Nurse by numbers: The impact of early warning systems on nurses' higher‐order thinking, a quantitative study

Abstract

AbstractAimTo evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher‐order thinking skills.DesignA concurrent mixed methods study design.MethodUsing an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher‐order thinking. Likert‐type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers.ResultsMost of the 305 (91%) participants included in the analysis had more than 5 years of nursing experience. Most nurses supported the early warning tool and were happy to comply with escalation protocols if the early warning score concurred with their assessment of the patient (63.6%). When the score and the nurse's higher‐order thinking did not align, some had the confidence to override the escalation protocol (40.0%), while others omitted (69.4%) or inaccurately documented vital signs (63.3%) to achieve the desired score. Very few nurses (3.6%) believe using early warning tools did not impede the development of higher‐order thinking.ConclusionAlthough experienced nurses appreciate the support of early warning tools, most value patient safety above the tools and rely on their higher‐order thinking. The sustained development and use of nurses' higher‐order thinking should be encouraged, possibly by adding a critical thinking criterion to existing algorithmic tools.ImpactThe study has implications for all nurses who utilize algorithmic tools, such as early warning systems, in their practice. Relying heavily on algorithmic tools risks impeding the development of higher‐order thinking. Most experienced nurses prioritize their higher‐order thinking in decision‐making but believe early warning tools can impede higher‐order thinking.Patient or Public ContributionRegistered nurses participated as survey respondents.