Background: - Decision making at clinical level is the way in which nurses perceived to arrive at appropriate decisions in practical nursing situations. And these decisions have a direct impact on the health status of the patients, poor clinical reasoning skill leads to increasing numbers of adverse patient outcomes. Nurses are required to make decisions with multiple foci for example, diagnosis, intervention, interaction and evaluation in dynamic contexts, using a diverse knowledge base decisional pattern. However, inability to recognize clinical situation is the major cause of errors in decisions. Objectives: - To assess nurse’s clinical decision making approach in hospital settings, Addis Ababa, Ethiopia, 2017. Methods: - Institution based cross-sectional descriptive study was conducted on 390 nurses. To determine the sample size a single proportional formula was used. Self-administered English version questionnaire (theoretical framework developing instrument by Lauri and Sanna Salanterä, included Hammond’s CCT) was used. The instrument used to investigate nurses’ clinical decision making patterns at clinical practice level. To explain study population in relation to relevant variables, descriptive statistics like: frequencies and percentages were calculated. Multi nominal logistic regression was used to show the association between CDM and associated factors among nurses. Permission was obtained from IRB. Information obtained from participants was kept secured and confidential. Result: Clinical decision making score in this study ranges from 46 to 82 (mean = 65.5, SD = 4.5). Two hundred sixty two (67.2%) of the participant scored in analytical decision making category. One hundred twenty five of respondents (32.1%) scored in the category of quasi decision making which is a combination of both analytic and intuitive decision making process. Out of the total 390 respondents only three (0.8%) of them categorized as using intuitive decision making method when dealing with patient. Organizational type/private sectors (p=0.021), clinical simulation (P=0.031) and ICU department (P=0.025) were factors associated with clinical decision making Conclusion and recommendation: This study found that there was clinical nurses inclination to the use of analytical decision making to the most part, So, health delivery organizations to encourage nurses in particular clinical situation enable them to make decision that is timely and accurate as possible and also the use of quasi rational decision making method in there day today nursing practice with only a very few of them making intuitive decision making method. Organizational type (private sector), clinical simulation and ICU department were factors associated with CDM. Keys Words: - Clinical decision making, Nurses, Intuition, and Analytical, Quasi-rational.