The association of clinical experience and emergency nurses' diagnostic reasoning

Diagnostic reasoning is a pivotal part of nursing practice. Nursing practice continues to increase in complexity, therefore, diagnostic reasoning tasks have become more cognitively demanding for nurses. Understanding the type of diagnostic reasoning strategies that nurses use is needed to assist less experienced nurses and nursing students in decision-making. Heuristics are cognitive shortcuts that simplify decision-making in uncertain and complex situations. Many patient encounters are needed to build cognitive schema. More experienced nurses, then, are more likely to use heuristics to advance the diagnostic reasoning process. Therefore, this study was conducted to determine if an association exists between each of four types of the representativeness heuristic and years of clinical nursing experience.; The participants were 219 members of the Emergency Nurses Association from a random sample of 620 from among 21,577 members. Participants at the time of the study were employed at least 16 hours per week as an emergency nurses delivering direct care to patients. Participants were administered the Clinical Inference Vignettes which included sixteen clinical situations relevant to emergency nursing. Demographic data were collected using the Nurse Demographic Sheet.; Data were analyzed using the chi-square test of association and the nonparametric Mann-Whitney and Kruskal-Wallis tests. Results indicated that experienced nurses were significantly more likely to make judgments based on perceived causal systems than less experienced nurses. Inferences requiring estimates based on the frequency of a health problem, eliciting judgments of similarity to a single case, and eliciting judgments of similarity of a subset to a population did not differ between the experience subgroups.; Future studies are recommended to explore emergency nurses' use of heuristics in diagnostic reasoning that include the use of multiple methods to explicate the complexity of the diagnostic reasoning process, such as investigator observations in the clinical setting and the use of a psychometrically mature instrument. Implications for nursing education include using case studies that illustrate clinical dilemmas, providing strategies about how expert nurses think, and facilitating the student's cognitive development and diagnostic reasoning processes.