Decision Making and Problem Solving in Nursing
Comprehensive Clinical Notes for Nursing Students
Table of Contents
Introduction to Decision Making and Problem Solving
In the dynamic healthcare environment, nurses are constantly faced with situations requiring quick and effective decisions. Decision making and problem solving are fundamental skills in nursing practice that directly impact patient outcomes and safety.
Key Point: Decision making in nursing is the process of choosing between alternatives to reach a desirable outcome, while problem solving involves identifying issues and implementing solutions. Both processes rely heavily on critical thinking skills.
The complexity of healthcare today demands that nurses develop structured approaches to making decisions. Whether determining how to prioritize care for multiple patients, intervening in a rapidly deteriorating situation, or collaborating on a treatment plan, nurses must employ systematic thinking methods.
The Interconnected Nature of Nursing Decision Skills
Critical Thinking
Problem Solving
Decision Making
Patient Outcomes
Understanding these processes can help nurses improve their clinical practice, enhance patient safety, and contribute to better healthcare outcomes. This resource provides a comprehensive guide to decision making and problem solving frameworks relevant to nursing practice.
Critical Thinking in Nursing
Critical thinking serves as the foundation for effective decision making and problem solving in nursing. It involves the intellectually disciplined process of actively conceptualizing, analyzing, and evaluating information gathered from observation, experience, reflection, reasoning, or communication.
Clinical Application: Critical thinking enables nurses to question assumptions, examine evidence, and consider multiple perspectives before making clinical decisions. It’s the cognitive engine that drives effective nursing practice.
Components of Critical Thinking
| Component | Description | Nursing Application |
|---|---|---|
| Interpretation | Understanding and expressing the meaning of data | Interpreting lab results and patient assessment findings |
| Analysis | Breaking down information into parts | Identifying patterns in patient symptoms and responses |
| Evaluation | Assessing credibility and significance | Determining the clinical significance of findings |
| Inference | Drawing logical conclusions | Predicting potential outcomes based on patient data |
| Explanation | Presenting results of reasoning | Communicating rationale for interventions |
| Self-Regulation | Monitoring own thinking | Reflecting on care decisions and making adjustments |
Developing Critical Thinking Skills
Mnemonic: “CRITICAL”
C – Consider the context and circumstances
R – Recognize assumptions and biases
I – Inquire for evidence and information
T – Test hypotheses and alternatives
I – Interpret data accurately
C – Collaborate with others for perspective
A – Analyze arguments and reasoning
L – Learn from the process and outcomes
Nurses who excel in critical thinking demonstrate intellectual curiosity, humility, integrity, and perseverance. They approach clinical situations with an open mind while maintaining healthy skepticism about assumptions and conventional wisdom.
The Critical Thinking Process in Nursing
Collect Information
Patient assessment, lab data, observations
Analyze Findings
Identify patterns and relationships
Generate Solutions
Consider multiple intervention options
Evaluate Options
Compare risks and benefits
Implement Decision
Take action based on analysis
Reflect & Refine
Evaluate outcomes and adjust approach
Developing critical thinking skills takes deliberate practice and reflective experience. Nursing education programs increasingly emphasize these skills as essential to safe, effective practice in today’s complex healthcare environment.
The Decision Making Process
Decision making is a systematic process of choosing between alternative courses of action. In nursing, these decisions directly impact patient care outcomes and must be based on sound critical thinking.
Types of Nursing Decisions
Clinical Decisions
Focused on patient assessment, diagnosis, interventions, and evaluations. These decisions require application of evidence-based practice and clinical knowledge.
Example: Determining whether a patient needs immediate intervention for rising blood pressure.
Administrative Decisions
Related to management of resources, staffing, and unit operations. These decisions impact efficiency and effectiveness of care delivery.
Example: Determining nurse-patient assignments based on acuity and staff expertise.
Ethical Decisions
Involve moral dilemmas and competing values. These decisions require consideration of patient autonomy, beneficence, justice, and non-maleficence.
Example: Balancing patient autonomy with safety concerns in refusal of treatment.
Emergency Decisions
Rapid decisions made under pressure with limited time and information. These require quick critical thinking and prioritization.
Example: Prioritizing interventions during a cardiac arrest situation.
