Aims This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. Background IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. Evaluation The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. Key issues Organizational policies and CDSS design affect implementation and user adoption. Conclusions Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. Implications for nursing management Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.