Need Help With Critical Thinking Skills

samdombek · Dec 7, 2009

I'm an older nurse too, with almost 3 yrs experience, but often wonder about my critical thinking skills, too. Can you give some examples of where they said you were lacking?

sethmctenn · Dec 7, 2009

I'm pasting in some links below. I hope that they help. I think that if you tell your supervisor that you really heard what he or she had to say and are addressing it using an audio course, some case studies, etc... it will be a much better response than most nurses give them about critcism.

I'd be willing to bet that the speed issue is just as big a concern.

Good luck,

Seth

doing case studies may help...

http://cmbi.bjmu.edu.cn/news/report/2004/medinfo2004/pdffiles/papers/050_d040005590.pdf

I think you can sign up for case studies on evolve.elsevier.com

Here are some CD or CD/ROM courses

http://www.hcmarketplace.com/prod-574/Developing-Critical-Thinking-Skills-in-New-Graduate-Nurses.html

http://www.hcmarketplace.com/prod-5003/Critical-Thinking-in-the-MedicalSurgical-Unit.html

http://www.criticalthinking.org/resources/HE/ctandnursing.cfm

pennyaline · Dec 7, 2009

It kills me when I hear people say that their managers or department heads waited months to tell them that their work performance is below expectations. These kinds of problems are correctly addressed early and in an ongoing fashion. And then to suggest that it may mean that the employee is, in so many words, not cut out for the job really frosts my cookies!

If you have been at this particular job since August, it seems that you are now at or nearing the end of your probationary period. What kind of orientation or preceptorship have you had during this time? You are, after all, a new nurse with less than one year of experience. What does your employer expect from someone with your limited time in the role?

Your "supervisor" sounds like a putz with near-zero managerial skills and who could do with some critical thinking skills of her own.

I'm going to be upfront with you and tell you that, based on what I've seen in decades of nursing, your employer trying to get you to quit. This is the start of a campaign to get you to second guess yourself, doubt your own abilities and leave of your own volition. But don't be fooled. Very likely if you don't decide to leave within a VERY short timeframe, they will fire you. I'm sorry to say it, and I'm sorry to be able to say it. I wish I couldn't say it with such certainty, but I've seen it and seen it and seen it and seen it, and I've seen may very capable yet personally insecure nurses ridden out on a rail.

Get a copy of that big list of complaints that your supervisor confronted you with. Demand copies of every disciplinary action, verbal or written, these people give you. Keep them. Remember that they hired you knowing that you have limited experience, and it seems that they have done little to guide or help improve your work performance during your time there. If they didn't, it matters very much.

RNgrrl09 · Dec 7, 2009

Luvtosmile. Don't be discouraged and don't let anyone discourage you from being a nurse. You passed nursing school and you passed your boards. With that said, try to rectify the things that you can.

To address the speed issue- try talking with others on your floor to see how they organize their day. What type of brain sheets do they use, group tasks, if you can come in a little earlier to see what your assignment is so that you can set your priorities for the day. It may be you need to change to another shift- evenings or NOCs when less ancillary staff are there and you won't have that to deal with feeling rushed on top of caring for your patients. Maybe the unit is too fast paced and you may need to change units. When you are feeling overwhelmed, slow down, take a deep breath and think about what your priorities are. I started in June as an new RN in LTC on a subacute/rehab floor. I'm an older new grad RN too.

I don't know what was said regarding your critical thinking skills, but I do know that as new nurses we are novice practitioners. Nursing school and passing the boards shows that we can provide the minimum of safe care. We are not practiced critical thinkers. Some catch on quicker than others, but you can learn this- when giving a medication ask yourself why you are giving it. Always look up medications you are not familiar with and always question yourself as to why you are doing an intervention. If you don't understand something- look up that information or ask your colleagues. Get a good med/surg care plan book to assist with this. I hope the best for you and let us know how your doing.:redbeathe

luvtosmile · Dec 7, 2009

But if I leave what do I say in another interview with another employer, I know I need help with these skills. I got a good first review but then something came up and they extended by orientation time 6 weeks and then today bam, a long list of complaints and this is the first I had heard of it. What do I do.

Virgo_RN, BSN, RN · Dec 7, 2009

But if I leave what do I say in another interview with another employer, I know I need help with these skills. I got a good first review but then something came up and they extended by orientation time 6 weeks and then today bam, a long list of complaints and this is the first I had heard of it. What do I do.

You ask for help fixing it.

HouTx, BSN, MSN, EdD · Dec 7, 2009

How awful!

"Critical Thinking" has become a buzz-word blanket term that everyone is using when they can't think of anything else. You deserve to have more specific information... this is like a coach telling a player just to 'get on the ball'. Without additional information, you don't even know what to fix.

In my world, Critical Thinking means:

Problem identification - determining the nature of the problem based on subjective & objective data - and refining selection based upon baseline knowledge. For instance, could that chest pain be more likely due to cardiac or pulmonary problems?

Deciding on Interventions - what should you do to fix the problem that you just identified? Selection of interventions is based upon your own knowledge, policy/procedure, physician orders, etc.

Prioritizing your interventions - what do you have to do NOW; what can be delayed a bit? (this is the essence of time management)

Does this help?

subee, MSN, CRNA · Dec 8, 2009

But if I leave what do I say in another interview with another employer, I know I need help with these skills. I got a good first review but then something came up and they extended by orientation time 6 weeks and then today bam, a long list of complaints and this is the first I had heard of it. What do I do.

I would ask staff to specifically address the "critical skill" that you are lacking as the situation arises and not be passive-aggressive and attack you with broad generalizations. Its kinda hard to think about the fine points when you're still treading water. Its perfectly normal to feel lousy about your ability to do your job for about one year. And then you get up one day and go to work feeling the blessed relief of confidence. Your manager is not being helpful by not being specific. If they're not interested in teaching newbies then they ought to get out of management - its just part of the job and also part of being a decent person. You deserve better.

MaxAttack, BSN, RN · Dec 8, 2009

It's the job of anyone in a management position to not only address issues in a timely fashion before they're problems, but offer constructive advice. They're not only there to supervise and manage, but to build their teams and act as a role model. It throws up a red flag when someone in a position of power can't live up to these simple expectations, and it shows they didn't really know what they were getting into and don't know what they're doing.

Approach her and ask for more details, and then ask her advice on correcting the issues or if she has resources you could turn to.

If she comes across as uncaring and doesn't seem interested in doing anything but critiquing, go over her head, especially if you think your job is in jeopardy. The quicker the problem is addressed, the quicker attention can be brought to a potentially bad supervisor and it'll be her ass on the line, not yours. No one should feel threatened, and a good manager knows that's the worst type of motivation.