ABSTRACT
Decisions are made in a specific setting that shapes how the patient is known and defines boundaries of acceptable outcomes. Healthcare delivery involves multiple participants and incorporates individual and team peer review of the developing narrative. The trajectory towards expert decision-making practice requires the nurse to know the patient, which involves learning how to create and develop a narrative. This stage characterises the location of the inexperienced decision maker and requires some propositional learning and some learning that can only be gained through experience of local practice. The nurse had at least three different roles– as nurse carer, care manager and medical assistant. It might be that in other clinical disciplines or other countries, nurses have different or additional roles. The inexperienced decision maker has to learn how the system of healthcare is structured at general and local levels. General knowledge includes awareness of the policy framework that shapes the requirements of healthcare delivery.
