In the hospital, once I had to make an instant decision when multiple patients needed assistance at the same time. One patient asked for help to go to the washroom, another requested for pain killer and third need their vital signs to be taken. I had to decide which patient to help first.
Through the decision making process I was able to decide which situation is most important. I prioritized the patient safety and considered the potential consequences of delaying care. I decided to help first the patient who need assistance to go to bathroom because waiting could result in fall.
After that I administered the medication to other patient and then checked the vitals. I learned from this experience how prioritizing the task is important in nursing. When more than one patients require assistance at once. The decision making process helps nurses to stay organized and selecting the best way to take action.

Every day is full of decision making and hoping we make the correct ones! Today, I have a leaking ceiling in one of our offices. It is not severe, although it is posing an issue as it is dripping directly where a staff sits. There is other vacant office space, there made the decision to relocate their office space for their health and safety. The staff felt they could manage ok and were not really pleased with this move, however, a larger issue could be in the near future not to mention a risk with water dripping near electrical cords etc. Other alternatives were explored, however, relocating seems to be the safest route.

One example of a decision I made at work was deciding whether to give a resident their medication early because they were very anxious and upset. Before deciding, I paused and reviewed the resident’s care plan, checked with the charge nurse, and considered possible effects of giving the medication early. By going through this process, I was able to make a safe decision that calmed the resident without causing any harm. I think following a structured decision-making process helped me weigh the risks and benefits, consider alternatives, and ensure the decision was safe and appropriate for the resident.

Decision-making is important in nursing because nurses often have to act quickly while considering what is best for the patient. For instance, I once looked after a long-term resident who suddenly stopped eating and became more withdrawn. At first, they might just be having an off day, which can happen. But I had to decide whether to watch and wait or to investigate further.

I decided to assess the resident’s condition more closely. I checked their vital signs, read recent notes, and talked with them about how they were feeling. I also asked other team members for their thoughts. We discovered the resident was in pain, which explained the changes in their appetite and mood. After we shared what we found and started the appropriate care, the resident improved.

Thinking back, using a formal decision-making process could have helped, as it encourages nurses to gather information, consider different options, and anticipate the consequences of each choice. Decision-making models by Jasovsky and Kamiensky (2007) and Kelly and Crawford (2012) emphasize assessing the situation, exploring alternatives, and considering possible outcomes before taking action. Even though I did many of these things naturally, being more aware of the process can help nurses make better choices in the future.

As I reflect on the posted scenario described in the first question, it seems that the decision-making process was applied, only I was not conscious of using it. And as I am onsite 3 days a week, an evaluation of the outcome of my suggestion to go to the Union and then leaving the nurses’ station to return to the unit will not be clearly known for a few more days. The follow up on this drags the process out but it is a significant lesson learned.
Had I consciously applied the decision-making process, I likely would have explained to the PSWs and the other RPN my thought process and what I was engaging in to let them know that I was not avoiding their concerns but rather supporting them by covering the unit while they were discussing the next steps in resolving their work load expectations.

quick decision making seems to always be needed as a nursing manager. the other day there was an unexpected death on our floor. it was right at breakfast time when the charge nurse need to be administering medications to all residents. I made the very quick decision to jump in and follow our unexpected death policy to support my team and quickly report to senior leadership that my support was needed, missing an meeting that morning.

Swift decision-making is very important in clinical practice. During one of my shift, we had a fire alarm buzzing. It was notified to us that the fire was located on the floor above us and just right above one of our resident rooms. Initially, there was smoke detected in our resident room. I called on our PSW staff members, and I made a quick decision to move our resident out of the room. PSW staff provided timely assistance and moved the resident. After a few minutes, our resident room had a sprinkler break — because of the fire upstairs—and flooded the room. It was a challenging time that warranted quick decision to safeguard our resident and I am thankful to our staff who did an amazing job.

I advocated strongly for a health and safety recommendation that I believed would benefit workers, but when the JHSC declined it, I respected the process and took the time to listen to their concerns. Even though as co chair I wanted to push the recommendation forward, I recognized the importance of collaborative decision making and chose not to pursue it further.

