Intuitive knowledge and decision making by registered nurses working in acute care medical-surgical settings

A quantitative cross-sectional correlational approach was used to examine the decision-making practices of registered nurses who work in an acute care medical-surgical setting. The purpose of this study was to examine the relationship between type of decision making used and years of experience, educational preparation, and gender. Data were collected over a six-month period using the Smith Intuition Instrument and Jenkins' Clinical Decision Making in Nursing Scale. Purposive sampling methods were used to target registered nurses who work at least 16 hours per week and no longer working with a preceptor. The sample of 111 registered nurses was assigned to one of two groups based on years of experience. Data were analyzed using descriptive and inferential statistics. Study findings suggest the prevalence of registered nurses working in acute care medical-surgical settings use both analytical and intuitive strategies when making clinical decisions. However, experience, educational preparation, and gender were identified as having a more positive relationship with intuitive decision-making. Female registered nurses with at least five years of experience who were prepared at the Associate level reported a higher frequency of physical sensations when taking care of patients. Implications for nursing practice include the need for systems that support the medical-surgical registered nurses' ability to develop skills that facilitate early recognition of cues and patterns that may influence clinical decision making, nursing interventions, and patient outcomes. Experiential learning occurs over time; however, the quality and practical application of the knowledge gained may not be reflected in safe quality nursing practice. The importance of a pragmatic clinical decision-making component in nursing programs regardless to the level of preparation cannot be over emphasized.