Lack of Critical Thinking Skills is a term thrown at new nurses everyday, but often not defined. I agree with you in that part of your Critical Thinking Skills comes from time,.from trial and error and you just can't speed that up. I have seen many a new grad become frustrated with this term, feeling that they need specific details on what to change or improve on. The problem with that is that this term really means that you need to take all the details that you've learned over the years, lump them together and see the whole picture.
We actually have a critical thinking skills lab in our preceptor-ship. We do exercises, often not even nursing related, to encourage you to think, ask the right questions and respond with the correct interventions.
One of my favorites is the "Help me with my car" scenario. If I called you on the phone and said "Oh my gosh Lunar, I can't get my car started. Can you help me please?" What would you do? Many of the class gives the response "I know nothing about cars, you should call someone who does!" Not bad advice,..but do you really no "nothing" about cars? Don't we all drive a car everyday. Didn't we all have to pass a test to get a license?
Lets see if we can get this car started. We start out by coming up with all the "obvious" reasons a car might not start....out of gas, dead battery, some of the more experienced people mention things like alternators and fuel pumps. We start with what we think is an easy fix and ask, "do you have gas in the car?",.."yes, I put $47 worth of gas in it yesterday and it drove fine then",...ok,.."well is it possible that someone stole you gas?",....."well,..my gas tank has a lid with a lock and it doesn't appear to have been tampered with",...ok then,...well probably not out of gas,.."Is the battery dead",...."how can I tell if the battery is dead?",...hhhmmm,.."how old is the battery?",....."I put a new battery in 6 months ago",...ok,..well it shouldn't be that,..."Is the battery attached to the car?",..."I pop the hood and yes it appears to be connected properly",......this goes on for over an hour with the class coming up with all different scenarios of why this car isn't starting.
Then finally people start asking more detailed questions,..."What happens when you try to start the car? Does it make a strange noise? Does it try to start at all?",.....as we continue to ask questions,..we realize that the key doesn't even turn in the ignition and that lo and behold,..I've grabbed my husbands set of keys!
Now this process usually takes two hours of class time. What turns out to be a silly mistake,.easily fixed,.took 15 college graduates 2hrs to figure out! The point here is the process. Asking the right questions. Observing. Using our deductive reasoning and finding a solution.
This thinking process is exactly what you as a nurse uses everyday to care for pts. Is every chest pain an MI? Of course not,...but you know how to figure it out,....you know what to do,.....start that line, draw those labs, get the EKG,..put the pt on O2 and a monitor,....from there you can start asking all the right questions,.....where is your pain,..what were you doing when the pain started,..how long have you had this pain,....etc
I try to tell all my new grads to think ahead. Learn to anticipate what you need to do to help get the answers. A great way to do this is to listen when the doc examines the pt. Listen to what questions he/she asks,..what type of physical information does he obtain,.what labs seem most important? Look at those lab results. Learn why the first three pts are sent home with pepcid and the next one is rushed to the cath lab.
Hang in there. Tell your boss that you are going to be more aware of not only what the doc orders for your pt,..but what info he expects from you and what info will be most useful in any given situation, and that you are going to try to be better at anticipating what needs to be done to speed up this whole process.
Becoming a great nurse takes experience. Make the most of your time so that you get the best experience that you can.
Best of luck to you!
(wow,..sorry this was sooooo looong..