Acute care nurse practitioners (ACNPs) provide care in a variety of settings and for a wide range of patient acuities. Flexible use of both analytic and nonanalytic thinking is necessary for safer and efficient diagnostic reasoning (DR). The purpose of this article is to review the diagnostic thought process required of ACNPs, provide a case-based example of DR in a complex secondary headache scenario, and identify key tools to help ACNP learners develop strong DR skills. Multiple strategies for developing or advancing DR competencies can be used by ACNP learners at all levels using learner-driven approaches. Statistically significant improvement in DR performance can be achieved with intentional, learner-driven activities and metacognitive exercises. ACNP learners have the opportunity to master DR using various system 1, system 2, and metacognitive processes to ensure safe and effective DR, even in the most complex of cases.
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