ABSTRACT Many researchers who have explored nurse decision making have concluded that decision making is a learned skill that must be taught by nurse educators. Yet little research has been conducted to explore nursing students’ decision making. If nurse educators are to teach this skill, it is necessary to have a better understanding of the kinds of decisions students are making in the clinical setting and the factors that influence this process. Once we have a greater knowledge in this area, curricular materials can be developed to ensure this skill is taught throughout an undergraduate education, resulting in graduates who pos- sess strong, independent, and interdependent decision making skills. This article will describe one component (the kinds of decisions) of a larger qualitative case study that explored the kinds of decisions and the factors that influenced nursing students’ decision making throughout a baccalaureate degree program. C linical decision making is a skill learned most often in the clinical setting. It is frequently an implicit element in the core nursing curricula, and it is as- sumed this requisite skill develops over time, without di- rect teaching on the topic. Given that this is a cornerstone skill for nurses, it appears that more intentional research related to the topic of the development of nurse decision making is warranted. It is imperative that we, as educa- tors, begin to understand the kinds of decisions baccalau- reate nursing (BSN) students are making and the factors that influence their decision making. After this is known, we can begin to develop explicit curricula to facilitate the improvement of decision making skills, thereby enhancing students’ cognitive abilities and ability to provide quality patient care. BACKGROUND In keeping with a qualitative case study tradition, the literature review conducted prior to the study aimed to identify gaps in the literature related to the phenome- non of nursing student decision making. The literature was later used to interpret the findings. Theoretically, decision making begins with the educational process (Brigham, 1993; Brooks & Shepherd, 1990). Hughes and Young (1992) noted that the foundation for effective deci- sion making “begins during the undergraduate curricu- lum when students are taught to develop nursing diagno- ses and select appropriate interventions” (p. 12). There is also evidence that the decision making habits developed and reinforced during clinical experiences carry over into professional practice (Jenkins, 1985). Typically, clinical decision making has been taught using the nursing pro- cess, a requisite in nursing programs, but is less effective in teaching students how to make decisions, to determine what resources to use, and to explore how to execute the plan within this framework (Brooks & Thomas, 1997). Studies by Baxter (2000) and Baxter and Rideout (2006) focused on the decision making activities of second-year BSN students enrolled in their first surgical clinical placement. Decision Making by Baccalaureate Nursing Students in the Clinical Setting Pamela E. Baxter, PhD, RN; and Sheryl Boblin, PhD, RN Received: January 5, 2006 Accepted: December 7, 2006 Dr. Baxter is Assistant Professor, and Dr. Boblin is Associate Pro- fessor, School of Nursing, McMaster University, Hamilton, Ontario, Canada. The authors acknowledge Dr. Elizabeth Rideout and Dr. Cottie Ofosu for their valuable contributions to this research project. They also thank the Canadian Nurses Foundation/CHSRF. Address correspondence to Pamela E. Baxter, PhD, RN, Assis- tant Professor, School of Nursing, McMaster University, 1200 Main Street W., HSB-3N28C, Hamilton, Ontario, Canada L8N 3Z5; e-mail: baxterp@mcmaster.ca. August 2008, Vol. 47, No. 8 345 JNE0808BAXTER.indd 345 JNE0808BAXTER.indd 345 9/3/2008 2:14:31 PM 9/3/2008 2:14:31 PM