So Frustrated! "think like a nurse"

carolinapooh, BSN, RN · Mar 26, 2010

Don't let buzz words and jargon throw you.

Critical thinking is something you do EVERY DAY (at least I hope it is) - it's at the analytical level of Bloom's Taxonomy (google that if you're not familiar). It's higher level thinking.

It's not unique to nursing and the fact that it's such a buzz word sort of annoys me.

I have a friend who's an engineer, one who's an MD, and another who flies jets. Of course, I have a ton of friends who are nurses. They ALL use critical thinking. Essentially it's an ability to look at situation A and think through possibilities - consider consequences - realize what might happen in A if you do X and forget to do or overlook B and Z. You just have to do it in the context of nursing. It's not that you can't "think critically" - because if you couldn't you wouldn't have gotten into nursing school in the first place. You'd never leave the house as far as I'm concerned.

My friend the structural engineer can't even begin to imagine how I do what I do - and I know this because he's told me! But I'll be hanged if I'd know where to start constructing a bridge, because I have no knowledge of what's involved. But that doesn't mean I can't think through a problem and make educated decisions - it means I can't build bridges!

You can think. You're just having to learn how to think through different types of situations and realize sequelae that can result from the disease process, or from giving the wrong drug, or from giving the RIGHT drug, for that matter. You do need to learn to "think like a nurse" - just like my one friend had to learn how to look at a structural problem and "think like an engineer" and my other friend who flies C17s had to learn how to "think like a pilot" when all her cockpit lights are going off and how I had to learn to "think like a cop" when I was an Air Force police officer and I had to go question a suspect or follow somebody into a dark building. But I would hope at your age you KNOW how to "critically think" - you just need to learn how to "think like a nurse" - to be able to look at a problem from the medical point of view and take in ALL the details (labs, psychosocial, pharmaceutical - everything) and that takes time.

It's a buzzword for something you're already doing. Don't get too lost in the details of it.

daisyfleur70 · Mar 26, 2010

I agree with the above poster. I started nursing school in February and I was soooo intimidated by "critical thinking." It's not so bad. Critical thinking is something that you do every day.

To oversimplify things a bit, when you are cooking or baking something new, you have to follow a recipe. The first few times it's more time consuming, and mistakes are easy to make because they are unfamiliar. (the learning process). After you've cooked/baked the dish a few times, it becomes intuitive, and steps are second nature. So if you decide to bake a cake one day, you assess your pantry, do you have all of the ingredients and supplies? What if you are missing some items, what do you do next, etc.

So the theory you learn in class and the procedures you simulate in lab are kind of like the recipe. Clinicals is where you are attempting to bake. LOL!

It's always nerve wracking to be watched, especially when you know you are being evaluated. If your clinical instructor hasn't given you any negative feedback, then you must be doing ok. :) Heaven knows if you mess up, someone will tell you!

Just try to relax and trust your instincts, and do your best. Good luck! :)

trae55 · Mar 27, 2010

It sounds more like a confindence issue and it will come to you in time as you build your skills. I remember when I took speech and the teacher asked us if anyone was nervous about public speaking. My answer was only if I wasn't prepared. I used to be in sales and could go up in front of a group of people and give a presentation with no problem. It didn't even occur to me to be nervous. I was excited because I knew what I was talking about so much and had REHEorificeD so much that I couldn't wait to knock their socks off. But, get me in a situation where I hadn't reheorificed and didn't know the material up, down, and inside out and I would barely be able to put two sentences together. Practice, practice, practice. The more you do it the more your confindence will grow.

glovedgoddess · Mar 27, 2010

I definitely recognize it's a confidence issue thats affecting my clinical experiences. Thank you for the advice though! :)

black_knight · Mar 27, 2010

great replies. I agree it's just a matter of getting comfortable with the labs, diagnoses, meds, skills etc. When you start becoming comfortable, everything will fall into place. Good luck.

delvenia · Mar 27, 2010

As a nurse with only 6 months of experiance, all i can say is give it time. You first have to be familiar and knowledgable with the material learned and as time goes on and yoou see certain things you will start to think through how they effect various things in the body.