Decision Making Models in Nursing
| Model | Key Features | Best Used When |
|---|---|---|
| Rational Model | Systematic, logical approach with clear steps | Time allows for thorough analysis and comparison |
| Intuitive Model | Based on expertise, pattern recognition, and “gut feeling” | Rapid decisions needed with limited information |
| Shared Decision Model | Collaborative process involving patient/family preferences | Patient autonomy is prioritized and options have trade-offs |
| Recognition-Primed Model | Combine situation recognition with mental simulation | Experienced clinicians face familiar situations |
| Evidence-Based Model | Integrates research evidence with clinical expertise | Complex clinical problems with available evidence |
The 6-Step Decision Making Process
Mnemonic: “DECIDE”
D – Define the problem clearly
E – Explore all alternatives
C – Consider the consequences of each option
I – Identify the best solution
D – Develop and implement an action plan
E – Evaluate the results and learn
Circular Decision Making Process
Thinking
Problem
Data
Options
Choose
Plan
Results
Effective decision making in nursing requires:
- Continuous development of critical thinking skills
- Knowledge of relevant evidence-based practices and guidelines
- Consideration of individual patient factors and preferences
- Awareness of resource constraints and organizational policies
- Reflection on previous decisions to improve future judgment
Problem Solving Models in Nursing
Problem solving is the process of identifying an issue, determining its cause, and implementing a solution. While decision making focuses on selecting between alternatives, problem solving encompasses a broader process of issue identification and resolution.
Key Point: Problem solving requires strong critical thinking skills and analytical reasoning. It forms the foundation for effective nursing interventions and quality improvement initiatives.
The Nursing Process as a Problem-Solving Framework
The nursing process is the most fundamental problem-solving framework in nursing practice, providing a systematic approach to patient care.
The Nursing Process
Assessment
- Collect comprehensive patient data
- Document patient history
- Perform physical assessment
- Review lab and diagnostic results
Diagnosis
- Analyze assessment data
- Identify actual/potential health problems
- Formulate nursing diagnoses
- Prioritize patient needs
Planning
- Set measurable, realistic goals
- Develop specific nursing interventions
- Collaborate with healthcare team
- Incorporate evidence-based practices
Implementation
- Execute the care plan
- Perform nursing interventions
- Document all actions taken
- Communicate with healthcare team
Evaluation
- Assess patient response to interventions
- Compare outcomes with established goals
- Modify care plan as needed
- Reassess continuously
Additional Problem-Solving Models
PDSA Cycle (Plan-Do-Study-Act)
A quality improvement model that focuses on continuous improvement through small, iterative changes.
- Plan: Identify opportunity and plan change
- Do: Implement the change
- Study: Analyze results and lessons
- Act: Adopt, adapt, or abandon based on results
Root Cause Analysis (RCA)
A structured method to identify the fundamental cause of a problem or adverse event.
- Define the problem clearly
- Collect data related to the problem
- Identify possible causal factors
- Ask “why” repeatedly to find root causes
- Develop and implement solutions
SOAP Method
A documentation framework that also serves as a problem-solving model.
- Subjective: Patient’s symptoms and concerns
- Objective: Measurable, observable data
- Assessment: Analysis and diagnosis
- Plan: Treatment and follow-up
SBAR Communication
A structured communication technique that can also be used for problem-solving.
- Situation: What is happening now?
- Background: What is the clinical context?
- Assessment: What do I think is going on?
- Recommendation: What should be done?
Mnemonic: “SOLVE”
S – State the problem clearly
O – Observe and gather relevant information
L – List possible solutions
V – Validate and choose the best approach
E – Execute and evaluate results
Clinical Application: When faced with a complex clinical problem, try using multiple problem-solving frameworks in combination. For example, you might use the nursing process for overall patient care while employing root cause analysis to address a specific complication. Critical thinking skills help you determine which approach is most appropriate for each situation.
Clinical Judgment in Nursing
Clinical judgment is the outcome of critical thinking in nursing practice. It represents the nurse’s ability to recognize cues, analyze information, and take appropriate actions in clinical situations. Clinical judgment combines knowledge, experience, and reasoning to guide patient care decisions.
Tanner’s Clinical Judgment Model
Tanner’s Four-Step Model of Clinical Judgment
1. Noticing
Initial grasp of the situation through observation and recognition of patterns and deviations. This involves perceiving important information and recognizing when something requires attention.
