OBJECTIVE Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS A three-group pretest-posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision-making process. RESULTS Nurse practitioners had modest insight into their clinical decision-making process. CONCLUSIONS Self-insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. CONCLUSIONS Self-insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.