How nurses contribute to medical treatment decision-making with physicians: a scoping review
TL;DR
A model is developed that illustrates how the interplay between personal, organisational and cultural factors determines whether nurses’ clinically relevant observations are acknowledged and integrated into medical treatment decisions.
Abstract
Objectives To map existing literature on nurses’ contributions to medical decision-making in hospital care, the factors influencing their involvement and how both nurses and physicians perceive this contribution. Design A scoping review was conducted following Arksey & O'Malley’s framework and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-Systematic Review and Meta-Analyses extension for Scoping Reviews (ScR) checklist Data sources A broad literature search was conducted in PubMed, CINAHL and the Cochrane Library. The initial search was performed in October–November 2023 and updated in December 2025, with no time or language restrictions. Eligibility criteria Empirical studies were screened by two independent researchers and included if they reported on nurses’ involvement in or attempts to contribute to decision-making regarding medical treatments for adult patients in the hospital. Data extraction and synthesis Data were charted using a predefined extraction form. Extracted data were coded, grouped and examined inductively to identify recurring patterns, which were discussed and refined by the two reviewers. Results A total of 111 studies were included, encompassing a wide range of study designs and clinical settings. Studies have reported that nurses often contribute to decision-making in subtle ways during ward rounds, multidisciplinary meetings and informal interactions, drawing on their observations and advocating for patients’ interests. Nurses reported moderate involvement, while physicians acknowledged nurses’ expertise but did not consistently recognise their input. We developed a model that illustrates how the interplay between personal, organisational and cultural factors determines whether nurses’ clinically relevant observations are acknowledged and integrated into medical treatment decisions. Conclusion Nurses contribute to medical treatment decision-making in various but often subtle, ways. Unfortunately, their contributions are not consistently recognised within decision-making processes.