Need input! Whats your experience with critical thinking?

RockinNurse2018 · Apr 2, 2018

My experience is that it has taken me 2.5 years to develop any sort of critical thinking process at all. In fact, my first nursing position ended during orientation over 2 years ago because my brain refused to retain the information it needed to, and thus, prohibited any real critical thinking to take place. Now, I am doing much better thinking and acting through situations that come up, but it is not in the care setting that I wanted to be in. I'll always be disappointed that it took me so long to start critically thinking, because I really wanted my first nursing position to work out. That was the position that would have led me to a great career. In fact, I'm a little angry that my brain has now decided to work, now when I'm stuck in a field of nursing I didn't expect to get into. However, many of my colleagues were able to jump into critical care roles from the start, and for whatever reason, it clicked. I wish I would have learned their tricks for retaining information and critically thinking before it was too late.

gromit1084 · Apr 4, 2018

Hey RockinNurse2018, that sounds like such an aweful experience. I am so sorry! It sounds like you are in a much better place with it now, though. thats great!

I am curious what in particular was challenging about the process you went through in learning how to think. You mentioned about your brain not being able to retain information. Can you tell me a little bit more about that?

PS- Don't give up hope on having a great career! I truly believe a nurse is capable of so much, and now with experience and wisdom you've earned, I am sure you could go back to that specialty (if that is what you want, of course)

:)

thanks for the reply

offlabel · Apr 4, 2018

The nursing model of education does not lend itself to "critical thinking". It is a reactive, wait for orders, check the orders mentality that is bound to care by policy. That isn't always a bad thing per se, but the RN's that are actually able to rise above their training a think critically have embraced more of a medical model of thinking that involves creative problem solving and decision making. Those individuals either go on to advanced practice, leave the bedside out of frustration or remain to be the unit grump for most of their careers.

gromit1084 · Apr 4, 2018

Yeah, I agree critical thinking isn't quite taught in schools. Mostly because real critical thinking in the real world is very highly context based and how can you teach that with multiple choice?

nurseliz12 · Apr 4, 2018

Hi! As a new grad starting in critical care, developing critical thinking skills has been one of the biggest challenges I have met so far. However, from the beginning of my orientation, my preceptors have encouraged me to build these skills by asking me to talk through the same 5 questions at the beginning of every shift. The questions are:

What is my patient's main problem? What is the worst thing that could happen? What am I going to do about it? What are the outcomes we are hoping to see from our patient by the end of shift? What are we going to do to get them there?

Thinking through these questions has really helped developed my critical thinking skills because they helped me to organize my thoughts and look at the big picture. In addition, as a new nurse, these questions have been really helpful to me because they break down the thought processes that go into critical thinking.

Susie2310 · Apr 5, 2018

The nursing model of education does not lend itself to "critical thinking". It is a reactive, wait for orders, check the orders mentality that is bound to care by policy. That isn't always a bad thing per se, but the RN's that are actually able to rise above their training a think critically have embraced more of a medical model of thinking that involves creative problem solving and decision making. Those individuals either go on to advanced practice, leave the bedside out of frustration or remain to be the unit grump for most of their careers.

I strongly disagree. Critical thinking is not the unique purview of the medical model; that is ridiculous. Far more is expected of nurses than just being reactive. When I was a student over 20 years ago, we were very definitely taught to think critically and to use the Nursing Process (subjective and objective assessment, analysis of the data, planning, implementation, and evaluation) as an organizational method when we provided nursing care to patients. We used the Nursing Process from the very first day of our student clinicals in acute care in the hospitals when we took care of patients, and we were expected to do so. We also had plenty of opportunity to use both critical thinking and the Nursing Process when we prepared our care plans and formulated nursing diagnoses.

I'm pretty sure that critical thinking and use of the Nursing Process is still being taught in nursing programs, especially ADN programs. Nurses are very definitely expected to think critically, and this subject is expounded in detail in good nursing/procedural text books. From a legal point of view, nurses are absolutely expected to use critical thinking in the care they provide, not just to be reactive or passive.

Susie2310 · Apr 5, 2018

I strongly disagree. Critical thinking is not the unique purview of the medical model; that is ridiculous. Far more is expected of nurses than just being reactive. When I was a student over 20 years ago, we were very definitely taught to think critically and to use the Nursing Process (subjective and objective assessment, analysis of the data, planning, implementation, and evaluation) as an organizational method when we provided nursing care to patients. We used the Nursing Process from the very first day of our student clinicals in acute care in the hospitals when we took care of patients, and we were expected to do so. We also had plenty of opportunity to use both critical thinking and the Nursing Process when we prepared our care plans and formulated nursing diagnoses.
I'm pretty sure that critical thinking and use of the Nursing Process is still being taught in nursing programs, especially ADN programs. Nurses are very definitely expected to think critically, and this subject is expounded in detail in good nursing/procedural text books. From a legal point of view, nurses are absolutely expected to use critical thinking in the care they provide, not just to be reactive or passive.

