Objective: This paper aims to retrospectively explore client decision making via two case studies prompting us as nurses to reflect on the factors that lead to this. Clients do not always act in ‘their own best interests’ as ‘defined by health professionals’. Our response and understanding of this is key if we are to support and devise strategies encouraging more appropriate decisions and improved outcomes. Setting: Sole nurse practitioner in community health practice in isolated rural Australia. Primary Argument: In the rush of daily chronic care caseload management, factors affecting client decision making are often overlooked. Client decisions around care often result in poor outcomes for isolated rural clients. Improved client outcomes can be gained if nurses, (aware of these decision making factors), are able to assist clients to overcome their decision making barriers. Conclusion: In rural nursing practice client decision making is multifactorial. By reflecting on clients decisions and addressing barriers in this context, short term and long term strategies can be implemented to improve the decision making process resulting in improved outcomes for isolated rural clients