Critical thinking? How do you define it?

icuRNmaggie, BSN, RN · May 21, 2015

Critical thinking - definition: the objective analysis and evaluation of an issue to develop a plan.

I have never liked this catch phrase because I believe it is my job to be a thinker. Here is an example of being a thinker:

Your patient's foot is blue gray cold and pulseless.

The other foot is warm with a dopplerable pulse so you know it is not a ruptured AAA and you know that the mottling is not a sign of acidosis.

From experience you know that this is likely an arterial blockage and that without intervention the patient will lose the foot.

A thinking nurse will be on the phone to someone immediately to obtain orders for an arterial duplex as well as a vascular surgery consult because it is likely to be a surgical emergency.

You will develop your thinking skills with experience and development of your knowledge base. You may have never seen a ruptured AAA have tearing chest pain and lose the pulses in his feet. You may have never seen a person so severely acidotic that the feet are cool and mottled. Other nurses have seen it all and done it dozens of times.

Until you have seen it all, you ask a colleague to take a look at the problem and ask him or her what do you think? This is what a reasonable and prudent nurse would do. As an orientee, it is your job to learn to differentiate what is urgent and what can wait. A good preceptor will challenge you to be a thinking nurse and to develop this skill. If you feel that every nurse is telling you something different, then the onus is on you to read up on that particular problem.

A large part of critical thinking is trusting your intuition. If you can not put your finger on it, just say so, and ask a colleague for help. It is okay to say that something is very wrong and I don't know what this is. Your gut feelings are almost always correct when it comes to assessment skills.

Libby1987 · May 21, 2015

I'm having a hard time with this lately because I've never had to train newer nurses. I was a new nurse at one time of course but until recently everyone I trained had solid nursing experience behind them. Now I/we not only have to teach the particular nuances of home health but how to think critically. I want to say, "we can't spoon feed you every possible scenario so we need you to apply what you've learned and build on it."

Argh, I wish it were that simple.

And what's more difficult is what to do or say to someone who does not naturally develop it with experience. Some seem to stay in singular thinking.

Today's nursing with such high acuities just doesn't allow much for different learners.

Jules A, MSN · May 21, 2015

Very simply imo it is largely Common Sense which is augmented by your education and experience.

tsm007 · May 21, 2015

Now I/we not only have to teach the particular nuances of home health but how to think critically. I want to say, "we can't spoon feed you every possible scenario so we need you to apply what you've learned and build on it."

In my case I feel like the preceptor is attempting to "spoon feed" me things that I wish she would just let me do somethings myself so I can figure it out. I think she thinks I'm incompetent. Things like missing things on an assessment - she tells me before I have a chance to figure it out myself. I don't chart things I don't do. When I go to chart believe me I would catch that I didn't do it. And if I caught that I forgot it and had to go back for it a few times believe me I would remember. I feel for preceptors because I get it. They hired me to do a job and they don't have 6 months for me to figure it out even if in 6 months to a year I would be an awesome nurse at their facility. It's a tricky situation letting someone learn and being safe. So this is not bashing on my preceptor in that regard. She is a fantastic nurse and knows her stuff. However because she has seen bad things happen it is clearly hard for her to let go without being 100% sure I know what I am doing. I get that too. I just feel I will not learn to critically think if someone is doing the thinking for me before I have the chance to think it through myself.

I feel awful that all I do is come on this forum and ask questions, but hell it's the only place I feel safe to ask questions right now. And I am a persistent human being. (Or so I keep telling myself anyway.) There are so many things I don't know. I literally googled nurse coach today to see if I could pay someone to help me with my bazillion questions. I want to do a good job! I would come in on my off time to figure this out. I am not lazy. I am not stupid. I am however clearly sucking at "critical thinking" at the moment.