I agree Angusami;
Swift decision-making is very important in clinical practice. During one of my shift working at an overnight Respite facility I was informed that a client was exhibiting aggressive behaviours towards another client. I quickly decided to remove the client at risk to another location and tried to de-escalate the situation. The safety of the non-aggressive client and the safety of the staff is always the highest priority, requiring immediate action.

A recent example of decision-making at work occurred last week when our clinic experienced a scheduling error that resulted in several double-booked appointments. At the same time, our EMR system began to go down, which typically shows subtle warning signs beforehand. Recognizing these early signs, I quickly anticipated that we might lose access to patient information. Acting proactively, I printed the schedule to ensure we had access to patient names and contact details. Once this backup was secured, I shifted my focus to maintaining clinic flow by rooming patients, taking vital signs, and assisting the PCP to reduce their workload during the disruption.

My decision-making process was: identifying early warning signs, anticipating potential system failure, and prioritizing patient flow, helped minimize delays and maintain organization during a chaotic situation. This approach ensured that patient care continued as smoothly as possible despite the technical and scheduling challenges.

As nurses we have to be quick on our feet. When working on our dementia unit one of our residents Judy can escalate quickly which can lead to upsetting other residents.
Judy will pace the hallways calling out loudly for family and when she is unable to re-direct she will start ramming her walker into staff and co-residents.
With Judy I tend to focus on the preventative side (managing her pain, provide quiet spaces, etc.) to prevent possible behaviours. However, one evening she was found outside of dinning room calling out and about to ram her walker into co-residents. Two PSWs witnessed and I attended the situation and instructed the PSWs to clear away the other residents immediately. I made this decision as I know that it is extremely hard to re-direct Judy when she is in that state and I wanted to ensure everyone’s safety as quick as possible while Judy calms down. Judy’s behaviour did subside and she joined us later in the common lounge.

(Judy’s name was used for example purposes only, not residents real name)

This example required immediate decision making, however I do think it is possible to use the decision making process when you know your residents. This is a great reflective example to evaluate. I think I handle the situation well to ensure everyone’s safety.

There are some decisions we make as nurses that are what would be called “routine decisions”, often at the LTC home that I work at , there are call ins or no show’s at the last minute and adjusting the staff involves looking at the process that is in place to move staff to appropriate areas to help facilitate proper safety for staff and residents. Although there is a process, there is still day to day differences in residents needs on each unit, so there is always a component of the “innovative decision” making to ensure that the right staff is in the right place for the needs at that time.
In these cases, using a consistent approach is important.

I was very unfamiliar with a unit I was working on but the staff were long time regulars so they were very helpful. Right before breakfast they alerted me that a resident was unresponsive/ sleepy. I walked in the room and immediately knew this resident had passed away. The staff were all hysterical as they have worked that unit for many years and this was a very loved resident. I quickly made a phone call to the charge nurse, then made a quick decision and called the unit supervisor to see if there were any extra staff that could possibly cover for breakfast so the staff could mourn. Luckily, there were a few floats in the building so they came to cover for a few hours as the staff was still adjusting. The staff was thankful for this as they were processing their grief during their shift.

One decision I made at work where I now reflect and feel the decision making process would have helped was making a decision to leave a previous job. During the pandemic I found myself in a role working from home and feeling isolated. At the same time I had a family member in another province that was facing a health crisis and I was the only family member able to support her. Although I had some vacation time I could use it would not be enough. So I approached my immediate manger to request an exception to work from another province to support my sister. This request was declined. Considering the isolation and challenges already at the time due to COVID I became disengaged in my role and gave my notice. I spent the next few months supporting my sister through her treatment and recovery. Once she was on the mend and her outcomes looked positive I realized I left a job I truly enjoyed. I believe this was a loss for me but also for the organization I left. In reflection if I had used the decision making process as it is presented in our readings I may have looked at other options/alternatives such a a leave of absence. I do believe it would have supported a more thoughtful process.

