Make the Right Decision: Managing Decision Fatigue as a Nurse Practitioner

Last Updated/Verified: Dec 7, 2020

Healthcare providers face a wide variety of job stressors including demanding hours, personal risks, and emotional strains—and nurse practitioners are no exception. All of these factors can lead to burnout, a multifactorial state of physical or mental exhaustion due to job-related stress. One of the most threatening contributors to burnout in nurse practitioners and other healthcare providers is decision fatigue. While most individuals will manage some level of decision fatigue in their daily lives, the process of evaluating, diagnosing, and treating medical issues adds another layer of significant stress for nurse practitioners. In addition to causing burnout, persistent decision fatigue is exhausting and poses serious risks to both NPs and the patients they serve.

Decision Points

Heavy patient loads, short appointment times, and long work hours can all contribute directly to decision fatigue for nurse practitioners. There are many decisions involved in each step of managing health conditions, including evaluating, diagnosing, interpreting test results, implementing treatments, and ensuring follow-up. Evidence-based guidelines are frequently evolving to match emerging scientific advances across the medical field. Incorporating these changes involves another layer of decision-making in the healthcare setting. Nurse practitioners are required to make decisions during individual patient encounters, as well as when reviewing test results days later. In clinical practice, providers often make decisions regarding multiple patients simultaneously.

Provider Risks

Decision fatigue grows significantly over the course of a long or demanding shift, and may lead to a variety of effects on healthcare providers including:

  • General fatigue
  • Anxiety
  • Lack of attention
  • Difficulty concentrating

These factors affect providers' physical and emotional ability to care for patients and can impact their overall performance. This ultimately affects the ability to offer consistent quality care. As decision fatigue sets in, providers may inadvertently:

  • Overlook important new or presenting symptoms
  • Overprescribe antibiotics
  • Take longer to make treatment decisions
  • Overprescribe high-risk medications including pain medications
  • Experience difficulty in resisting inappropriate treatments
  • Order unnecessary laboratory, imaging, or diagnostic tests
  • Suffer legal consequences related to poor decision-making in diagnosis and treatment

Patient Risks

Each patient deserves the full attention of their healthcare provider. However, the serious consequences of decision fatigue imposed on healthcare providers can extend directly to the patients they treat. These effects include:

  • Delayed treatment
  • Treatment with inappropriate medications
  • Unnecessary diagnostic tests
  • Misdiagnosis

Decision Fatigue Prevention

While decision fatigue cannot be eliminated entirely due to the ever-changing healthcare environment and ongoing demands around patient care, there are several important ways that employers and individual providers can prevent and reduce healthcare decision fatigue. This includes:

Many excellent resources are available and easily accessible to providers to quickly reference during a patient evaluation. Algorithms, decision trees, and clinical pathways are available for a variety of common and complex illnesses and medical conditions. These tools offer a predictable clinical course based on sequenced interventions that guide clinicians in treating specific medical issues. Nurse practitioners can seek out these tools to guide their decision-making process. Commercially available clinical resource tools, such as Up-To-Date, offer current clinical pathways. Some electronic medical records have built-in decision trees for providers. These tools ensure appropriate care for presenting symptoms, and allow providers to easily and efficiently tailor care based on the specifics of patient symptoms. All of the tools utilize up-to-date, evidence-based guidelines aimed at providing consistent care for all patients. Effective clinical resources are imperative in fighting potential decision fatigue, as they help organize and minimize choices during times of critical decision-making and offer a clear path for treatment and improved patient health.

A key step in preventing and managing decision fatigue is recognizing the signs. Providers can monitor for signals of exhaustion, irritability, and rushing through work in themselves and their colleagues. Providers can also implement specific habits into their own practice to avoid entering a state of decision fatigue. Some simple but effective strategies to reduce day-to-day decision fatigue include:

  • Scheduled breaks throughout the day
  • Deep breathing
  • Healthy snacking
  • Brief periods of physical movement
  • Re-checking E-scripts prior to sending
  • Consultation support with other providers
  • Consistent use of decision trees

To stay vigilant in patient care, addressing decision fatigue is more important than ever. Understanding what decision fatigue is, how it presents itself, and effective ways to prevent it will significantly impact the health and job performance of nurse practitioners and ultimately lead to better patient outcomes. By embracing healthy habits and clear clinical pathways, nurse practitioners can effectively minimize overload during critical decision points. By effectively managing decision fatigue in the healthcare space, providers will feel more supported throughout their demanding work days and can fully focus on providing the best possible care for patients. 

Kelly Coloff, FNP