2. Interpreting
Developing understanding of the situation by identifying patterns, analyzing data, and determining the nature of the problem. This involves making sense of what has been noticed.
3. Responding
Deciding on a course of action based on interpretation and then taking action. This includes determining what interventions are needed and implementing them.
4. Reflecting
Evaluating outcomes and learning from the experience. This includes both reflection-in-action (during the event) and reflection-on-action (after the event has occurred).
Factors Influencing Clinical Judgment
| Factor | Impact on Clinical Judgment | Strategies to Enhance |
|---|---|---|
| Knowledge Base | Provides foundation for recognizing patterns and interpreting data | Continuous education, evidence-based practice updates |
| Experience | Develops intuition and ability to quickly recognize situations | Clinical practice, case studies, simulation |
| Critical Thinking Skills | Enables analysis and evaluation of complex information | Practice with clinical reasoning exercises, reflection |
| Personal Biases | Can influence perception and interpretation of situations | Self-awareness, mindfulness, seeking diverse perspectives |
| Contextual Factors | Workplace environment, time constraints, resources | Systems improvement, situation awareness training |
| Patient Factors | Unique characteristics, preferences, and complexity | Patient-centered care, cultural competence |
Developing Clinical Judgment Skills
Deliberate Practice
Intentional, focused practice with specific goals and feedback. This can include:
- Case study analysis
- Clinical simulation scenarios
- Peer-reviewed practice sessions
- Reflection on challenging cases
Knowledge Building
Expanding theoretical and practical knowledge through:
- Continuing education
- Reading current research
- Interprofessional learning
- Specialty certification
Reflective Practice
Systematically examining clinical experiences:
- Clinical journaling
- Debriefing after critical events
- Guided reflection with mentors
- Self-evaluation of decision processes
Feedback and Mentorship
Learning from experienced clinicians:
- Seeking constructive feedback
- Establishing mentoring relationships
- Participating in clinical rounds
- Collaborative decision-making
Mnemonic: “CLINICAL”
C – Consider all available information
L – Look for patterns and inconsistencies
I – Investigate unclear or conflicting data
N – Note patient’s unique characteristics
I – Interpret findings based on knowledge
C – Connect findings to potential nursing diagnoses
A – Analyze potential interventions
L – Learn from outcomes through reflection
Key Point: Clinical judgment is not simply applying rules or protocols—it requires contextual understanding and critical thinking. Developing sound clinical judgment is an ongoing process that improves with experience, reflection, and deliberate practice.
Ethical Decision Making in Nursing
Ethical decision making involves resolving moral dilemmas by applying ethical principles and frameworks. Nurses frequently encounter situations where values conflict and must use critical thinking skills to navigate these complex scenarios.
Core Ethical Principles in Nursing
Autonomy
Respecting individuals’ rights to make their own decisions.
Example: Respecting a patient’s refusal of treatment even when it conflicts with clinical recommendations.
Beneficence
Acting in the best interest of patients and providing care that benefits them.
Example: Recommending and implementing interventions that promote healing and comfort.
Non-maleficence
Avoiding causing harm; “first, do no harm.”
Example: Carefully weighing benefits versus risks of interventions to avoid unnecessary adverse effects.
Justice
Fair, equitable, and appropriate treatment for all patients.
Example: Ensuring all patients receive the same quality of care regardless of socioeconomic status or other factors.
Fidelity
Keeping promises and being faithful to professional commitments.
Example: Following through on commitments made to patients and maintaining confidentiality.
Veracity
Being truthful and providing accurate information.
Example: Honestly disclosing the risks and benefits of procedures to patients.
Ethical Decision-Making Frameworks
The Four-Box Method for Ethical Analysis
Medical Indications
- What is the patient’s medical problem?
- What are the goals of treatment?
- What are the probabilities of success?
- How can harm be avoided?
Patient Preferences
- What has the patient expressed about preferences?
- Is the patient mentally capable of making decisions?
- Has the patient been informed of benefits and risks?
- Has consent been obtained?
Quality of Life
- What physical, mental, and social deficits may result?
- What quality of life judgments are being made?
- What are the prospects for returning to normal life?
- Are biases influencing quality of life evaluations?
Contextual Features
- Are there family issues affecting treatment decisions?
- Are there provider or institutional conflicts of interest?
- Are there economic or allocation factors?
- Are there religious or cultural factors?