Jules A, MSN · May 21, 2015

In my case I feel like the preceptor is attempting to "spoon feed" me things that I wish she would just let me do somethings myself so I can figure it out. I think she thinks I'm incompetent. Things like missing things on an assessment - she tells me before I have a chance to figure it out myself. I don't chart things I don't do. When I go to chart believe me I would catch that I didn't do it. And if I caught that I forgot it and had to go back for it a few times believe me I would remember. I feel for preceptors because I get it. They hired me to do a job and they don't have 6 months for me to figure it out even if in 6 months to a year I would be an awesome nurse at their facility. It's a tricky situation letting someone learn and being safe. So this is not bashing on my preceptor in that regard. She is a fantastic nurse and knows her stuff. However because she has seen bad things happen it is clearly hard for her to let go without being 100% sure I know what I am doing. I get that too. I just feel I will not learn to critically think if someone is doing the thinking for me before I have the chance to think it through myself.
I feel awful that all I do is come on this forum and ask questions, but hell it's the only place I feel safe to ask questions right now. And I am a persistent human being. (Or so I keep telling myself anyway.) There are so many things I don't know. I literally googled nurse coach today to see if I could pay someone to help me with my bazillion questions. I want to do a good job! I would come in on my off time to figure this out. I am not lazy. I am not stupid. I am however clearly sucking at "critical thinking" at the moment.

You seem to have a lot of insight and a positive attitude so I would guess your critical thinking skills are intact just not honed for nursing yet as to be expected. Maybe I'm wrong but because she seems to be spoonfeeding you things doesn't necessarily mean she thinks you aren't competent or are going to screw it up. It could just mean that she is pressed for time and there are things she would rather put right up front in an effort to head off issues she has seen with other orientees. Ask her for feedback. Consider carrying a small notebook to jot things down. When I first started working as a NP I did this because there were times when I was overwhelmed and knew I had seen a particular scenario before but couldn't for the life of me remember the answer. And definitely post here because there is a lot of experienced nurses here who have been there, done that and can help you with questions!! Hang in there.

LadyFree28, BSN, LPN, RN · May 21, 2015

Very simply imo it is largely Common Sense which is augmented by your education and experience.

Ah, but "common sense" ain't "common". :cool:

Critical Thinking, In my interpretation is a series of aspects that help one understand the WHY and HOW of the information presented to them in order to make a series of decisions based on subjective and objective assessments at hand.

I think critical thinking requires some common sense as well; however, I have found that there are a percentage of people that struggle with common sense.

LadyFree28, BSN, LPN, RN · May 21, 2015

In my case I feel like the preceptor is attempting to "spoon feed" me things that I wish she would just let me do somethings myself so I can figure it out. I think she thinks I'm incompetent. Things like missing things on an assessment - she tells me before I have a chance to figure it out myself. I don't chart things I don't do. When I go to chart believe me I would catch that I didn't do it. And if I caught that I forgot it and had to go back for it a few times believe me I would remember.

Ok.

Deep breath.

What steps have you taken to self correct assessments and documentation?

If you miss something once, if your preceptor does it, then the next time you assess, then you know that is what you should be doing; assessment is the key to building a base as to what your interventions and plan is supposed to be; instead of thinking you are incompetent; start reflecting on the WHY, and communicating to your preceptor the WHY of that part of the assessment that is crucial, or helpful to your patients.

I feel for preceptors because I get it. They hired me to do a job and they don't have 6 months for me to figure it out even if in 6 months to a year I would be an awesome nurse at their facility. It's a tricky situation letting someone learn and being safe. So this is not bashing on my preceptor in that regard. She is a fantastic nurse and knows her stuff. However because she has seen bad things happen it is clearly hard for her to let go without being 100% sure I know what I am doing. I get that too. I just feel I will not learn to critically think if someone is doing the thinking for me before I have the chance to think it through myself.

The key to learning, especially as a new nurse is sometimes observation; become active in stating that you want to help and ask questions; also if you assist and you learn better working "hands on" verbalize this as well in order to help yourself understand the WHY. Make sure when there is time to ask questions and provide your own feedback to your own job performance.

