Hi everyone. I'm a new grad who just started my new job 2 months ago at a medsurg unit and my orientation period is about to end next week. I met up with my manager and preceptor this week and I'm a little worried about what they said about me. They said I am not getting the full picture or that I'm not using my critical thinking skills (e.g. not understanding fully about my patients). I am currently working on days and it's always hectic to get things done especially when you gotta admit and discharge patients. I hardly have the time to take a break or read up on the patient's history. I told them that it's going to take me time to develop my critical thinking skills and not everyone learns at the same pace. I also requested to be on nights once my orientation is done so I don't feel swamped. I know what I'm doing on the floor, but what should I do to prove to them that I'm using my thinking skills? Can you even develop critical thinking in a week? Are there any tips or books that I can read to develop that critical thinking? I really want to keep my job and I'm doing all that I can by trying to read up on my nursing stuffs. I really hope there is light at the end of the tunnel. Any advice?

This happened to me at the end of my preceptorship. I was called into HR and told if I didn't shape up in two weeks I'd be fired. Of course that made me more nervous but what happened is that one of the educators (who was very nice) followed me around for a shift. This really helped me, during that shift one of my patients asked who to write a letter to about my excellent care! Anyway, the educator reported that I was a good new grad nurse and off I went.

Is there any way a friendly nurse could follow you and see if you are ready to be on your own? It really saved me.

I really wish it was that easy. My preceptor has been following me til this day and she knows that I can do the skills and patient care. I just need to hone down on my thinking skills, which I lack. I know that critical thinking can't be develop miraculously, it builds with time and that's what I need when I'm on my own. If only there are some ways that I can show them that I can handle it on my own without her guiding me.

As a long-time (non-academic) nurse educator, I just HATE this!!! It's like your manager calling you on the carpet and telling you need to "get on the ball" or else... (actually happened). So, what the heck does that even mean?? It serves no purpose to just provoke free-floating anxiety.

You deserve more concrete information. Your manager and preceptor need to tell you - in concrete terms - exactly what events led them to the conclusion that you do not have critical thinking skills. They need to tell you exactly what 'success' would look like; e.g., what specific types of behavior/actions would indicate that you are meeting expectations as a critical thinker. I would seriously question their ability to evaluate critical thinking if they cannot even provide you with this level of information.

So - here's my explanation of what critical thinking looks like in terms of observable behavior. You are able to:

1. identify that the patient has a problem (ex: no urine in foley bag)

2. determine what is causing the problem (in general terms, not at the molecular level - LOL) - looking for additional information if needed to validate your conclusions (ex: palpate bladder, examine foley drainage system, review I & O, assess for S&S of fluid overload, etc)

3. identify appropriate interventions (ex: unkink foley drainage, irrigate foley, reposition patient, notify physician with assessment findings to obtain diuretic order or increase fluids)

4. Prioritize interventions to maintain patient safety

Does that help at all?