How do I develop Critical Thinking/Backbone?

  1. I am on my fifth week of orientation on a critical care unit. My preceptor (I was not assigned a primary) had told me yesterday at the end of the shift that I have a good head on my shoulders and I am continuing to develop that. I am quiet, timid and need to be assertive. She said I need to develop more critical thinking, to problem solve on my own without her help, develop instincts and take initiative. She also mentioned that since I have had past experience as a patient care tech, that I may still have the mind set that it is the nurse's job to do the work. This may be true. I am in a grey area as far as learning what to do. I try to figure things out, my preceptor is no where to be found, then I am asking another preceptor who is busy preceptoring to help me. I really want to do my best and shine with this profession.

    Any advice/suggestions are very much appreciated.

    I was looking into the Navy Reserves in order to develop a social backbone. Maybe working one weekend a month and two weeks a year with the navy as a nurse would bring up my confidence and also help to pay off my school loans. I bought a book on assertiveness, and after reading some, I realized that reading vs. practicing the act are two different worlds!
    Last edit by amy0123 on Sep 30, '06
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  2. 9 Comments

  3. by   AB_NormalRN
    Amy? We are in the same boat with less that one year experience...once you learn the ropes, the Docs, protocols, policies, skills, etc. I'm sure you will feel a whole lot more confident. The more confident you become the more backbone you will get and the greater your critical thinking skills become. In short order you will prolly be almost intune and it will come as second nature.

    AB
  4. by   Daytonite
    I think you are taking your preceptors comments too emotionally. I understand that it's difficult not to. The only wisdom I can offer you is that as you develop better mastery over the various nursing skills, your level of confidence increases and that has a direct effect on your attitude. It takes time to master skills. And, that includes practicing assertiveness techniques!

    This idea your preceptor brought up of you still having the mind set that it is the nurse's job to do the work comes from a very human response that we all fall prey to when we are new at something. That is that when we are unsure of the things we are supposed to be doing we regress to doing the things we already know how to do. One of the biggest problems I saw occurring with new grads was they would run to do nursing aide work with the patients while their RN work got behind. Then, they would end up being upset and crying at the end of their shift because they had been awfully busy all day helping their patients, yet had just been railed on by some crabby old nurse for having failed to do something that was a very RN thing. This, again, comes partly from a true ignorance of what the RN job entails, lacking the ability to prioritize tasks, and slipping back to performing tasks already mastered in order to remain busy and still feel worthy. When I was a kid and forced to take piano lessons it was always easier to try to get away with playing a piano piece I had already mastered during practice than the piece I was really supposed to be working on--it was too hard! Eventually, after playing it over and over and over, I got better at playing it. The same thing applies to all the things you are now being asked to perform as an RN. It will take time and doing them over and over and over before you eventually master them. Just try not to cheat like I did and get away with doing things that you already mastered and somebody else is now responsible for doing (the CNAs).

    It takes months to become acclimated to the role of being an RN. Five weeks is only a drop in the bucket. I know you want to be a fully functioning nurse, but you can't push time. And, right now what you need is time. As for your preceptor, to my way of thinking all she's done is give you an opinion. It doesn't necessarily mean it's a good one or that you have to agree with it.
  5. by   Tweety
    Good luck. I'm sure you're preceptor was only giving you feedback on what to work on. There's no magic to becoming a critical thinker other than time and experience. I'm sure she didn't mean you couldn't come to her with questions.
  6. by   JudithL_in_NH
    Amy--

    One quick suggestion. When I was being precepted, at about the same point where you are, my preceptor told me to stop coming to her describing a situation and asking her what to do--instead, she wanted me to come to her, describe the situation, then tell her what I thought needed to be done!

    This can be very difficult when you're presented with a scenario you've never seen before (your first head trauma or first status asthmaticus or whatever)and have no experience base to draw on, but you can access what you do know about pathophys and basic nursing and make a stab at what the appropriate intervention should be.

    You "make points" for demonstrating initiative and basic problem solving, start gaining confidence in your nursing judgment, and the preceptor will certainly lyk if she doesn't think your proposed intervention is the most effective one, then you can problem solve together.

    I've been at it now for a year and a half--and it is still often difficult, there's so much I still haven't seen or done--but your confidence will increase. I don't lack assertiveness, but I am a "quiet" person--I believe there's room for all sorts of nurses in critical care--most units need a few calmer heads to balance out the Type-As. :-)

    Best of luck
  7. by   Ruby Vee
    [font="comic sans ms"]there's no magic to developing assertiveness, but it does require confidence. in order to have confidence, it's a good idea (not essential, as i've had the unhappy experience of learning, but a good idea!) to have knowlege and skills. at five weeks, you're only beginning your career. you will develop confidence as you develop knowlege and skills -- sometimes it seems like it takes forever, though!

    the advice judith gave was great, too. when you go to your preceptor, always have a solution in mind. it may not be the correct solution, but that's how you learn. ask why her solution is better than yours if you don't understand. and her solution may not be as good! i was precepting a nursing student a few months ago, when we were taking care of a developmentally delayed young adult. ryan showed me a whole new way to get him to take his meds! i've been a nurse for 28 years, and he hadn't even finished school yet, but i learned from him!
  8. by   jjjoy
    Oh, this is a topic I have very mixed emotions on.