In nursing, decision‑making isn’t something that happens only during emergencies — it’s part of almost every task I do throughout a shift. I practice routine decision‑making every day because there are policies, guidelines, and standards of care that guide how we respond to different situations.
For example:

Responding to different code statuses such as Code Blue, Code Yellow, or Code White requires quick thinking, knowing the protocol, and understanding each resident’s care plan.

Managing high‑risk fall residents means constantly assessing their environment, mobility, and behavior, and deciding what interventions are needed to keep them safe.

Following IPAC (Infection Prevention and Control) involves making decisions about PPE, isolation precautions, hand hygiene, and preventing the spread of infection.

Monitoring for skin breakdown requires ongoing assessment and deciding when to escalate concerns, apply interventions, or involve the wound care team.

Supporting residents with BSO (Behavioural Supports Ontario) means using de‑escalation techniques, understanding triggers, and choosing the safest approach for each situation.

One decision I made at work was prioritizing which patient to see first during a position. One patient was asking for help, while another he’d more urgent clinical needs. I chose to attend the more critical patient first. Looking back, using a clear decision-making process would have helped me feel more confident in that moment. Even though it worked out, having a structured approach can make decisions quicker and more consistent under pressure.

As a community Nurse case manager, I often need to make swift decisions when booking assessments for clients coming onto service. At times we receive calls for clients needing immediate care or coverage. As a manager I need to ‘triage’ the different clients assessment dates and decide who needs to be assessed/ services started first and who I can possibly move a day or more. This involves me looking at each client’s current clinical status, support systems, and overall needs. I then have to look ahead to see what postponing the assessment or care would look like and how it would affect each client individually. During this process, I always ensure all listed information is complete and correct, as intake notes are sometimes completed by other team members who lack the details needed for me to make an informed decision. I believe it’s important to look backwards ( the information given) as well and predict how my decision will impact that clients individual needs. There are times I gather more information regarding the clients and it changes the ‘triage’ order I created-which I think is also an important part of the entire critical thinking, problem-solving, and planning that I complete.

Making decisions on a whim is never ideal. I know I have made quick decisions in the past, once I had a full schedule for blood draws and a client showed up a day early for their appointment. I felt bad for them and quickly decided that I would squeeze them in still. Well this was probably the wrong decision because the client ended up being more complex and a longer appointment and this pushed all my other clients’ appointments back almost an hour.
I know the other client’s were not impressed with my tardiness, and in hindsight I think if I took the time to go through the decision making process then I would have been able to see that the greater good would be to ask that client to come back at their scheduled appointment instead of trying to make it work.
I think the decision making process allows you to see the bigger picture and gather your thoughts/ think clearer. This helps avoid rash, emotional, or impulsive decisions.

An example of decision making that I have came accross recently was during morning care, a resident with dementia refused their scheduled pain medication. I observed signs of discomfort, including facial grimacing and restlessness, and had to decide how to respond. I considered several options: insisting for them to take the medication, skipping it completely, or trying a different approach. I weighed the resident’s right to refuse, their pain level, and facility policies, and decided to respect the refusal for now and
re-approach after breakfast offering the medication again, using a calm and encouraging approach, the resident was receptive to taking the medication after they had breakfast.
I monitored the resident’s comfort, and informed the nurse. This decision balanced resident rights, safety, and comfort.

This is the continuation of my topic from discussion 1. On discussion 1, my topic was about a res. who pocketed her dinner and I made a critical thinking to serve the res. pureed texture for breakfast (I forgot to mention, the lady was on regular texture). My decision-making process was , I want to see how the res. swallow the pureed texture, whether, res. is not able to swallow anything at all or she is just having difficulty swallowing meat, having less confidence to swallow the meat? The res. was offered pureed texture for breakfast. Res. did not have difficulty swallowing the pureed texture, no pocketing noted.

