Using the Nursing Process to Guide Decision Making

By Tom Ludwig, RN, MBA, FACMPE

What is the nursing process?

According to, the nursing process is a modified version of the scientific method. It is used to assess patients’ needs and create a course of action to address and solve their medical problems.  The nursing process I learned in in the mid-1980’s was developed in 1926 by Ida Jean Orlando.  It consisted of four steps: assess, plan, implement and evaluate.  The process was expanded in recent years to include “diagnose” as the second step.  (“Diagnose” had previously been part of the “assess” step.)  This framework is used by nurses to balance the use of scientific evidence and personal interpretation.

How do the steps work?

Here’s how the five steps of the nursing process are defined:

  • Assess: Use data, observation and interviewing to determine the patient’s needs.
  • Diagnose: Identify an actual or potential problem you can control or change.
  • Plan: Establish clear, measurable goals and determine the steps that are needed to reach them.
  • Implement: Put the plan into play.
  • Evaluate: How successful were you in meeting the goals?  Do you need to change anything?

How can this apply to medical practice management?

The nursing process is a great decision-making model for everyday use.  I know of many clinic administrators and managers who feel that all they do is put out fires on a daily basis.  When you are in this type of mode, it is very easy to make knee-jerk decisions in order to keep from having to put one more problem on your to-do list.  The nursing process will make you stop and think about what you are doing and then provide you with a framework for going about addressing the issue.  In fact, teaching your staff to use the nursing process could actually decrease the number of problems they bring to you.

Importance of first and last steps

I can’t stress enough how important the first and last steps are.  When people are in that “firefighting” mode, they have a tendency to stick to the middle three steps – diagnose, plan and implement.  While it might seem like it’s a quicker way to deal with things, in reality it can result in a lot of wasted time.

If you take time to assess the problem first, you will get a much better idea of the nature and extent of the problem.  Evaluating the nature of the problem will help you identify the actual cause(s), which will then have you addressing things that will help you reach the desired outcome.  Evaluating the extent of the problem will help you identify the severity of the issue and whether it happens often enough to address – or if it is really a problem in the first place.

Evaluating the effectiveness of your plan allows you to make necessary changes because of unforeseen or unintended outcomes. A process that is broken, or one that is no longer relevant because of changing conditions, can result not only in wasted time but also in a lot of frustration for providers and staff – which usually means more work for you.

Obviously, the nursing process might not be appropriate for emergency situations where time is of the essence.  When it is used, however, it can help organize your thoughts during an otherwise hectic day and improve your problem-solving capabilities.


Tom Ludwig, RN, MBA, FACMPE is the President and CEO of Forward Healthcare Solutions LLC.    Efficiency in Practice is the free eNewsletter for medical practice managers who want to save time, money and reduce risk.  For more information and to access your FREE report, Patient Collections: It’s Make or Break for Many Practices, visit 

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