; Ritter, 2003). Expert, more experienced nurses are more proactive in collecting relevant cues and anticipating problems in order to make higher quality decisions (Hoffman, Aitken, & Duffield, 2009). Intuition / Ethics Intuition is described as “knowing the patient”, having a “gut feeling”, a subconscious way that nurses deliberately recognize similar situations from past and compare them to present decisions (Benner, 2001; Ramezani et al., 2009). It is knowledge from within a person (Andersson et al., 2006) It is context dependent and relies heavily on sensory and perceptual data from multiple sources (Hicks et al., 2003; Tanner, 2006). Link to tacit knowledge, the knowledge nurses use but find it difficult to articulate (Hancock & Durham, 2007) Tacit knowledge emerges from experience and becomes intuitive - deciding without necessarily being consciously aware of the knowledge on which it is based. Environment / Costs CDM is a reflection of the clinical landscape, incorporating patient situation, stress level, available resources, and interpersonal relationships (Bucknall, 2003; Ebright et al., 2003). External factors that reflect work environment (nursing unit, patient complexity) are considered in every ultimate decision (Anderson et al., 2006). Critical care environment requires rapid pace, high frequency decisions thus revealing the environment to be the biggest influence in the CDM process (Bucknall, 2000). Project Purpose Conclusion/Themes Clinical Decision-Making Presented by Kristi Stinson, RN, MSN, Doctoral Student, RWJF Scholar, Seton Hall University Decision making is an essential process of human nature (Noone, 2002; Tanner, 2006). Clinical decision-making, or CDM, is a phenomenon that is integral to healthcare practice. The overall goal of CDM is to provide the highest quality patient care based on the best resources available. Knowing what factors influence this process increase the likelihood of providing safer care. Nurses are accountable for their decisions to both their organizations and profession; therefore, it is imperative that there be an understanding of the mechanisms of high quality CDM (Muir, 2004). The purpose of this project is to examine the concept of clinical decision- making from the nursing perspective, determine its defining attributes, and explore gaps in the existing knowledge base. Understanding the cognitive processes, related factors and thought models that nurses use when solving problems can be useful to nursing practice, nursing education, and the healthcare society at large. Like all healthcare professionals, nurses have had to adapt to the increased emphasis on the need for evidence-based healthcare decision in clinical practice. However, despite over three decades of research and investigation, nurses’ clinical decision-making processes and the factors that influence them, such as education (L1), experience (L2), intuition (R1), and environment (R2) remain unclear (Hicks et al., 2003). There is no consensus about which factor is the predominant in the ultimate decision made by the nurse (Ferrario, 2003; Girot, 2000; Hicks et al., 2003; Hoffman et al., 2009). A clearer definition of the clinical decision-making process will help to further define the body of existing nursing knowledge as well as create a broader sense of professional identity.