As a BSO nurse I have to assess the resident after receiving a referral. Among the behavioral referrals sometimes I get recommendations to initiate 1:1 support for resident to have a quick fix. To arrange a 1:1 support staff is time consuming. There are also criteria/eligibilities to get the approval for the support.
Recently. one of the residents was having repetitive falls and needed to be on w/c for safety. Resident was non-compliant and restless in the w/c. Staff started pushing me to get the 1:1 support for resident as they can’t monitor resident continuously.
I decided to gather information why resident is restless and what was bothering him to stay in the w/c.
I talked to the resident and found he was provided with a tilt w/c. He was unable to self-propel as staff were keeping his w/c on tilt position. He likes to watch TV, and he was used to change channels as needed. But now, he can’t reach the TV remote, which making him frustrated and restless.
I straightened resident’s w/c and asked resident to self-propel. I showed him to use both of his hand to push the w/c. Resident learned to use the w/c very quickly. Then writer encouraged resident to call staff when he needed the TV remote. I educated the resident about falls safety measures and the importance to maintain the safety measures. Resident was understandable. I started a DOS for resident to track his restlessness and compliancy at the w/c. This way resident was on frequent monitoring and staff were told to encourage resident to self-propel. After 5 days of observation, resident was compliant on his w/c, no falls, no restless was noted and I didn’t need to assign a 1:1 support staff for resident.
In this event, I have identified the decision, gathered information, looked for alternatives, I implemented the plan and evaluated the outcome which helped me to make an effective decision.

In my quality improvement role, I have gained a lot of experience with decision making, especially learning how to make decisions with the management team. I remember the first time I had to collaborate a decision with the management team. I had my ideas ready and organized for discussion, but I was very nervous because it was very new to me and uncomfortable. The reason for this decision making is the HQO data have increased significantly in the last few months, comparing to the provincial and national average, as those numbers were quite concerning. I implemented QI tools, data, charts, graphs, audits to show to my team what is the concern, what I did to find the cause and effect and what solution should be implemented. Surprisingly enough, I thought I didn’t do enough, but my managers were amazed of my findings. Long story short they all 100% agreed with the solution and the idea has significantly brought our HQO data below the provincial and national average. I really liked the idea of implementing a ‘Nominal Decision Making’ idea into the group meetings because I think it is a great idea in phase 2 to show everyone’s decisions and ideas (without the possibility of someone voice may not be heard). I think that would be a very effective way to come up with a decision that everyone can agree with, stay interested in and take action once the decision is made.

Every decision-making we do is coupled with hope that the result will be successful and everything that we thought could be done and could work and is something that we could try again if it ever happens that a similar situation arises.

A time at work I made a decision was during morning glucometer checks, my patient’s sugar was 4.5. Normal, yes but my patient expressed that was on the lower end and his endocrinologist liked him 5-6. Patient was receiving his home unit of long acting insulin at bed time. Upon assessing his chart, it appeared his morning glum had been in the mid 4’s for the last consecutive number of days. I asked the patient if he had been eating less than usual since being here. Patient stated “yes, the food here sucks”. He also went on to explain at home he usually has a peanut butter sandwich before bed however here he was only receiving a piece of cheese. I made a decision in this moment to act on it, I could have just left it like the previous nurses as it was technically within normal limits but I identified the need, the patient was not in his goal target for his blood sugar and he was not eating enough as he did not like the food. My goal was to get the dietitian involved to help with meal selections while in hospital and wrote in this chart / informed dietary to change his HS snack to a peanut butter sandwich. I did explore alternatives here, possibly inquiring with MD to lower HS insulin however, as blood glucose was in normal range and I was on for the whole weekend I decided to start with attempt dietary changes similar to home diet and see if the adjustment improved AM glucose and if it did not, the next morning glucose I would evaluate and bring it to the MD. That night, patient received his peanut butter sandwich and in the morning his glum was 5.9.

I do believe the decision-making process would have helped because sometimes at work I find we get so much information handed to us at one time. Having the decision-making tool helps put organize your thoughts in a step by step order. It also helps you see a bigger picture, instead of just making the decision, it allows you to thoroughly think it through and ensure you are not missing anything. ” Identify alternative or actions” I think this is a key step many probably omit when making decisions but one of the most important steps to me. It forces you to stop and think of how if you do this action this would happen but if you do an alternative action this could happen. It allows you to obtain different perspectives on the same situation. This tool also reminds you to evaluate your decision. I think it’s very easy to make a decision and just forget about it. Okay task completed, check, now moving onto the next but this reminds you to go back and evaluate the outcome of your decision.