I feel awful that all I do is come on this forum and ask questions, but hell it's the only place I feel safe to ask questions right now. And I am a persistent human being. (Or so I keep telling myself anyway.) There are so many things I don't know. I literally googled nurse coach today to see if I could pay someone to help me with my bazillion questions. I want to do a good job! I would come in on my off time to figure this out. I am not lazy. I am not stupid. I am however clearly sucking at "critical thinking" at the moment.

As much as I love this website, understand this; your goal is to become as safe, competent beginner nurse; you SHOULD be asking a "bazillion questions", which can be answered when you are having conversations about your patients for the day; I also agree with writing down answers and little tidbits fore fit rue reference to help. I will also state to self-study; reflect what you seen in a patient and look it up; understand the nursing process in what you can do in the future when you encounter another pt with the same diagnoses or a similar assessment.

It gets easier-you are new, if you have good communication skills, confident in your learning style, willing to understand your preceptors learning style, and willing to soak up the information, as well as know where you can find your resources, which include P&P and educational resources, you will get it. :yes:

Libby1987 · May 21, 2015

In my case I feel like the preceptor is attempting to "spoon feed" me things that I wish she would just let me do somethings myself so I can figure it out. I think she thinks I'm incompetent. Things like missing things on an assessment - she tells me before I have a chance to figure it out myself. I don't chart things I don't do. When I go to chart believe me I would catch that I didn't do it. And if I caught that I forgot it and had to go back for it a few times believe me I would remember. I feel for preceptors because I get it. They hired me to do a job and they don't have 6 months for me to figure it out even if in 6 months to a year I would be an awesome nurse at their facility. It's a tricky situation letting someone learn and being safe. So this is not bashing on my preceptor in that regard. She is a fantastic nurse and knows her stuff. However because she has seen bad things happen it is clearly hard for her to let go without being 100% sure I know what I am doing. I get that too. I just feel I will not learn to critically think if someone is doing the thinking for me before I have the chance to think it through myself.
I feel awful that all I do is come on this forum and ask questions, but hell it's the only place I feel safe to ask questions right now. And I am a persistent human being. (Or so I keep telling myself anyway.) There are so many things I don't know. I literally googled nurse coach today to see if I could pay someone to help me with my bazillion questions. I want to do a good job! I would come in on my off time to figure this out. I am not lazy. I am not stupid. I am however clearly sucking at "critical thinking" at the moment.

It might just be me but the combination of the increasing acuity and lack of acute care opportunities for new grads has pushed orientation beyond my capabilities. I can't turn out a nurse in even double the customary time. We have become a training ground, something we haven't needed to do before and it exceeds what a nurse who is already managing patients can pull off in the same circumstances. My admin is responding by developing a skills lab and reassigning a well inclined manager to head up the training, it won't speed up the critical thinking but at least shaves a layer off of the learning process in the field.

Ironically there were more residency programs when the acuity was much lower and there was (at least in my perception) more time to allow a new nurse to work through processes.

ETA I would encourage you to keep asking questions. I think digging in and doing everything you can to succeed to is to be commended, not feel awful about.

tsm007 · May 21, 2015

My admin is responding by developing a skills lab and reassigning a well inclined manager to head up the training, it won't speed up the critical thinking but at least shaves a layer off of the learning process in the field.

That's a good idea. You know I'm going to start writing some of these ideas down and will give my feedback on orientation at my next eval. I think just having a day on the floor with a simulation that includes finding supplies, working the IV pumps, using the pyxis, and other real world skills would help cut down wasted time for nurses on training. Heck even a scavenger hunt would be phenomenal (and you wouldn't even have to pay anyone to do that just give me a list). Half of my darn slow downs are stupid things like not being able to find a darn bandaid!

I am going to keep asking questions and I am already keeping a notepad. Thanks for all your suggestions.