Critical thinking on tests vs clinical setting

[sm2013_SN]

I just completed my first year as a nursing student, and right now I am working as a med tech at an assisted living community, where I am able to pass meds and chart on my residents, as well as send them to the hospital if needed. I have always been really book smart, and do extremely well on all my nursing exams. I am able to critical think very effectively for an exam. However, I feel like it is difficult for me to translate this type of critical thinking into my real life practice. Things that I know I could have thought of do not go through my mind during a real assessment. For example, the other day when a patient has blood in his urine, I didn't think to check the catheter insertion site to realize that my patient's catheter had been pulled out a little. It took the tech after me to realize that. I feel like that is something that should have crossed my mind.. any advice on how to become a better critical thinker in a clinical setting, where ultimately it is going to matter the most when I am done with nursing school? I keep doubting myself and wondering if I am meant to be a nurse. I also keep comparing myself to other students who are able to critically think better than I am..

[Ruby Vee, BSN]

recognizing that you missed something is the beginning of critical thinking. You'll get there :)

This is why I do not understand nurse who, after 6 months to a year, think they "got it" I have been a nurse for 5+ years and still learn every day-mostly about the things I don't know I don't know.

I've been a nurse for 40 years, and I still learn something new every day. True competence (and critical thinking) occurs at that moment when you realize that you don't know what you don't know.

[drkshadez]

Critical Thinking comes into play mostly with patients who have comorbidities or complex situations.

A patient comes in complaining that his throat feels tight and is on losartan for hypertension. You need to know the side effects and what to assess for and if it is really a side effect or something else. Is it angioedema or could it be something else? The critical thinking part is this: as a nurse, you have to look at even the most subtle changes that can emerge into big problems. Part of RNs responsibility is patient safety which includes paying attention to even the most slightest changes. We do not want patients coding on our floors if we can prevent it.

Whenever I have nursing students, I don't treat them as "free help." I love having students because one of my strongest abilities as a nurse is education. I had a patient described as above with a first year nursing student. I went through the whole RAAS system (how kidneys control BP), what causes BP to become too high, and the medications to prevent it with side effects. Then, we went to the bedside and showed them how the pathology and pharm connect to the bedside. That is just one example.

[sm2013_SN]

I'm definitely gonna use a mental checklist like this one! It really helps me break it down. Thank you so much!

[JKL33]

I will now try to look at situations like this not as a "I should have known that. I must be terrible" but rather "this is a good learning experience and I have gained knowledge that will help me with future clinical decisions."

That's exactly right!! You can do it!