Nurses make hundreds of decisions during every shift.

Some are obvious and high stakes, recognizing a change in a patient’s condition, prioritizing care, or responding to an emergency. Others happen almost automatically: Which patient do I see first? Can this medication wait five minutes? Do I call the provider now or reassess first? Is this patient safe to ambulate?

Each decision requires mental energy.

Over the course of a busy shift, that mental workload can build to what researchers call decision fatigue, a decline in the quality or efficiency of decision-making after making many decisions over an extended period. Recent nursing research suggests decision fatigue may affect both patient care and nurses’ own well-being (1).

What Is Decision Fatigue?

Decision fatigue doesn’t mean you’re incapable of making good decisions. Instead, it describes the gradual depletion of the mental resources needed to weigh options, solve problems, and make thoughtful choices. As cognitive demands accumulate, the brain naturally looks for ways to conserve energy.

Researchers have found that decision fatigue may lead people to:

• Delay making decisions.
• Choose the safest or most familiar option.
• Feel less confident in their choices.
• Experience slower thinking and increased mental exhaustion (2).

For nurses, whose work requires continuous assessment, prioritization, and clinical judgment, that mental load can be substantial.

Why Nurses Are Especially Vulnerable

Unlike many professions, nursing rarely offers long stretches of uninterrupted work. A typical shift may include:

• Constant interruptions.
• Rapid task switching.
• Multiple competing priorities.
• High-stakes clinical decisions.
• Documentation.
• Communication with patients, families, providers, and colleagues.

Add staffing shortages, unexpected emergencies, or skipped breaks, and it’s easy to see how mental resources become depleted. A 2025 concept analysis identified heavy workloads, inadequate staffing, stress, insufficient sleep, and lack of organizational support as key contributors to decision fatigue in nursing (3).

What Does the Research Say?

While researchers are still learning about decision fatigue in healthcare, evidence continues to grow. A recent systematic review examining healthcare professionals found evidence that decision fatigue can influence diagnostic, prescribing, testing, and treatment decisions over the course of a work period, although the authors note more research is needed to fully understand the mechanisms involved. Other nursing research has found that better sleep quality, stronger resilience, and greater organizational support are associated with lower levels of decision fatigue among nurses (4). Earlier research involving nurses working a medical telephone triage service found that as more time passed since a rest break, nurses became increasingly likely to make conservative referral decisions, a pattern consistent with decision fatigue.

Reducing Decision Fatigue

There is no quick fix, but both individuals and organizations can help reduce cognitive overload. Strategies supported by emerging evidence include:

• Taking scheduled rest breaks whenever possible.
• Prioritizing adequate sleep between shifts.
• Reducing unnecessary interruptions.
• Using standardized protocols and checklists when appropriate.
• Creating supportive work environments where nurses have adequate staffing and resources.

Give Yourself Some Grace

If you’ve ever driven home after a shift feeling mentally drained, not because of one difficult patient, but because of hundreds of decisions and you’re not alone. Decision fatigue isn’t a sign of weakness or poor judgment. It’s a normal response to sustained cognitive demand.

Recognizing it is the first step toward creating healthier workplaces that support both nurses and the patients who depend on them.

Sources

1. Goudarzian AH, et al. Decision Fatigue in Nursing: An Evolutionary Concept Analysis. Health Science Reports.2025.
2. Maier M, et al. Systematic Review of the Effects of Decision Fatigue in Healthcare Professionals on Medical Decision-Making. Health Psychology Review. 2025.
3. Wang X, et al. Decision Fatigue among Nurses in a Third-Level Grade A Hospital in China: A Cross-Sectional Study on Prevalence and Predictors. International Nursing Review. 2025.
4. Linder JA, et al. Clinical Decisions and Time Since Rest Break: An Analysis of Decision Fatigue in Nurses.Health Psychology. 2019.