We as nurses make decisions at work every day. I believe the decision-making process would be beneficial making any decision, but a time that stands out to me of when it would have been extra useful would be when I was in the middle of providing care to a patient but I could hear that there was a call bell ringing for a period of time. I had to make the decision to either pause my care to answer the call bell to potentially prevent a fall or to continue with my care with a patient I was already helping and ignoring the call bell hoping that another nurse would be available. I think being more familiar with the decision-making process would have helped me to make my decision.

I had a resident who at baseline had an unsteady gait and was a high risk for falls. During a shift he had a fall and after my initial assessment while monitoring his vitals I notice that his blood pressure was decreasing. I informed my charge nurse of my findings and assumption of something more to be happening with the resident, and she insisted that his baseline is hypotensive to keep monitoring. When my next set of vital his BP was still slowing lowering I was more adamant on him being sent out and if she was not going to I was. When he returned he had a diagnosis of pneumonia. He had no other symptoms pointing to pneumonia so if I hadn’t of made that decision he could have quickly declined.

Nurses engage in decision-making on a daily basis in the workplace. Identifying problems and collecting relevant data to resolve them safely are essential components of effective decision-making. Evaluating alternative actions, along with their potential benefits and consequences, is also a critical step in this process.

For example, when a patient is receiving an IV infusion and the pump begins to beep, indicating an occlusion, I assess the situation and implement appropriate interventions. These may include flushing the IV line, checking for kinks in the tubing, and ensuring that the infusion is properly positioned. I then evaluate whether the IV line is functioning effectively after these interventions. This scenario demonstrates the application of the decision-making process in nursing practice.

I believe we inherently do the decision process. It made me think of pain management. I had a resident who was on a tube feed, unable to verbalize their needs and was showing increased signs of pain. She received her routine pain medications but this was not effective in lowering her pain. Family often on the unit but were not there at the time. Discussed with my RN about her pain and that her routine medications were not effective. The RN informed me that family was against any further pain medication. Hearing this I put a plan into place with my Psw’s for non medicinal pain interventions. We repositioned for comfort, checked her bowel records, put a pain assessment in place and did a full head to toe assessment. However these quick interventions were ineffective. I stressed the importance of getting this resident comfortable with my RN and she felt that family would again not agree to it. I informed her that I was a capce certified nurse and that if she was not going to address this that I would discuss it with the family. I called the poa provided the information and advocated for the resident with sincerity and respect. The family was thankful for the call and agreed to have the doctor called and the resident received the next level of pain medications. The new medication was effective in reducing or eliminating her pain after a few doses.

During my shift, I noticed a patient was having difficulty swallowing their medication and seemed frustrated. I recognized the need to address this safely and ensure the patient received their dose. My goal was to help the patient take the medication without risk of choking. I considered alternatives: forcing the medication, crushing it (if safe), or consulting the physician for a different form. I chose to assess the patient, check the medication guidelines, and contact the physician, who approved a liquid form. The patient was able to take the medication safely. Using the decision-making process helped me act thoughtfully and avoid harm.

A frequent decision I have to make in my role as medication nurse is where to begin on the unit with the medications. From the 24 hr report, I can prioritize who has been exhibiting an increase in pain, who has had a recent fall, who has been having increased responsive behaviours to name a few. From there, I can decide who may have a requirement for medications before others and start with those residents first. This example requires information gathering, implementing a plan and evaluated how the needs of the residents were taken care of.

going back to my example from discussion 1, managing responsive behaviours, the decision making process can certainly help increase efficiency to diffuse situations by comparing previous interventions that were helpful or not. you might notice the behaviour sooner or know that one intervention, that may seem helpful, will actually make things worse for a specific resident. armed with this knowledge you can more quickly narrow down which interventions will actually help.

the daily frequent checks I have to make as a nurse is constantly observation my patients and constantly reading their chats and making sure they are up to date. Looking at their behavior and giving a safe environment.

The decision making process is an excellent tool depending on the situation. Sometimes, when time allows, you can weigh the options based on the data available and make the choice you feel is best. In other scenarios, you make the choice that seems correct in the moment and may later review the info and come to the conclusion that your choice resulted in the outcome being better or worse.

