Journal of Advanced Nursing, 1997, 25, 229–237 Nurses’ reflections on problems associated with decision-making in critical care settings Tracey Bucknall BN Graduate Diploma in Advanced Nursing RN Intensive Care Certificate Doctoral Candidate, School of Behavioural Health Sciences, La Trobe University, Bundoora and Shane Thomas BA(Hons) DipPubPol PhD MAPsS AFBPsS Director, Thomas and Associates, 34 Beaver Street, Essendon, Australia Accepted for publication 8 February 1996 BUCKNALL T. & THOMAS S. (1997) Journal of Advanced Nursing 25, 229–237 Nurses’ reflections on problems associated with decision-making in critical care settings The present study investigated nurses’ perceptions of the problems associated with their decision-making in critical care settings. This paper reports a survey of 230 Australian practising critical care nurses. In responses to a set of structured questions concerning various difficulties in making decisions, it was found that between 22 and 56% of nurses reported to be experiencing difficulties on a weekly or more frequent basis ‘due to knowledge base’, ‘lack of time to make decisions’, ‘lack of time to implement decisions’, and ‘personal values conflicts with other staff ’. Nearly one-third (30·3%) of the respondents indicated that they disagreed with other staff who were responsible for making decisions in their units on at least a weekly basis. The nurses were also invited to comment in writing on their concerns in a variety of areas. Major sources of nurse dissatisfaction included: treatment decisions for patients with poor prognoses; disharmony with medical staff concerning decision autonomy issues, especially with junior doctors; time constraints on nursing care; the demands of new intensive care technology upon the nurses’ knowledge bases; and the need for in-service education to address this problem. The paper concludes with arguments for the use of in-depth interviews to further study these issues. setting. In most western countries, medicine holds the leg- AUTONOMY OF CLINICAL NURSES ally sanctioned monopoly over central tasks like diagnosis and therapeutic measures. Therefore, it is not surprising In recent years there has been an increasing interest in issues associated with the autonomy of nurses in clinical that many nurses are uncomfortable with this apparently large power disparity (McCoppin & Gardner 1994). practice. In many countries, there is a long standing and ongoing tension between nurses and medical practitioners, Some nurse theoreticians and professional bodies have advocated the abandonment of medical diagnostic termi- with nurses wishing to increase their autonomy ( Jenkins 1989). Although there have been changes in the levels of nology in favour of a nursing diagnostic taxonomy (Carroll- Johnson & Paquette 1994). The development of nursing nurses’ inputs into decision-making, the changes have often been slow and variable from clinical setting to diagnosis has been advocated by authors such as Carpenito (1995) in order to differentiate the nurse’s role from the domain of the physician. It is assumed that this will reduce Correspondence: Tracey Bucknall, School of Behavioural Health Sciences, La Trobe University, Bundoora, 3083 Victoria, Australia. role overlap and conflict, and secure increased nurse 229 © 1997 Blackwell Science Ltd