Mnemonic: “MORAL”
M – Massage the dilemma (identify the problem)
O – Outline options (consider alternatives)
R – Review criteria and resolve (apply ethical principles)
A – Affirm position and act (implement decision)
L – Look back (evaluate outcomes and reflect)
Common Ethical Dilemmas in Nursing
| Ethical Dilemma | Conflicting Principles | Critical Thinking Approach |
|---|---|---|
| End-of-life care decisions | Autonomy vs. Beneficence | Examine advance directives, consult ethics committee, consider family input while prioritizing patient wishes |
| Allocation of scarce resources | Justice vs. Beneficence | Apply established resource allocation frameworks, consult institutional policies, consider both individual needs and population health |
| Informed consent issues | Autonomy vs. Non-maleficence | Assess patient capacity, ensure comprehensive disclosure, consider cultural factors, document understanding |
| Confidentiality breaches | Fidelity vs. Non-maleficence | Understand legal requirements for disclosure, evaluate potential harm, consult policies, minimize information shared |
| Treatment refusal | Autonomy vs. Beneficence | Ensure patient understands consequences, explore reasons for refusal, evaluate capacity, document thoroughly |
Clinical Application: When facing ethical dilemmas, nursing students should learn to use structured ethical frameworks to guide their thinking. Applying critical thinking to ethical situations involves consideration of multiple perspectives, consultation with colleagues and ethics committees when appropriate, and reflection on personal biases that may influence decision-making.
Barriers to Effective Decision Making
Even with strong critical thinking skills, nurses face various barriers that can impede effective decision making and problem solving. Recognizing these barriers is the first step toward mitigating their impact.
Cognitive Barriers
Cognitive Biases
- Confirmation bias: Seeking information that confirms existing beliefs
- Anchoring bias: Over-relying on first piece of information
- Availability bias: Overestimating likelihood of events that come to mind easily
- Overconfidence bias: Excessive faith in one’s own knowledge
Decision Fatigue
The deterioration of decision quality after making multiple decisions.
Nurses often experience decision fatigue toward the end of long shifts, potentially compromising decision making ability when high-stakes situations arise.
Example: A nurse who has made numerous decisions throughout a 12-hour shift may struggle to think clearly about a complex patient issue that arises near shift end.
Information Overload
Excessive information that exceeds cognitive processing capacity.
Healthcare environments generate vast amounts of data, making it challenging to identify relevant information for decision making.
Example: A nurse reviewing a patient’s extensive electronic health record may miss critical information amid overwhelming documentation.
Limited Critical Thinking Skills
Insufficient development of analytical reasoning abilities.
Without strong critical thinking skills, nurses may rely on routines or protocols without considering unique patient factors.
Example: Applying a standard intervention without analyzing whether it’s appropriate for a patient’s specific circumstances.
Environmental and Situational Barriers
Environmental Factors Affecting Decision Making
Interpersonal and Organizational Barriers
| Barrier | Impact on Decision Making | Mitigation Strategy |
|---|---|---|
| Hierarchical structures | May inhibit nurses from speaking up or questioning decisions | Promote psychological safety, implement structured communication tools (SBAR) |
| Communication breakdowns | Lead to misunderstandings and information gaps | Standardized handoffs, closed-loop communication, team training |
| Policy constraints | May limit flexibility in decision making | Create policies that allow for clinical judgment, establish variance protocols |
| Organizational culture | May discourage innovation or questioning | Leadership support for shared governance, recognition of problem solving |
| Team dynamics | Conflicts or poor collaboration can hinder collective decision making | Team building, interprofessional education, conflict resolution training |
Warning: Being unaware of these barriers can lead to poor decisions even when nurses have strong clinical knowledge. Regular reflection on decision-making processes helps identify when barriers are influencing clinical judgment. Developing strong critical thinking habits can help overcome many of these obstacles.
Strategies to Improve Decision Making and Problem Solving
Developing effective decision making and problem solving skills requires deliberate practice and the application of specific strategies. These approaches can strengthen critical thinking abilities and lead to improved patient outcomes.
Evidence-Based Strategies
Structured Reflection
Systematic examination of clinical experiences to extract learning and improve future practice.
Implementation:
- Maintain a decision journal
- Use structured reflection models (Gibbs, Johns)
- Schedule regular reflection time
- Seek feedback on decisions from peers
Clinical Decision Support Tools
Resources and technologies that provide evidence-based guidance for specific clinical situations.
