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The Role of Independent Decision Making in Nursing Practice

  • 12 Pages
  • Published On: 08-12-2023

Introduction

In nursing, independent decision-making is the aspect that explains nurses are solely responsible for acting on their own to take the initiative of planning and delivering care without instructions from others in any other disciple (Thomas and Mraz, 2017). The independent decision-making by the nurses helps to reflect their autonomy in practice where they are empowered with independence to make any decision of care to be provided to the patient. The independent decision-making is important in nursing because it helps to take immediate care decision by the nurses to deliver appropriate care to the patient for saving their life and enhancing their health condition (Khair & Chaplin, 2017). However, after transition of the student nurses to professional nursing practise it is seen that at the initial level the new graduate nurses’ experiences hardship with making independent decision of care for the patients. This leads them in facing hindrance with delivering timely care in time of emergency and lose confidence along with show failure of competence to deliver appropriate care to the patients. It makes the new graduate nurses face lack of satisfaction in delivering care and at times regulatory actions from organisations (Dragusheva et al., 2018).

Purpose

The purpose of the current report is to explore evidence to understand the reason behind inability of the new graduate nurses in making independent care decision. In this context, themes are to be developed and the facts are to be compared in them to determine limitations and gaps leading to the cause. Thereafter, recommendations with approved evidence is to be mentioned in the study to overcome the challenges of independent decision-making by the new graduate nurses.

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Analysis

Theme 1: Organisational culture influencing independent decision-making for newly qualified nurses

The organisational culture is referred to the underlying values, assumptions, beliefs and ways of interacting with staffs that contributes to the development of unique psychological and social environment in the organisation (Wong et al., 2018). According to Cappelletti et al. (2014), independent decision-making by the newly qualified nurses is influenced by the culture and surrounding environment of the care in the organisation. This is because a supportive organisational culture is seen to create positive environment for the new graduate nurses to be able to explore wider context in their profession and avail experience to make independent decision. As argued by Ludin (2018), newly qualified nurses are able to show effective independent decision-making when the organisational culture provides them to have active advice and support in need. This is because the active advice and support availability leads the new graduate nurses feel they have a lifeline to access while making independent care decision so that any hesitation can be resolved, and they can confidently rake the independent decision with accuracy. The independent decision-making by nurses does not mean they are working alone or without guidance but indicates that safety assistance is present in need to help the nurses overcome insecurity and uncertainty faced while making independent care decision (Wong et al., 2018).

The organisational culture which creates increased workload for the newly qualified nurses also acts as key reason behind the new nurse’s inability in making independent care decision. This is because high and irrelevant workload on the new nurses makes them develop dissatisfaction with the job role and stressed which leads to tie them back in making effective analysis of care situation and upgrade knowledge and skills to create improved independent decision of care delivery (Tubbs-Cooley et al., 2019). In 2020, it is mentioned that there is nearly 1.6 million job opening for nurses in Australia and they are facing nearly 200,00 shortage of nursing professional (Quinn, 2013). This shortage of nurses has created increased workload on the new qualified nurses been recruited as they are made to work more to deliver increased care to the patient to meet the shortfall (Quinn, 2013). Thus, it has created issue of independent care decision-making among the newly qualified nurses in Australia as they are unable to have time to make effective communication with patients to understand their situation and accordingly make independent care decision for them. Thee nurses instead are seen to depend on the health analysis made by experienced professionals and follow their guidance to delivery care rather than taking own decision in delivering support (Haddad, Annamaraju & Toney-Butler et al., 2020).

In contrast, the study by Nibbelink & Brewer (2018) mentions that organisational culture that does not include systematic resources and protocols for specifying the steps to be followed in different nature of care acts as a reason behind the newly qualified nurse's inability to make independent care decision. This is because such lack of resources in the organisational environment leads the new nurses confused about the structures to be followed and tools to be used in framing the independent care decision which is supportive of the care policies and rules in the care environment (Nibbelink & Brewer, 2018). As argued by Wong et al. (2018), organisational culture supporting peer learning leads the newly qualified nurses in making independent care decision. This is because peer learning leads the new graduate nurses know experience actions from peers and adapt the skills which are not known to them during the student phase and acting as barrier to make independent decision in care.

