The effects of time pressure and experience on nurses' risk assessment decisions: a signal detection analysis.
BACKGROUND
Time pressure and, occasionally, suboptimal assessment decisions are features of nursing in acute care.


OBJECTIVE
To explore the effect of generic and specialist clinical experience on the ability to detect the need to take action in acute care and the impact of time pressure on nurses' decision-making performance.


METHODS
Experienced acute care registered nurses (n = 241) were presented with 50 vignettes of real clinical risk assessments. Each vignette contained seven information cues. In response to these vignettes, nurses had to decide whether to intervene or not. The 26 vignettes were time limited and mixed randomly into the 50 cases. Signal detection analysis was used to establish nurses' performance, personal decision thresholds ([beta]), and their abilities (d') to distinguish a signal of clinical risk from the clinical noise of noncontributory information.


RESULTS
Nurses had significantly lower d' and were significantly less likely to indicate intervening under time pressure. For ability-but not threshold-there was a significant interaction of time pressure and years of experience in acute care. With no time pressure, d' increased in line with years of experience. Under time pressure, there was no effect.


CONCLUSIONS
Time pressure reduced nurses' ability to detect the need and the tendency to report intervening. Thus, there were more failures to report appropriate intervention under time pressure, and the positive effects of clinical experience were negated under time pressure. More and larger scale research on the effect on clinical outcomes of time pressured nursing choices is required.
Thompson
Carl
C
Department of Health Sciences, University of York, UK. cat4@york.ac.uk
Dalgleish
Len
L
Bucknall
Tracey
T
Estabrooks
Carole
C
Hutchinson
Alison M
AM
Fraser
Kim
K
de Vos
Rien
R
Binnekade
Jan
J
Barrett
Gez
G
Saunders
Jane
J
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D002983:Clinical Competence / Q000592:standards; D003422:Critical Care / Q000458:organization & administration; D003657:Decision Making; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007600:Judgment; D008875:Middle Aged; D016294:Models, Nursing; D008960:Models, Psychological; D020380:Needs Assessment; D009426:Netherlands; D009730:Nursing Assessment / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D018570:Risk Assessment / Q000458:organization & administration*; D017603:Signal Detection, Psychological; D013997:Time Factors; D017748:Time Management / Q000458:organization & administration*; D035501:Uncertainty; D006113:United Kingdom