Implementation:
- Utilize clinical practice guidelines
- Implement decision algorithms
- Use validated assessment tools
- Leverage electronic clinical decision support
Cognitive Debiasing
Techniques to minimize the impact of cognitive biases on decision making.
Implementation:
- Consider alternatives (ask “what else could this be?”)
- Seek diverse perspectives
- Develop metacognitive awareness
- Use structured decision processes
Simulation Training
Practice making decisions in realistic but safe environments to build confidence and competence.
Implementation:
- Participate in high-fidelity simulations
- Engage in case-based learning
- Practice with virtual patients
- Conduct thorough debriefings focused on decision processes
Mnemonic: “THINK”
T – Test your assumptions
H – Highlight what’s most important
I – Investigate alternatives
N – Navigate through information systematically
K – Keep reflecting on your reasoning process
Developing Critical Thinking Skills
Critical Thinking Development Cycle
Team-Based Strategies
| Strategy | Description | Benefits |
|---|---|---|
| Collaborative Decision Making | Involving multiple team members in the decision process | Diverse perspectives, shared responsibility, increased buy-in |
| Interprofessional Huddles | Brief team meetings to discuss complex patient issues | Real-time problem solving, coordinated care, shared mental models |
| Peer Consultation | Seeking input from colleagues about difficult decisions | Reduced cognitive biases, knowledge sharing, mentorship |
| Case Reviews | Systematic examination of complex cases after resolution | Shared learning, process improvement, identification of system issues |
| Decision Debriefs | Structured team discussions about decision processes | Continuous improvement, team learning, psychological safety |
Key Point: Improving decision making and problem solving is an ongoing process that requires deliberate practice and self-awareness. By consistently applying these strategies, nurses can develop stronger critical thinking skills and make more effective clinical decisions.
Case Studies in Nursing Decision Making
Analyzing real-world scenarios helps bridge the gap between theoretical knowledge and practical application. The following case studies illustrate different aspects of decision making and problem solving in nursing practice.
Case Study 1: Prioritization Decision
Scenario:
A nurse begins the shift with five patients:
- Patient A: Post-operative day 1 after appendectomy, complaining of increasing pain (7/10)
- Patient B: Admitted with pneumonia, due for IV antibiotics
- Patient C: Diabetic patient with blood glucose of 42 mg/dL, appearing lethargic
- Patient D: Stable heart failure patient awaiting discharge education
- Patient E: Patient admitted with cellulitis requiring wound assessment
Decision Challenge:
In what order should the nurse attend to these patients?
Critical Thinking Process:
- Assess each situation for potential threats to life, safety, and comfort
- Use ABC (Airway, Breathing, Circulation) assessment as initial framework
- Consider time sensitivity of each intervention
- Apply Maslow’s hierarchy to help prioritize needs
Decision Made:
Patient C should be attended to first (hypoglycemia is immediately life-threatening), followed by Patient A (pain management), Patient B (time-sensitive medication), Patient E (assessment required), and Patient D (stable condition).
Learning Points:
- Prioritization requires rapid assessment of multiple factors
- Physiological needs take precedence over other needs
- Systematic application of critical thinking helps manage competing demands
- Decision frameworks like ABC assessment provide structure in high-pressure situations
Case Study 2: Ethical Decision Making
Scenario:
An 85-year-old patient with moderate dementia has been hospitalized for pneumonia. Although alert, the patient becomes confused intermittently. The patient repeatedly pulls out the IV line needed for antibiotics. The physician orders soft restraints, but the patient’s daughter disagrees, stating her mother would never want to be restrained.
Decision Challenge:
Should the nurse implement restraints to maintain necessary treatment, or honor the family’s wishes to avoid restraints?
Critical Thinking Process:
- Identify the ethical principles in conflict (beneficence vs. autonomy)
- Gather additional information (patient’s advance directives, mental capacity)
- Consider alternatives to restraints (family presence, mitt protectors, increased monitoring)
- Consult hospital policy on least restrictive interventions
- Involve interdisciplinary team (physician, ethics committee)
Decision Made:
The nurse decides to implement alternatives to restraints first, including repositioning the IV to a less accessible site, using a sleeve cover, increasing monitoring, and requesting family presence when possible. The nurse documents the decision-making process and continues to evaluate the effectiveness of these interventions.
