Critical thinking

First off, it seems you are talking about critical thinking rather than critical care. If I read you right, you're in LTC. Critical care is quite different. I'm sure that if you ask your post to be moved out of critical care nursing and into either LTC or first year after licensure, you'll get more useful responses.

Second -- critical thinking is a bit like what we used to call "common sense" before common sense became uncommon. I see many new grads who have excelled in book learning and test taking who "just don't get it." I was probably one of them.

I've never worked in LTC, so bear with me. Critical thinking is easier to explain in the absence. I worked with a new grad once who was quite proud of the fact that she had her "time management skills" down in her first two weeks. She gave all of her medications right on time, including that 18:00 dose of Coumadin (an anticoagulant) which she have right on time. What she had failed to note was that the patient's INR was 9 (WELL above the therapeutic range), his urine was cherry red, his hemoglobin and hematocrit were dropping steadily and his chest tube drainage had skyrocketed. Perhaps giving an anticoagulant in that situation was not the best thing for that patient.

Perhaps this scenerio is a little more on point: A patient's daughter calls you, concerned that the resident (who has documented Alzheimer's) is far more confused than she was yesterday, and she is now agitated and combative, which is new for her. You've noticed that she's been incontinent of urine quite frequently when she's always been able to toilet herself until this afternoon. She has a low grade temperature and cries when she urinates. Do you dismiss this as just an expected deterioration of mental status from Alzheimer's? Or do investigate further and find that she has a UTI?

Sorry -- I have to end this prematurely, but it's probably already quite long enough.

Ruby Vee hit the nail on the head. Critical thinking....is asking why and what else? In LTC, you do more focused assessments and a lot of times you can miss the big picture. It is also about priorities. There are a million things to do, but if you have someone that needs meds, ivs, labs....those simple dressing changes are going to have to wait.