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Posted: August 20th, 2023

As nurses you have all learned the importance of clinical decision making, critical thinking and clinical judgement to making effective and safe patient care decisions in practice. As you move into your role of advanced practice nurse whether that is leadership and management or NP, how does this change? Does it? This week read through some of the articles provided about how nurses and advanced practice nurse make decisions in practice.

Is there a difference between the skills required by the bedside nurse and those needed by APN? Support the discussion with rationale and readings.
As you transition to your role as an APN what clinical decision-making skills do you feel are needed for nurses planning to be NP? Nurse leaders? Support this with course readings and other academic literature. Are these different, if so why or why not?
What standardized decision-making tool has been created to guide nurses at all levels to make practice decisions? Why was this created, what is the purpose of the tool? How would this be used in your role as an APN; be specific and describe how to apply this tool. Are there other standardized clinical decision-making tools to guide NP/APN to make decisions in practice? Should these be employed and/or are they employed in all care setting for NP? Provide a rationale.
Explain your rationale. Describe the role of the Consensus Model for APRN.

As nurses transition to advanced practice roles, such as nurse practitioners (NP) or nurse leaders, there are indeed differences in the skills required for clinical decision-making compared to bedside nursing. While the fundamental principles of clinical decision-making, critical thinking, and clinical judgment remain crucial, advanced practice nurses must expand and deepen their skills to meet the demands of their new roles.

Differences in Skills Required:
a) Nurse Practitioners: As NPs take on the responsibility of diagnosing, treating, and managing patients, their clinical decision-making skills must incorporate advanced assessment and diagnostic reasoning. NPs need to develop proficiency in differential diagnosis, formulating and implementing evidence-based treatment plans, and monitoring patient outcomes. Advanced pharmacological knowledge and the ability to make informed prescribing decisions are also essential skills for NPs. Additionally, NPs often engage in more independent decision-making compared to bedside nurses, requiring a high level of autonomy and accountability.
b) Nurse Leaders: Leadership and management roles also require distinct clinical decision-making skills. Nurse leaders must navigate complex organizational systems, allocate resources effectively, and make decisions that impact the overall functioning and outcomes of the healthcare team. Decision-making in this context involves considering factors such as strategic planning, financial implications, quality improvement, and risk management. Nurse leaders must balance the needs of patients, staff, and the organization while aligning decisions with evidence-based practice and regulatory standards.

To support the discussion, I recommend exploring articles like:

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). Saunders.
Standardized Decision-Making Tools:
One standardized decision-making tool commonly used in nursing practice is the “Clinical Decision-Making Algorithm.” These algorithms provide a step-by-step approach to guide clinicians in making evidence-based decisions based on patient-specific characteristics, symptoms, and available treatment options. They are designed to enhance consistency and quality of care across various healthcare settings.
As an advanced practice nurse, the Clinical Decision-Making Algorithm can be applied by following these steps:

Gather relevant patient information and assess the situation.
Identify the presenting problem or diagnosis.
Review the algorithm to determine the appropriate pathway for decision-making.
Follow the algorithm’s decision points, considering patient-specific factors.
Implement the recommended interventions or treatment options.
Monitor and evaluate patient outcomes.
Adjust the plan of care as necessary.
While the Clinical Decision-Making Algorithm is a widely used tool, other standardized tools, such as practice guidelines, clinical protocols, and evidence-based practice models, can guide NPs and APNs in decision-making. Their application may vary across care settings, depending on the availability of resources, practice guidelines, and institutional policies.

Consensus Model for APRN:
The Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation is a collaborative effort by several nursing organizations to establish uniformity and consistency in APRN regulation across the United States. Its purpose is to guide state boards of nursing in adopting regulations that govern APRN education, certification, and licensure.
The Consensus Model outlines four APRN roles: Certified Nurse Practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), and Clinical Nurse Specialist (CNS). It establishes criteria for APRN education, certification, and scope of practice, aiming to ensure that APRNs have the necessary competencies to provide safe and effective care within their respective roles.

The Consensus Model helps to standardize the requirements and scope of practice for APRNs, promoting consistency in decision-making, patient care, and professional mobility across states. It ensures that APRNs are adequately prepared to assume advanced practice roles and contribute to high-quality healthcare

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