Module 4, Question 1 Response

The reading helped me to simply pay more attention to the clinical decisions I make. Sometimes as an RN, I feel like the most important and critical clinical decisions are the responsibility of the physician in charge, however, that is not necessarily true. The RN is the health care provider that is with the patient the most and usually the first to recognize the need for an intervention, therefore, I must make critical decisions to care for my patients and know when to involve the physicians for further intervention. Clinical decision making cannot be taken lightly because the life of a patient is on the line. Especially in my area of critical care, one decision can change the status of a patient very quickly. It is important to know how to make appropriate clinical decisions and if answers aren't known, it is critical to know where to find the answers, whether it be from resources such as a clinical decision support system, or another source. I realize that the more experience I have as a RN, the more my clinical decision making skills will improve because I will be exposed to more situations with time, but I must also be aware of the possible heuristics and biases as are discussed below. I also realize that as I transition from the role of RN to ACNP, clinical decision making will be even more critical, as with more hierarchy comes more responsibility.

I believe that nursing experience is a tool that in invaluable and cannot be replaced. I have always learned best and been able to remember details better when I have experienced a situation or patient case and treatment personally. With that said, one has to be cautious to not let previous experience narrow the way of thinking or decision making. Sometimes, if a healthcare provider feels too comfortable and experienced in certain areas, there can be misdiagnoses because the clinician simply assumes a certain diagnosis due to a few obvious signs and symptoms without exploring fully the full set of signs and symptoms with which the patient presents. Tversky and Kahneman (1974) mention this idea, representativeness, as one of three hueristics which can possibly lead to biases in decision making. This idea could also be described as overconfidence, as described by Thompson (2003). As mentioned, nursing experience is critical in clinical decision making. It is obvious the difference in ability in clinical decision making between a new graduate RN and one that has working in the ICU for 20 years, or even 1 year, however, the biases need to be kept in mind and avoided when possible. Also, it is crucial to always be implementing evidence based practice in clinical decisions. Sometimes, when clinicians have been in the business for awhile, they make decisions based on past experience because that is the way they have always done it, however, it is necessary to stay informed on current evidence based practice and implement new findings into decision making in order to better treat the patients. For some, this might require using other resources, such as a CDSS, or studying recent research literature, or possibly a little humility in order to be willing to deviate a little from they way things have always been done in the past.