How DNPs Develop Situational Awareness in Healthcare

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A nurse leader sitting at a desk in a medical office and smiling.

Situational awareness (SA), or the ability to anticipate and act on needs based on the surrounding events, began as a foundational theory for sound decision-making in military planning, law enforcement, and aviation. However, it has since been adopted in the nursing field to promote effective leadership and improved patient outcomes.

Healthcare leaders are responsible for properly employing situational awareness as it relates to decision-making and teamwork in a clinical setting. SA is at its best when manifested in a culture that prioritizes communication and creates the best outcomes for patients.

For nurse leaders, situational awareness in healthcare means understanding how to be prepared in any situation and removing obstacles for better delivery of care. Nurse leaders are responsible for creating a culture of open communication and respect, which can help nurses to develop situational awareness. For registered nurses (RNs) pursuing higher levels of education, such as through an online DNP program, learning how to operate as an effective nurse manager is one way to improve SA in healthcare.

Levels of Situational Awareness

Situational awareness has its roots in industries that require split-second decisions in life-and-death situations — such as military exercises, law enforcement operations, and aviation emergencies. In healthcare, situational awareness links the understanding of a patient’s current and future needs to clinical decision-making.

In 1995, Mica Endsley, Ph.D., a former U.S. Air Force chief scientist, and situational awareness theorist, defined three levels of situational awareness that are commonly referenced today.

Level 1: Perception

Clinicians gather patient information through performing physical exams, reading medical charts, reviewing data, and speaking with other team members. Paying attention to anomalies or changes in a patient’s health during this data-gathering stage is a key part of effective situational awareness in healthcare.

Level 2: Comprehension

Clinicians analyze and examine the information gathered and use the results to form an actionable decision regarding a patient’s treatment plan.

Level 3: Projection

With information and decisions from the first and second levels of situational awareness, clinicians can predict events that may occur, which supports short-term planning.

These three levels are key for nurses who want to be proactive when dealing with patients.

How to Develop Situational Awareness

In the journal Nursing Management, nurse practitioner (NP) Kirsten Drake states that being an effective nurse manager using SA begins with self-awareness.

“Evaluating your strengths, challenges (weaknesses) and natural leadership tendencies will help you understand how you tend to respond to situations. Leaders with high emotional intelligence who can recognize their own and others’ emotions exhibit stronger situational awareness,” Drake said.

Drake also said a critical component of SA is observation. Nurse leaders must watch routine and uncommon events alike to learn how the staff reacts. Being present in the moment allows nurse leaders to understand and assess the situation. These are fundamental stepping-stones in learning how to develop situational awareness.

When reviewing the circumstances of a situation, nurse leaders should consider an after-action review, which should focus on the actual outcome instead of the intended results.

“This practice is frequently a team activity that can provide you with insightful information about how your team works and help you learn from being transparent about your actions, as well as those of your team members,” Drake said.

Drake also noted nurse leaders must remember that all actions and decisions have consequences and that a failure to act is an action as well. She said the best leaders involve staff members in decision-making for a better level of overall accountability.

Benefits of Situational Awareness for Nurse Leaders

According to Amplion, situational awareness in healthcare provides key advantages in many areas.

Better Patient Outcomes

If utilizing SA properly, nurses will pick up on any changes in patients’ health, allowing for quick adjustments to treatments and better overall patient outcomes. Frank Grant, president, and CEO of Amplion, said SA helps clinicians become proactive rather than reactive.

Improved Patient Satisfaction

If patients find themselves cared for and their health concerns properly addressed, they are likely to feel more satisfied with their treatment and the nurses who provided it.

Fewer Patient Safety Errors

As nurses’ SA develops, they are able to better perceive and predict errors that could affect patient safety, such as noticing an unusual spike in a patient’s blood pressure that might indicate a problem with their medication.

Increased Nurse Retention

Nurses who are successful when treating patients will be encouraged to stay and continue working in their clinical setting.“Clinicians are constantly faced with situations that require on-the-spot thinking and response,” Grant said. “Achieving situational awareness . . . takes practice.”

An Education That Understands the Importance of Situational Awareness in Healthcare

Proficiency in situational awareness in healthcare may be challenging to attain, and generally must be cultivated over time. However, Duquesne University understands its importance and offers an online DNP program that can prepare RNs to become leaders who use SA to improve patient outcomes. The terminal nursing education has two tracks to choose from Clinical Leadership, and Executive Nurse Leadership and Health Care Management.

The DNP curriculum can help you take your nursing skills to the next level as you advance in your nursing career. Classes in the DNP program include Ethical Leadership in Complex Organizations, Organizational Leadership in Nursing and Healthcare, and Evidence-Based Nursing Practice and Policy Development. Explore the curriculum, and begin your career in nursing leadership today.

Recommended Readings

Nursing Career Paths and Advancement Guide Nurse Practitioner vs. Physician: Examining the Key Differences

DNP vs. NP: Comparing Career Paths in Nursing


4 Benefits of Leveraging Real-Time Situational Awareness in Healthcare

Health Catalyst, “Improving Patient Safety: Lessons From a Military Operations Framework”

Health Environments Research & Design Journal, “Nurse Cognition, Space, and Situation Awareness”

JAMIA, “Different Roles with Different Goals: Designing to Support Shared Situational Awareness Between Patients and Clinicians in the Hospital”

Nursing Management, “How to Hone Situational Awareness

Textbook of Patient Safety and Clinical Risk Management, “Non-technical Skills in Healthcare”