    I get that new nurses need to learn to be proactive and think for themselves. What I don't get is the seeming 'damned if you do, damned if you don't' approach that many new nurses face. As the new nurse on orientation, if you're quiet, you're told to ask more questions. If you ask a bunch of questions, you're generally critiqued to think for yourself. If you venture an educated guess and are wrong, you're often given a look like "oh my god! how did you graduate?" and told "Oh no! That's not right!" If you venture an educated guess and are right the attitude received is of "well, of course!" with a tone that says "everyone knows that" and dismissed immediately.

    It's the ultimate crash course in not letting anyone else's attitude, assumptions, opinion, bad mood or bad habits affect your own sense of self and confidence. At a time when you really don't have all the skills or knowledge you need. You have to keep asking questions and persisting over your own learning issues in the face of harried and active discouragement to "bother" others with something that the them seems "obvious" or "a waste of time" or whatever.

    You have to "prioritize" things and "organize" and hone those "critical thinking skills" and "nursing judgement", which of course, take months, even years, of experience to develop! Its common to hear that it takes at least a year to feel comfortable. So what's the point of telling new nurses things like 'prioritize' and 'use your nursing judgement.' That's a like a running coach telling his athletes to "run faster" and "move your legs." Not very helpful.

    Anyway, this kind of unsupportive attitude makes me so upset and I know I need to let it go because people can just be insensitive and I can't expect people to cater to my educational needs/learning style. But it just seems such a counterproductive way to bring up new nurses at a time when it would seem we'd want to help new nurses learn how to work better and faster and not just cull out the ones who are a bit slower on the uptake.
  9. by   amy0123
    Update:
    I have taken everyone's advice into consideration! After about one week, my preceptor said she noticed an improvement. A few days later there was an evaluation and they've decided that I am not improving fast enough. I felt dissappointed/frustrated at myself. So transfering to another unit would be the best option. They explained that I would be able to develop critical thinking, problem solving and confidence in a less stresdsful environment.
    I have two weeks. So last week I interviewed at one small 15 bed med/surg unit. My possible future nurse manager said "I had spoken with your NM about you, tell me what do you think she had to say about you? Anything else that you are leaving out? What would you bring to my unit? My staff?" etc.
    Oh?! I felt wide open and vulnerable, I wasn't sure what to say at first. Did my old NM ruin me or was she trying to help me by filling her in on my evaluation??? So I won't exactly start new with a clean slate, if this is the unit I choose. But I spoke as honestly about myself in the most positive light that I could.
    Any suggestions for a less stressful unit (if there is) for developing critical thinking, basic nursing skills and confidence? they have suggested CCU, med/surg, and a step down unit.
  10. by   PANurseRN1
    Quote from jjjoy
    Oh, this is a topic I have very mixed emotions on.

    I get that new nurses need to learn to be proactive and think for themselves. What I don't get is the seeming 'damned if you do, damned if you don't' approach that many new nurses face. As the new nurse on orientation, if you're quiet, you're told to ask more questions. If you ask a bunch of questions, you're generally critiqued to think for yourself. If you venture an educated guess and are wrong, you're often given a look like "oh my god! how did you graduate?" and told "Oh no! That's not right!" If you venture an educated guess and are right the attitude received is of "well, of course!" with a tone that says "everyone knows that" and dismissed immediately.

    It's the ultimate crash course in not letting anyone else's attitude, assumptions, opinion, bad mood or bad habits affect your own sense of self and confidence. At a time when you really don't have all the skills or knowledge you need. You have to keep asking questions and persisting over your own learning issues in the face of harried and active discouragement to "bother" others with something that the them seems "obvious" or "a waste of time" or whatever.

    You have to "prioritize" things and "organize" and hone those "critical thinking skills" and "nursing judgement", which of course, take months, even years, of experience to develop! Its common to hear that it takes at least a year to feel comfortable. So what's the point of telling new nurses things like 'prioritize' and 'use your nursing judgement.' That's a like a running coach telling his athletes to "run faster" and "move your legs." Not very helpful.

    Anyway, this kind of unsupportive attitude makes me so upset and I know I need to let it go because people can just be insensitive and I can't expect people to cater to my educational needs/learning style. But it just seems such a counterproductive way to bring up new nurses at a time when it would seem we'd want to help new nurses learn how to work better and faster and not just cull out the ones who are a bit slower on the uptake.
    It's the same way for the preceptor. Just read the posts from new nurses here about preceptors: not enough feedback; too much feedback; not enough support; too much support; she watches everything I do; she doesn't watch me enough; doesn't review my work; double checks everything I do...

    It's pretty exasperating on our end to try to figure out what you guys want. It's never right; no matter what a preceptor does, someone is always going to kvetch.
  11. by   tiggertoo
    Good luck I went through a similar thing. I think the points people made in this thread are valid. Critical thinking is developed by time in grade, there is no magic. I think that if they say you are not progressing as fast as they like, number one, they need to take some responsiblity, number two they need to explain to you exactly what the issue is and how you can correct it. It may be better for you to just resign, it would look and sound better on your resume than being fired, and it would show initiative in that you took there lack of support and help for what it was and left.

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