Learning Points:
- Ethical dilemmas rarely have a perfect solution
- Creative problem solving can sometimes resolve apparent conflicts
- Balancing competing ethical principles requires careful critical thinking
- Documentation of ethical decision processes is essential
- Continuous evaluation allows for adjustment as needed
Case Study 3: Clinical Deterioration
Scenario:
A post-operative patient returns to the surgical floor after an uncomplicated cholecystectomy. During routine assessment, the nurse notes the patient’s heart rate has increased from 80 to 110 bpm, respiratory rate from 16 to 22, and the patient reports feeling “a little short of breath.” Blood pressure and temperature are unchanged from previous readings.
Decision Challenge:
Is this a sign of clinical deterioration requiring intervention, or an expected post-operative finding?
Critical Thinking Process:
- Analyze vital sign trends rather than isolated readings
- Conduct focused respiratory and cardiac assessment
- Consider potential causes (pain, anxiety, pulmonary embolism, internal bleeding)
- Check recent lab values and medication administration
- Assess for additional symptoms (chest pain, incision appearance, anxiety)
Decision Made:
The nurse finds the surgical dressing is saturated with blood, suggesting post-operative bleeding. The nurse immediately notifies the surgeon, increases IV fluids, obtains stat hemoglobin levels, and prepares the patient for possible return to surgery.
Learning Points:
- Subtle changes can indicate serious complications
- Pattern recognition is a key component of critical thinking in clinical assessment
- Early intervention in clinical deterioration improves outcomes
- Systematic assessment helps distinguish between expected findings and complications
- When in doubt, it’s better to escalate concerns than to wait for more evidence of deterioration
Case Analysis Framework: “ANALYZE”
A – Assess the situation comprehensively
N – Note key clinical and contextual factors
A – Apply relevant knowledge and evidence
L – List possible actions and their consequences
Y – Yield a decision based on critical analysis
Z – Zero in on outcomes and evaluate effectiveness
E – Extract learning points for future application
Summary and Key Takeaways
Effective decision making and problem solving are essential competencies for nursing practice that directly impact patient outcomes. Throughout these notes, we’ve explored the foundations, processes, and strategies for developing these critical skills.
The Decision Making and Problem Solving Ecosystem
Foundations
- Critical thinking skills
- Knowledge base
- Ethical principles
- Evidence-based practice
- Self-awareness
Processes
- Problem identification
- Data gathering
- Option generation
- Analysis and evaluation
- Implementation
- Outcome assessment
Strategies
- Structured frameworks
- Reflection practices
- Collaborative approaches
- Bias mitigation
- Simulation and practice
- Continuous improvement
Key Takeaways
1. Critical thinking is the foundation
Cultivating critical thinking skills is essential for effective nursing decisions. This includes analysis, evaluation, inference, and reflection capabilities.
2. Structured approaches enhance outcomes
Utilizing systematic decision-making frameworks and problem-solving models provides structure and thoroughness to the process.
3. Context matters
Recognizing how environmental, organizational, and interpersonal factors influence decision making helps address barriers and constraints.
4. Ethics are integrated
Ethical principles and considerations are inherently embedded in nursing decisions, requiring conscious attention to values and principles.
5. Reflection drives improvement
Deliberate reflection on decision processes and outcomes leads to continuous improvement and development of expertise.
6. Collaboration enhances decisions
Team-based approaches to decision making leverage collective knowledge and reduce individual biases and limitations.
Practical Applications
For Developing Nurses:
- Practice articulating your thought process when making decisions
- Seek feedback from experienced nurses on your decision rationales
- Maintain a reflective journal about challenging decisions
- Engage in case studies and simulation scenarios regularly
- Identify your cognitive biases and develop strategies to counteract them
- Build a strong knowledge base through continuous learning
Decision making and problem solving in nursing are complex cognitive processes that directly impact patient care quality and safety. By developing strong critical thinking skills and applying structured approaches to clinical situations, nurses can enhance their ability to make effective decisions even in challenging circumstances.
As you progress in your nursing career, continue to refine these skills through deliberate practice, reflection, and learning from both successes and failures. Remember that becoming an expert decision maker requires time, experience, and conscious effort, but the journey ultimately leads to improved patient outcomes and professional satisfaction.