It depends on the hospital, the unit, and the extent of the involvement of nursing in the plan of care of the patients. I use critical thinking skills every day I work. I use it more when I have higher acuity patients. I am bedside with the patients for 12 hours. The doctors rely on me to use my critical thinking skills to advise them of subtle changes before they become critical. I am not a robot that blindly follow the doctor's orders and pass meds. The doctors have many patients under their care and rely on me to help guide the plan for the day for the patient. You have more autonomy in critical care. You will be given titration orders for many IV drips (Dopamine, sedation drips, etc) with parameters for titrating and standing orders that allow you to do certain things before calling the doctor. I may not be able to "diagnose" patients, but I can predict with high accuracy that if my patient is persistently vomiting, has a rigid stomach, bowel loops, and discolored abdomen, that they may have NEC. I can anticipate what the doctor is going to order and gather lab supplies and call the x-ray tech as I am calling the doctor. I am able to be proactive to their orders instead of reactive.