I've been a nurse for about 9 months now and I had a situation a few weeks back that made me question how well my critical thinking skills are developing. My patient had a nephrostomy tube 2ish days postop that had been draining urine beautifully all night, when at 0630 (of course it would happen right before shift change!) they rolled over and felt a sharp pain at the insertion site. I went in to assess the patient and his neph tube was now draining frank red blood. Otherwise asymptomatic. My charge nurse was off the floor at the moment, but thankfully the day nurse (who I'd gotten report from the night before and was getting the patient back) was already there and clocked in.
I knew that I needed to call the doctor and report what had happened, but it seemed like my mind went blank of everything else. Really basic stuff that I would have forgotten if the day nurse had not done it while I was paging the physician, like getting a set of vitals so I could tell the physician that the patient's BP was stable and the fact that the patient was on a heparin drip so I could get orders to stop it (important stuff!).
I'm so very grateful to the day nurse who helped me, and as soon as he mentioned something (like that he was going to get vitals for me) I immediately agreed that he was right and remembered those interventions would be important. But I'm concerned about what would have happened if he had not been there and I forgot to tell the physician the patient was on a heparin drip. I got so focused on the immediate issue I completely blanked about all the related issues.
I suppose what I'm ultimately asking is how long did it take for you to develop your critical thinking skills? I understand that I'm still a fairly new nurse, but should I be farther developed in my critical thinking skills at this point? And if so, what can I do to further develop them? Thinking back to my first few months on the floor, I know that I have improved a lot in this area, but I'm just concerned that one of these days it won't be enough.
Sorry, I did not realize I had a few more responses to the post. After having some time to think and reflect, I do think there were a number of factors at play in that situation. Yes, critical thinking development was probably the main one, but like Nurse Beth said, I probably panicked a bit, and like RubyVee mentioned, it was the end of the shift and I was fatigued. Overall, I've decided to stop feeling frustrated about what I did wrong and choose to learn from the situation so I can do more right next time. They'll always be something I can improve on, but I did learn a lot from the situation, and the patient was not harmed by my actions, which is sometimes all I can hope for.
chipper_RN
13 Posts
Sorry, I did not realize I had a few more responses to the post. After having some time to think and reflect, I do think there were a number of factors at play in that situation. Yes, critical thinking development was probably the main one, but like Nurse Beth said, I probably panicked a bit, and like RubyVee mentioned, it was the end of the shift and I was fatigued. Overall, I've decided to stop feeling frustrated about what I did wrong and choose to learn from the situation so I can do more right next time. They'll always be something I can improve on, but I did learn a lot from the situation, and the patient was not harmed by my actions, which is sometimes all I can hope for.
Thank you all again for your responses and ideas!