Comments for the authors
This is an interesting paper covering a survey study of EWS use and higher order thinking, it is well written, structured and has good flow. A proofread would be useful- eg for tense (eg page 5 says ‘we aim’ rather than aimed)
There are some interesting findings but also some issues which require addressing.
Multiple terms are used synonymously throughout (clinical judgment, critical thinking, decision making, advanced clinical reasoning skills etc) therefore the intro/background would benefit from a section clearly setting out the underpinning conceptualisation of ‘higher order thinking skills’ and giving a clear working definition for the reader.
To mitigate against a sense of over simplistic causality, greater recognition/acknowledgement of the complexity of ‘higher order thinking’ development and the multiplicity of factors that might influence it would also be beneficial.
There are 2 other main and interrelated issues:
There are repeated claims in the paper that this study provides ‘objective’ data. This is a survey, and therefore by its very nature relies on self-reports, and like all surveys and many data collection methods, is influenced by context, social desirability/acceptability, honesty, memory, etc. It explicitly sets out to collect perceptions and opinions which are by their very nature subjective, and the accounts/reports of EWS use are also subject to a range of influences/biases. The authors should reconsider such statements given the type of research and data collected. - Simply because data are quantitative, and/or perceptions have been quantified, does not render them objective.
This also relates to another issue of what is possible from this type of design: The discussion (Pg 14) states ‘Our study aimed to ascertain whether the mandated use of EWS vital signs tools impacts the development of higher-order thinking in nurses’ one could argue that this is overstated and goes beyond what is possible with this type of research based on self reports/perceptions. It would be more realistic to propose that it aimed to ‘assess/synthesis/investigate perceptions’ regarding the impact of EWS – not imply ‘actual’ impact (highly difficult if not impossible to ascertain).

Re population, recruitment and sample : Commendable that attention was paid to submissions potentially from bots as this is often overlooked. However it is not clear if the status of registered nurses was verified in some way other than the self identification.
Validity of the tool stated but not reported in this paper and a report is referenced which does not seem easily accessible and therefore it is difficult for the reader to assess validation of the survey instrument.
Findings seem well set out and supported by relevant tables, descriptive stats etc . there are some really interesting and insightful findings regarding reports of how EWS are used/manipulated.

Discussion: Statements need to be substantiated- eg ‘With the aging population, there is an increasing number of hospital patients with chronic conditions whose baseline vital signs are outside of the EWS tool's normal range’.- needs reference to substantiate.
Pg 14 discussion states ‘Our study aimed to ascertain whether the mandated use of EWS vital signs tools impacts the development of higher-order thinking in nurses’ one could argue that this is overstated, and the statement goes beyond what is possible with this type of research given it depends on self reports/perceptions. It would be more realistic to propose that it aimed to assess perceptions regarding the impact of EWS – not the ‘actual’ impact (highly difficult to ascertain).
There are some slightly overdrawn and generalised conclusions: ‘Our study has shown that experienced nurses prioritise patient safety over compliance with EWS guidelines and protocols’. This implies ‘all’ experienced nurses. Statements such as this need to be couched in terms which better indicate/acknowledge the limitations of the study – and therefore condition the conclusions which can be drawn.