Table 1.

Nursing practice levels and clinical decision support systems (CDSS) implementation implications

Practice level	Practice description	CDSS implementation implication
Novice/advanced beginner	Focus on the immediate needs for action for a clinical situation based on rules, protocols and practice	Nurse  Receptive audience
		CDSS  Assist with task organization  Provides guidance for action for unfamiliar situations  May be limited in distinguishing subtle difference in clinical situations
Competent	Crisis in confidence in their environment and focus on goal setting and time management	Nurse  Increased skepticism of system comprehensiveness
		CDSS  Provides structure for goal setting, care plans or care trajectories  Assists with standardizing practice  May limit professional growth beyond standard practice
Proficient	Understands situational and establishes situation-specific priorities	Nurse  May not be receptive to prescriptive systems that do not recognize situation specific challenges  Could provide valuable clinical knowledge and experience to design and implementation teams
		CDSS  May not further enhance clinical practice
Expert	Immediately grasps familiar situations and recognizes when he or she does not have a good grasp of a situation	Nurse  Difficulty in articulating expert practice knowledge but could provide practice narratives to assist with system development  May not be an appropriate audience for CDSS
		CDSS  May not further enhance clinical practice