Nurses in advanced roles make decisions and diagnoses on a daily basis as part of their role in general practice. Clinical reasoning and decision making are often neglected areas of training as more theoretical aspects of the process are given priority. The case study presented in this article forms the basis of an examination of how clinical reasoning and decision-making skills can be applied when assessing a patient attending a minor illness clinic with a cough. The decision-making process is broken down to demonstrate the use of evidence, judgement and clinical weighting of data apparent at each stage of the patient assessment.