It is hard to wade through all the decisions that you make in a day at work. I believe nursing competence involves being able to make these decisions using the decision making process all while being under pressure., knowing your decision will affect a persons life.
I work in a rural area with a mid-size hospital with an 18 bed unit do their emergency department. In one instance during caring for a patient that presented to Emerg with a migraine, they became worse and were nauseous and light sensitive. Being in an observation area with only curtains between patients didn’t provide much reprise for her. I made the decision to do a three way switch between patient rooms so that we could offer her a room with walls and a door, that wasn’t needed for an isolation patient at the time. It caused no harm to the other patients and everyone had appropriate rooms for their current needs. I was able to turn off the lights and lower the volume to give her a more comfortable place to rest.

As a supervisor now to PSWs, I had to handle a last-minute book off that left one of our clients without a visit. I had to act quickly – in which I decided to reassign tasks within the team and arrange for another staff to come in to work ensuring that the client was not left without care. The decision-making process helped because I had to quickly assess priorities, consider staff availability and choose the best options for the client while supporting the team. This allowed me to act promptly and not disrupt the continuity of care

An example of decision making process in my practice was when a current client showed contractures and increased health decline which allowed or funder to increase frequency for support and added respite care for client and caregiver. The current schedule at hand was not satisfying the need for care and support for client, on top of client now receiving respite care so that the caregiver could run some errands. Staff times were overlapping and caregiver was not able to leave client alone. I had the opportunity to speak with the caregiver to find out what the goal was for the times of care and respite. Once i had the information necessary to provide the PSWs in order to support client, i went back to the office to rearrange schedules. Now this scenario made me stop and evaluate all the moving parts in order to satisfy the need for client, staff and funder. I had to bring in my resources from the office such as coordination and HR to ensure staff were being assigned appropriately, hours for staff were maintained so not to go on overtime and complying with the increased time provided by the funder to support client. I was bale to host a meeting with the staff involved in the clients care and i reviewed the changes requested by the caregiver as well as the changes in times for care. Staff were able to provide input as to how the care works during their time with client and the difficulty they were having with the previous time restrictions. After gathering all the information and reconnecting with the office and clients caregiver we were able to make a decision on the changes required and the changes in schedule to continue to support the client while maintaining continuity of care. In turn staff were satisfied with the increased hours of pay, clients caregiver was able to leave client with PSW as the schedule worked for both the office and the clients caregiver and the client received the support and companionship necessary. A decision to make changes was required, but utilizing the decision making process enabled me to look at the bigger picture as not only the client would be affected, but staff and agency as well. The new information learned would’ve helped me to complete the decision process effectively in a timely manner as there are steps i have now learned that would’ve helped me simplify the process. In the end the appropriate the decision for the situation was made.

As an RPN whose main job is documentation, I do take occasional shifts on the floor. Even when I was on the floor routinely, I always did and always will consult with the whole disciplinary team when it comes to the resident. My observations alone are not always enough and the PSWs sometimes have more insight into the resident. Once I am able to get a solid picture, making a decision how to proceed is definitely clearer .

Using these decision-making models helps us step back from the chaos of a long-term care shift and make choices that are actually sustainable for the team. For example, when I’m short-staffed, my “gut” tells me to just run faster and skip my break, but the models force me to be more strategic. I start by looking at the “concentric circles” of my choices: if I pull a PSW from another unit to help a heavier one, I have to weigh how that affects resident care on both sides and whether it puts my remaining staff at risk for burnout. By following this structured process, I’m not just reacting; I’m proactively reassigning tasks and prioritizing care in a way that keeps the residents safe and the unit from falling apart.

I triaged my decisions according to the needs of the patient. I also seek and utilize my colleagues for help in times of needs. For example, I have to discharge a patient at this time, and ED is calling to “come pick-up your patient now”, and I have a family member wanting an update about their family right away.

In this scenario, I will discharge my patient and I will ask for help from another colleague to go pick up my patient in ED, and I will also ask the charge nurse to give an update to the family member about their love ones.