Improving critical thinking

JBMmom, MSN, NP · Oct 22, 2019

First, don't expect too much of yourself as a new nurse. It's awesome that you recognize this is something you want to work on and mostly it will come with time. Do you have coworkers that are readily available to talk things over when you find something you think needs to be addressed? Having someone else, in real time, that can confirm your findings and be a sounding board for the next step will be your best resource. As far as when to call the docs, consider what the assessment change means for your patient? Is it something that you think will rapidly need a higher level of care or an intervention? Then you need to call. Things like an acute change in mentation, a sudden onset of new chest pain, sudden severe shortness of breath, etc. Most subtle changes will mean it's something to make note of and monitor, but not necessarily call a doc. Good luck with your practice, sounds like you're doing your best and you will be successful!

mmc51264, BSN, MSN, RN · Oct 22, 2019

Time. Don't ignore something if your gut is telling you something. learn from more veteran nurses. It has taken me more than 5 years to truly trust my gut but the more you experience the better you get.

Be patient and ask questions when someone "catches" something that you would not necessarily have picked up on.

angelsigns · Oct 23, 2019

I think you being cognizant that you want to be detail oriented already puts you ahead of the game.

Take notes throughout the day of your patients activity. I write to do lists that help me stay organized.

As far as knowing when to contact the doctor, I always say if you feel its important to share then simply share it. You won't lose out on anything if you call the doctor, however you WILL lose a lot if you don't share something with the doctor that could have changed a patient's course of health. If the Dr gets mad for calling him because of something he found insignificant just shrug it off and move on. Better safe than sorry. Of course do consider details like if your working night shift and calling a Dr at 12 am or calling a surgeon in surgery.

Always go to your veteran nurses and charge nurses for guidance.

When in doubt just CALL THE DOCTOR, look at your policies and procedures over the topic, call a charge nurse, or even call an RRT

Sour Lemon · Oct 23, 2019

11 hours ago, RN416 said:
I'm a fairly new nurse struggling with critical thinking and being detail oriented. I'm working on trying to notice details and small changes in a patient's condition and feel like I'm improving at it. But the struggle that comes with that is, when I do notice something wrong or different, especially when the change is subtle, I either second guess my assessment or don't know what to do about it (like don't know when it's appropriate to call the doctor or just monitor). Does anyone have any tips on improving critical thinking skills and knowing what to do about an abnormal assessment finding?

I'm ten years in and ask for second opinions from my peers constantly. They ask for my thoughts, as well. I usually know what I'm leaning towards, but want to make sure someone else doesn't see something that I'm missing.

I suggest that you do that. ?

RN416 · Oct 29, 2019

Thank you all for your advice! ?

ruby_jane, BSN, RN · Oct 29, 2019

Critical thinking is like irony. We all think we know what it is but it's very hard to define. The "if this, then that" comes with time and experience, as has already been pointed out.

If you have a preceptor or other nurse who is stating that you don't have "critical thinking skills" then ask them to define exactly what that looks like. Good luck!

RN416 · Feb 17, 2020

Thank you all so much for your helpful replies!!