Late in 2024, an Appointment and Advice Care Center Registered Nurse (RN) Manager encountered an RN who was struggling with critical thinking and independent clinical judgement despite all the support provided through approved Appointment and Advice Care Center strategies. This led us to an enlightening article, “What-Why-How? Improving Clinical Judgement” from the American Nurse Journal, which introduced us to an evidence-based 5-step model.

Early in 2025, we decided to put this model to the test and created a Performance Improvement project for one RN. Within just three months, the results were remarkable. The RN showed significant improvement in non-emergent Care Center MD consults, with Advice outcomes increasing by 13%. The RN also gained confidence in assessing patients independently. Encouraged by these results, we expanded the trial to include 15 additional RNs on the manager’s team. Over the next three months, we observed a reduction in non-emergent Care Center MD consults by 1%-74% and, notably, zero clinical errors among the RNs. Each RN expressed that the critical thinking tool was highly beneficial and boosted their confidence in patient assessments.

Following the trial, we presented our project to the Vallejo Appointment and Advice Care Center RN Managers, who implemented the strategies from the Model. We then shared the Model in a Regional Manager meeting, emphasizing that it requires multiple sessions with each RN to reinforce the steps. We demonstrated a session during the meeting and then proceeded to create small groups of RNs for role-playing and practice using Appointment and Advice Care Center approved scenarios. The feedback was overwhelmingly positive, with many RNs appreciating the opportunity for team engagement and building their critical thinking skills.

In May 2025, our project received further validation when it was approved for a podium presentation at the Research and Innovation (RIA) conference in Pleasanton, where it was well received. The Appointment and Advice Care Center Training team has since taken the Model to the next level, incorporating it into RN Educator 1×1 sessions, Appointment and Advice Care Center RN WebNews Training Tips, and various training modules and job aids.