Exploring Existing Decision‐Making Practices for Nurses Working in General Adult Medical‐Surgical Inpatient Units: A Descriptive Qualitative Study

AIM: To explore existing nursing decision-making practices in everyday general adult medical-surgical inpatient units. DESIGN: A descriptive qualitative study. METHODS: Data were collected through focus group discussions with 12 nurses and interviews with two nurse managers. The participants were purposively selected. The focus group discussions and interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Five themes were identified: patient safety; routine nursing care; professional relationships; balancing care needs and organisational conditions; and the implicit dimension of nursing decision-making. Patient safety was the primary driver of decision-making. Urgent situations involved rapid, experience-based responses; repeated decisions could become routinised and less explicit; and uncertainty or complexity prompted explicit reasoning, information seeking and consultation. Professional relationships and organisational conditions also shaped decisions. CONCLUSION: Nursing decision-making is a situated and adaptive process that extends beyond visible clinical decisions. Some decisions may become implicit or less visible. Future research should further examine implicit and routinised decision-making and how reasoning processes vary across clinical and organisational contexts. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Education should support nurses in recognising and reflecting on different approaches to decision-making. Organisations should support competence-based autonomy and enhance the visibility of nursing decisions. IMPACT: Nurses' decisions are primarily guided by patient safety and shaped by situational, relational and organisational factors, providing relevant insights for nurses, educators and managers into the nature and processes of nursing decision-making. REPORTING METHOD: The study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.