Limitation and Gaps

The studies though highlighted workload as a potential reason of organisation culture that hindered independent decision-making ability in newly qualified nurses but fails to explain the way it has developed. This creates limitation in understanding way the exact issue could be resolved to influence newly qualified nurses make independent decision in care. The other gap experienced is that the way multi-disciplinary team in the organisational culture influences independent care decision by the newly qualified nurses is not been focussed. The focus was necessary because the multi-disciplinary team are seen to act as supportive factor to promote independent care decision among nurses as they allow sharing expertise to nurses to help them have better understanding of complex care to be delivered with independence.

Theme 2: Influence of personal nature and attitude in making independent decision by newly qualified nurses

The personal experience in nursing acts as evidence base for the nurses to understand and determine the do’s and don’ts in the professional along with the way thinking is to be processed to overcome complex issue in care to deliver independent support to the patients (Tuden, Borycki & Kushniruk, 2019). The personal experiences of the newly qualified nurses are seen to have enhanced influence on allowing them to make independent care decision. This is because new nurses are found to have limited experience compared to other experienced staff in delivering care out of short duration of working time. It causes them to face hindrance in making critical thinking and enhanced analysis of situation without hesitation in making independent decision (Panda, Begley & Daly, 2018). Thus, the confusion and lack of self-perception due to lack of experience in newly qualified nurse make them fail to develop independent care decision. As argued by Galuska et al. (2018), personal experience leads the newly qualified nurse unable to have attributes of intuition regarding certain care situation. This creates lack of awareness of care situation for the new nurses and raises their confusion in making independent care decision.

In contrast, it is mentioned that personal knolwdege and education level of the newly qualified nurses acts as reason behind influencing their independent decision-making skill. It is evident from the study of Wu et al. (2016) which mentions that significant link is present between the education level of the newly qualified nurses and their independent decision-making. This is because it was seen that the new nurses who were involved in raising their education level through further learning expressed higher ability to theoretically analyse situation on own to develop better independent decision of care. However, the study by Alaseeri, Rajab & Banakhar (2019) mentioned that lower self-confidence in newly qualified nurses causes them to face hindrance in making independent decision. This is because lack of self-confidence raises doubts and lack of assertiveness among the new nurses regarding effacious impact of the independent decision been made by them. Thus, out of weak thinking, then new graduate nurses show inability in making successful independent decision.

Limitations and gaps

The limitation experienced is that the studies did not explain how the newly recruited nurses could have experience even before joining the professional field as expected of them to allow them to make effective independent decision. This raises question behind accepting experience at work to be potential reason behind new nurse’s inability in making independent care decision. The other limitation is that the studies did not explain the way age of the nurses may influence their level of education which is potential reason related to independent decision-making. The studies also did not inform the way physical situation and self-confidence of the new nurses are related in influencing their independent decision-making in care. Thus, it created a gap in understanding to the extent personal attitude and nature hindered decision-making in new nurses.

Recommendations

Recommendation 1: Supportive organisational framework for work-related problems in allowing newly recruited nurses make independent care decision

The organisational framework for the new nurses is recommended to be made supportive and for this purpose peer support and supervision is required to be arranged as compulsory for the newly qualified nurses. This is because consultation with peers and supportive evidential information from the supervisors or professionals leads the newly qualified nurses develop ease in making independent decision-making (Hawkins, Jeong & Smith, 2019). It is evident as such condition lead the new nurses to be confident in making decision as they feel having adequate knowledge regarding the care topic which they usually lack due to inadequate practical information in the initial practise sessions (Hawkins, Jeong & Smith, 2019).

