Nurse tips for critical thinking

[Adrans]

Hello,

I have been told I need to work on critical thinking with medications numerous times. Can anyone please share tips with me to improve this area? I think a couple of my problems are that maybe I overthink too much and I lack confidence. Every work day, I ask the physician, my peers, and/or pharmacy medication questions when I'm not sure if I should give something, and my manager wants that to improve and it does slow down my med passes. Sometimes it's as simple as not being sure whether to give pain medication (narcotics) with low BP. Thanks all!

Background: I have been a nurse for a bit under a year. I work on a busy med-surg tele/vent floor in NJ. (We're in a covid "hot spot" zone, and well supplied with PPE!)

[KatieMI, BSN, MSN, RN]

If you are going to start to develop your critical thinking skills for real, it WILL slow you down for a while. It is a trained skill, not something one born with.

While, and for the very real, there are no magic rules applicable to all and every situation, there are certain principles you can start following:

- establish baseline. When you do your first assessment, make a "picture" of the patient in your head. Is he hemodynamically stable? What he is there for? What is his vitals, what they were for 24h? You need to know it, because if he always had BP 90/60, it is completely safe for him to be 80/50, for one example.

Always trust your assessment above everything else. ALWAYS. If in doubt, access the patient and ask yourself "what is going on"?

- prioritize. If BP is 90/55 but patient asymptomatic (assessment!) and baseline is 110/70 (see above), why not give pain med?

- please try not to treat numbers. Try instead to make sense out of them. If BP is 200/100 and HR is 61 patient is symptomatic (baseline 130/80, 70) will you give metoprolol?

- always hold in your mind the speed your meds are working. If you give lisinopril at 9 AM, it is not going to do anything any time soon. What about hydralazine?

- if you are more comfortable with parameters, ask for them. Same about PRNs.

- get into a habit to read about every drug you do not know as soon as you can. Get out your pharma textbook and re-read it till you understand.

- if in doubt, first stop and give yourself 20 to 30 seconds of thinking time. If you "just call and ask", you'll never learn how to think yourself, plus, you'll spend more time hangin' on that phone.

Follow the basic rules for mental hygiene; it is very difficult, especially in current situation but not doing so blocks any serious learning efforts, and you are going to change the way you are thinking, which is a pretty big deal for your brain. The rules are:

- working with stress (whatever works for you);

- no tobacco, alcohol and drugs; as little of sugar and caffeine as possible;

- sleep (preferably natural);

- physical exercise;

- nutrient-rich "Mediterranean" type or vegetarian diet;

- every day you are off, at least 2 hours of mental workout, such as active learning, playing chess/monopoly/any other tactic game, singing, playing music or doing crafts.