How to develop ICU critical thinking skills and move away from being "task" focused

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by midnitej midnitej (New) New

Go for it! That is a LOT of prep time! I've been a nurse for a year now, working on a medical floor with a high acuity. I just got hired for an ICU position and I'm only getting 8 weeks with a preceptor. That's it...and classroom time. Leap and the net will appear!

@midnitej

Hang in there! It is a lot starting out in the ICU as there are so many things to wrap your head around. I agree with the suggestions to read through the doctor's notes and h&p in free time pre/post work. It was so helpful to me when I first started out to do that so that I really got an idea of what the big issues were for the patient.

I agree that Critical Thinking skills take time to develop. It is a hard skill to build, especially when there are so many tasks around to distract your time. I would suggest bringing up things you don't fully understand to other nurses. Nobody knows everything! I ask questions of my brethren all the time. You can learn so much from it! Also when you have the time, get in on bad situations so that you get a picture in your head of it and can hear everyone trying to reason it out.

Something that helped me time-wise when I started and was running around trying to get everything done like a chicken with my head cut off(inevitably getting behind), was my preceptor telling me to check both patients quickly to make sure there was no emergency, set your alarms in those rooms and trust them to alert you if something is wrong, and then give yourself an hour in each room to get the big stuff done. That helped so much because it stopped my mind from wandering all over the place thinking of things I needed to get done. I was able to focus on one patient at a time.

Now for a book suggestion!

http://www.amazon.com/Notes-ICU-Nursing-Second-Edition/dp/0741417057/ref=sr_1_1?ie=UTF8&qid=1409579856&sr=8-1&keywords=MICU

This book called Notes on ICU Nursing is written in a very conversational tone and was huge for me when I first started out. They explain so many things in a very understandable way which was a good way for me to get a base to work from. They tell you some stories from their experience as well which really help drive the message home. This was invaluable to me.

Keep pressing! Every day you get more comfortable in the ICU.

@Henrica80

You can definitely be fine in the CCU! The program you are going into sounds great. I would recommend using that classroom time well to get a good understanding of the processes you will be seeing. If you are able I would start studying big processes in your free time in those weeks too, again that book above was great for me. Remember, they hired you and they wouldn't have if they didn't think you could do it! I say take the opportunity!

hey midnitej. I am in a similar situation. I am in my first month of preceptorship with 2 more to go. ( I have 1.5 years on a med/ tele floor and feel like a new nurse) I am doing my reading and following my preceptor. Saturday I start my second month and second preceptor (3 months, 3 preceptors) and I still feel lost. I have been reading and reviewing all of these new ICU related drugs and revisiting disease processes and reading on topics that I am unclear on. It is immensely overwhelming and you can at times feel like an outsider on the unit. Have faith and keep pushing. That is what I am doing. Curious to know how you are doing now as it has been a few months since this thread.....

Henrica80 if you are interested in CCU go for it. You have some good experience behind you. I am starting to see the going to CCU is a growing experience. Along with that comes some bumps and bruises but in the end, if you really want it and work for it, you will succeed. The program sounds great. I am only getting 3 months of preceptorship and had 7 classes. GO FOR IT!

I know this is an old thread, but I wanted to mention that I too am struggling with developing critical thinking skills as I am focused on tasks in a busy ICU on day shift. I'm still on orientation and I have until Christmas till I'm on my own (I get 12 weeks since I have a year of floor experience). The tips in this thread were great.

Hello,

I'm having the same situation and was wandering if you are willing to share your experience with this issue. Where are you now professionally. What did you do? What helped you?

Thank you you very much

Hello,

I'm having the same situation and was wandering if you are willing to share your experience with this issue. Where are you now professionally. What did you do? What helped you?

Thank you you very much

Get a medical (not nursing) pocket critical care handbook or phone app and use it at work. Get a good medical critical care textbook and read about your patient's problems and therapy for that day.

Nursing, by and large focuses on the what and when, as is totally appropriate. Medicine focuses on the "why and how". With all of the stuff that nurses have to do, the "why and how" frequently gets left to the folks writing the orders. Start learning about that, and you'll change the way you think about your patient's problems.

Aromatic

Has 3 years experience.

Get a medical (not nursing) pocket critical care handbook or phone app and use it at work. Get a good medical critical care textbook and read about your patient's problems and therapy for that day.

Nursing, by and large focuses on the what and when, as is totally appropriate. Medicine focuses on the "why and how". With all of the stuff that nurses have to do, the "why and how" frequently gets left to the folks writing the orders. Start learning about that, and you'll change the way you think about your patient's problems.

back when i worked as an np in the hospital setting i bought a copy of Massachusetts general hospital critical care review. reading that along with some moderate physiology text would work wonders

they have physiology books for USMLE step 1 that are pretty readable. 300 or so pages of diagrams and explainations. many of the books for medical school exams are more readable than some of the nursing texts i used back in school... some nursing authors i swear with their writing could confuse a top rate physics teacher if they wrote a calc 1 book

rabiamirou, BSN

Specializes in Mother-Baby Pediatrics. Has 4 years experience.

When I give meds I think of why I am giving the med and how it effects the patient.

This is a really good suggestion - its what we did in school - Funny that I have forgotten to do that!