Evidence

The evidence supporting the above fact is presented by the study of Ketelaar et al. (2015) where interview transcripts of the novice nurses mentioned that they feel ease in making independent decision-making with enhanced peer support. This is because consulting their independent ideas with the experience peers makes them develop better analysis if the idea has any error and rectify them to independent delivery care in successful manner to the patients. The study by Ketelaar et al. (2015) also provides evidence that supervision from experienced professionals helps novice or new nurses make enhanced independent decision in all aspect of the care. For example, one of the newly qualified nurses reported that availing professional guidance about the way hygiene and infection is to be controlled in infectious patients helped the new nurses in making enhanced independent decision to work with management infectious fluids from the patients. The other new nurse informed that supervision from experienced professional helped them in determining independently the way lifting position of the bed is to be maintained and at what angle it is to be maintained for best satisfaction and relaxation of the patients. In another study by Gizaw et al. (2018), it is mentioned that nurses who receive supervision are seen to make 2.878 times more likely effective independent care decision compared to those who did not received supervision.

Recommendation 2: Newley experienced nurses are to use decision-making framework or tools in making effective independent decision

The recommendation for the newly qualified nurse is that they are use decision-making framework or tool in making effective independent decision in care. This is because decision-making framework or tool provides step-by-step guidance to the new nurses regarding the way they are evaluate patient data and communicate with them to determine best care plan in an independent manner for them (Nibbelink & Brewer, 2018).

Evidence

The Nursing and Midwifery Board of Australia (NMBA) mentions that the professional care in nursing is regulated on the basis of best interest of the public. The National Decision-Making framework as the regulation would help the new nurses contribute making independent care decision that assures safety to the patients. This is because the framework imparts knolwdege to the new nurses regarding the principles to be followed in care for effective evaluation of care decision in taking the right independent idea of delivering care. The National Decision-Making framework is recommended to be used because it resolves doubt among the new nurses and raises confidence by making them recognise the way to apply the decision-making framework to develop evolutionary independent decision that are best for the patients. The framework is also to be used as it helps the new nurses in developing effective plan and negotiation of independent ideas to successfully implement them in practice to meet the raised health need of the public or patients (nursingmidwiferyboard.gov.au, 2020).

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Conclusion

The above discussion information that hindered organisational culture that does not support peer learning, systematic availability of resources, supervision and others are responsible for hindering independent decision-making by newly experienced nurses. Moreover, the personal attitude, knowledge and experience of the new nurses influence their way of developing independent decision-making. The recommendation in these contexts is that supporting organisational framework is to be formed and Decision-making framework is to be followed by new graduate nurses to be successful in making effective independent care decision.

References

Alaseeri, R., Rajab, A., & Banakhar, M. (2019). Factors Influencing Nurses’ Decision-Making Process: An Integrative Literature Review. IOSR Journal of Nursing and Health Science (IOSR-JNHS). 4 (11). pp. 36-48. https://www.iosrjournals.org/iosr-jnhs/papers/vol8-issue4/Series-2/E0804023648.pdf

Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and reasoning in nursing. Journal of Nursing Education, 53(8), 453-458. https://pubmed.ncbi.nlm.nih.gov/25050560/

Dragusheva, S., Petleshkova, P., Kasnakova, P., & Mavrov, M. (2018). The independent actions of trainee nurses during the pre-graduation traineeship. Trakia Journal of sciences, 16(1), 229-234. https://www.researchgate.net/profile/Snezhana-Dragusheva/publication/327339878_The_independent_actions_of_trainee_nurses_during_the_pre-graduation_traineeship/links/5d1db5ad299bf1547c9589d2/The-independent-actions-of-trainee-nurses-during-the-pre-graduation-traineeship.pdf

Galuska, L., Hahn, J., Polifroni, E. C., & Crow, G. (2018). A narrative analysis of nurses' experiences with meaning and joy in nursing practice. Nursing administration quarterly, 42(2), 154-163. https://greaterbostonnursing.org/wp/wp-content/uploads/na-of-nurses-experiences-with-meaning.pdf

