Effect of level of patient acuity on clinical decision making of critical care nurses with varying levels of knowledge and experience.

This study is an examination of the effect of patient acuity on the clinical decision making of critical care nurses (N = 68) completing two computerized clinical simulations. Ventricular tachycardia represented the high-acuity situation and atrial flutter the lower-acuity situation. Clinical decision making was measured by proficiency score, patient outcome (cure or die), and amount of data collected. Analyses of variance were conducted to examine proficiency score and the amount of data collected. Fisher's exact test and the McNemar test of homogeneity of proportions were used to examine patient outcome. In the atrial flutter simulation, proficiency scores were higher (p = 0.000), more dysrhythmias were cured (p less than 0.005), and more data were collected (p = 0.040). Experienced and inexperienced nurses did not differ on proficiency score; however, inexperienced nurses collected more data (p = 0.048) and cured fewer atrial flutter simulations (p = 0.040). Nurses certified in advanced cardiac life support had higher proficiency scores (p = 0.033) and collected fewer data (p = 0.048).