I want to add, on the subject of critical thinking, that far from being reactive or passive, part of our role is to advocate for our patients. Are the physician orders appropriate for the patient? Is our new admission (with a diagnosis of sepsis and acute renal failure) without orders? Do we need to contact the physician now to obtain appropriate medical orders? Is this medication and dose appropriate for the patient? Does this medication need to be held based on labs and/or patient assessment, and the physician notified? It is the nurse's job to contact the physician timely when necessary to clarify, question, obtain appropriate orders and even refuse to carry out inappropriate orders. This requires the ability to be assertive when necessary. We are the patient's last defense before an order, carried out by us, reaches the patient. Prioritization of care requires critical thinking. Bedside nurses have more opportunities to use critical thinking than they will ever dream of; thinking otherwise is really a grave error.

gromit1084 · Apr 7, 2018

I strongly disagree. Critical thinking is not the unique purview of the medical model; that is ridiculous. Far more is expected of nurses than just being reactive. When I was a student over 20 years ago, we were very definitely taught to think critically and to use the Nursing Process (subjective and objective assessment, analysis of the data, planning, implementation, and evaluation) as an organizational method when we provided nursing care to patients. We used the Nursing Process from the very first day of our student clinicals in acute care in the hospitals when we took care of patients, and we were expected to do so. We also had plenty of opportunity to use both critical thinking and the Nursing Process when we prepared our care plans and formulated nursing diagnoses.
I'm pretty sure that critical thinking and use of the Nursing Process is still being taught in nursing programs, especially ADN programs. Nurses are very definitely expected to think critically, and this subject is expounded in detail in good nursing/procedural text books. From a legal point of view, nurses are absolutely expected to use critical thinking in the care they provide, not just to be reactive or passive.

Susie2310, I very much agree with all you said. I think one of the main things that really frustrated me as a nursing student and new grad was that I would actively ask everyone around me to help me develop this skill and nobody could directly answer me/guide me. Nursing schools do try to teach it but it obviously is insufficient. So I ended up just doing it like the rest of us do: winging it until I somehow learned it. I am curious... did you have the same experience? How did you learn critical thinking in the real world?

Susie2310 · Apr 7, 2018

Susie2310, I very much agree with all you said. I think one of the main things that really frustrated me as a nursing student and new grad was that I would actively ask everyone around me to help me develop this skill and nobody could directly answer me/guide me. Nursing schools do try to teach it but it obviously is insufficient. So I ended up just doing it like the rest of us do: winging it until I somehow learned it. I am curious... did you have the same experience? How did you learn critical thinking in the real world?

As I said, I learned critical thinking in the real world, and I naturally used critical thinking in my life before nursing school, so it was not hard to apply it to nursing. I was in a nursing program (ADN) that taught and emphasized using critical thinking and the Nursing Process from day one. All of my instructors were practicing nurses in acute care, and they expected us to be able to articulate and demonstrate critical thinking in the care we provided, in our care plans, and in every learning activity we participated in throughout my ADN program. We were in clinicals providing total care two days a week in acute care hospitals, including summer school, so we had plenty of opportunity to work on developing critical thinking in nursing. I also did student work experience on an oncology unit, plus a preceptorship on the same unit, where my preceptor evaluated my use of critical thinking in the care I provided, all supervised by my clinical instructor. I was very prepared to use critical thinking after graduation.

Over the years, as my knowledge of nursing and medicine has increased, the knowledge/experience base that informs my critical thinking as a nurse has obviously expanded. I have studied a lot since becoming a nurse; both nursing and medicine. I maintain specialty certification and take 100 Continuing Education credits during a four year period; my state requires a large number (relatively speaking, as compared to some other states) of Continuing Education credits for license renewal, and I have always taken Continuing Education courses that challenge me and help me to improve my practice.

I hope this answers your question.

rabiamirou, BSN · Jun 30, 2018

I am going to write those down and put them on my badge! Thanks!

rabiamirou, BSN · Jun 30, 2018

This is the aspect of critical thinking that is difficult for me as a new nurse. As a nursing student it was always emphasized that we should be thinking independently about the needs of our patient. We did not interact too much with doctors. Now, I find myself worrying about whether I will sound like I do not know what I am talking about when I question a doctor's order. There are a lot of things that you just come to learn about why doctors do certain things, and at my hospital floor, doctors do not always want to explain their reasons for things. So where I used to be questioning as a student, now I am more hesitant and often assume that the Dr is doing something for a good reason. I have so many questions I cant ask for explanations all the time.

This is a key part of transitioning from school to real practice, knowing when you are right and they are wrong and being able to gain their confidence that you are bringing up something that they should pay attention to.

I find as a first year nurse, my challenge is to integrate my nursing school training with what happens in the work setting where I am exposed to independent clinical decision making 72 hours per week rather than during a semester with a preceptor.