Gizaw, A., Kidane, B., Negese, D., & Negassa, E. (2018). Factors affecting clinical decision-making practice among nurses working in Jimma University Medical Center, Jimma southwest Ethiopia. Ann Nurs Pract, 5(2), 1094. https://www.jscimedcentral.com/Nursing/nursing-5-1094.pdf

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Hawkins, N., Jeong, S., & Smith, T. (2019). New graduate registered nurses’ exposure to negative workplace behaviour in the acute care setting: An integrative review. International journal of nursing studies, 93, 41-54. https://www.sciencedirect.com/science/article/abs/pii/S0020748919300501

Ketelaar, S. M., Nieuwenhuijsen, K., Frings-Dresen, M. H., & Sluiter, J. K. (2015). Exploring novice nurses’ needs regarding their work-related health: a qualitative study. International archives of occupational and environmental health, 88(7), 953-962. https://link.springer.com/article/10.1007/s00420-015-1022-5

Khair, K., & Chaplin, S. (2017). What is a nurse-led service? A discussion paper. The Journal of Haemophilia Practice, 4(1), 4-13. https://www.researchgate.net/profile/Kate-Khair/publication/313035535_What_is_a_nurse-led_service_A_discussion_paper/links/58dd08ed92851c2c6b921bd0/What-is-a-nurse-led-service-A-discussion-paper.pdf

Ludin, S. M. (2018). Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey. Intensive and Critical Care Nursing, 44, 1-10. https://files.transtutors.com/cdn/uploadassignments/2892329_3_does-good-critical-thinking--nurses---ludin.pdf

Nibbelink, C. W., & Brewer, B. B. (2018). Decision‐making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917-928. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5867219/

nursingmidwiferyboard.gov.au (2020), Decision-making framework for nursing and midwifery, Retrieved on 29 January 2021 from: https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD19%2f29157&dbid=AP&chksum=9LilUkdFvM5AJeKIaJZd1A%3d%3d

Panda, S., Begley, C., & Daly, D. (2018). Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies. PloS one, 13(7), e0200941. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200941

Quinn, L. W. (2013). Throughput and nurses' workloads: Influences on nurse and patient outcomes. https://repository.upenn.edu/cgi/viewcontent.cgi?article=2072&context=edissertations

Thomas, C. M., & Mraz, M. A. (2017). Exploration into how simulation can effect new graduate transition. Clinical Simulation in Nursing, 13(10), 465-470. https://www.sciencedirect.com/science/article/abs/pii/S1876139916302043

Tubbs-Cooley, H. L., Mara, C. A., Carle, A. C., Mark, B. A., & Pickler, R. H. (2019). Association of nurse workload with missed nursing care in the neonatal intensive care unit. JAMA pediatrics, 173(1), 44-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583427/

Tuden, D. S., Borycki, E. M., & Kushniruk, A. W. (2019). Describing Telenurses' Decision Making Using Clinical Decision Support: Influential Factors Identified. In ITCH (pp. 424-429).

https://books.google.co.in/books?hl=enlr=id=6uOYDwAAQBAJoi=fndpg=PA424dq=factors personal experience affecting decision making in nursingots=MUtUjhyalfsig=LSRf2T6WbDrsyMV_qfqNY3VuZIcredir_esc=yv=onepageqf=false

Wong, S. W. J., Che, W. S. W., Cheng, M. T. C., Cheung, C. K., Cheung, T. Y. J., Lee, K. Y., ... & Yip, S. L. (2018). Challenges of fresh nursing graduates during their transition period. Journal of Nursing Education and Practice, 8(6), 30-37. https://www.researchgate.net/profile/Julia S W Wong/publication/322210267 Challenges of fresh nursing graduates during their transition period/links/5a4c568a0f7e9b8284c2f7eb/Challenges of fresh nursing graduates during their transition period.pdf

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