The best example of this that i can give is growing up as a child, you learn the basic things first and then as you gain more experiance with the things you learned about, you began wondering "what if". its the same with nursing and any other instrerest or occupation that one has. dont get frustrated because it is very difficult at first, but in about 6 to 12 months, it gets much better. just give it time. focus on learning the body systems and what they do and the critical thinking will come naturally after a while.

sometimes our instructors forget how it was to be in oour position because it comes so naturally to them. they forget at times that it is a process. just like if someone states something incorrect about soemthing that you know very well, you question "my goodness, they really dont know that!". so again, just give it time

SuesquatchRN, BSN, RN · Mar 27, 2010

If you were confident at this point THAT would be a reason for concern.

:)

editor2rn · Mar 27, 2010

I'm so glad this topic is here! I've had a rough couple weeks in clinical. I'm in my second semester of a four-semester program. I have great grades in theory (4.0), but in clinical, I feel unfocused and a little lost when I look at labs for patients. I get the basics (e.g., check BP before giving antihypertensives, know last bowel movement if giving a stool softener, check respirations before giving a pain med), but my instructor asks me questions that stump me, then I get flustered, and then she chews my a$$ for not knowing and not "being a nurse."

For example, this past week, I had a pt who had a pacemaker placed in the morning before I got to clinical. This patient had been admitted for acute bradycardia, and had a history of CHF, CAD, fibromyalgia, diabetes, nasal cancer, throat cancer, arthritis, and CKD.

I was going over meds with my instructor and I told her the BUN and creatinine were high and should we check with a doc before giving valsartan. She asked why her BUN and creatinine were high, and I checked the history on the kardex. She said I should know the history without looking at the kardex, that I was unfocused, and that I would not be able to take 3 patients (we currently take 2), if I had to check paperwork for answers to questions. She said I'm getting "lost in minutia" and losing the big picture. I feel that she's right, but I'm looking into the minutia to anticipate her questions (e.g., "How does gabapentin work for fibromyalgia opposed to neuropathic pain?" To which I replied, "Huh?").

I feel as if it takes me a long time to put all the little pieces together. I eventually get it, but apparently I'm not doing it fast enough. Nurses on the floor say I'm going to make a great nurse because I have a caring demeanor and I'm willing to work as a team to get things done for patients. But my confidence is blown. I used to look forward to clinicals, and now I'm starting to hate them. A few other classmates get the same treatment from this instructor, while others don't. She asks some of us mechanism of action on drugs, and others she never asks. Some of us she asks medical diagnosis questions, and others she doesn't.

At any rate, I just want to give the instructor what she wants so I can pass. I'm angry that I'm becoming uninterested in learning and more interested in figuring out what she wants so I can make it out of this class without having to repeat clinical.

If you've made it this far, thanks for reading my vent!:icon_roll

seasoned hopeful · Mar 28, 2010

thank you so much for all this encouragement. it really helps. it always seems like everyone knows what the instructor is talking about, but if you were to really question them they think you look like you think they look.....lol

"critical thinking" sounds like such a mystery that is not. thanks for all the comments about how long it takes to gain this feat as a nurse.

hang in all-----we will succeed:yeah: :nurse: :redbeathe:p

SCSTxRN · Mar 28, 2010

I'm the one everyone looks at when the instructor asks a question no one knows the answer to. Notice, I didn't say I'm the only one that knows the answer. That being said - if your clinical instructor is telling you to look at the whole picture, she might mean put the system back in the body.. that is, a client with heart failure, by definition, has blood that is not being pumped as well as it should be. That is going to lead to poor cellular oxygenation (even absent lung disease) and poor kidney function (because the kidneys are like coffee filters, and the heart is the coffee pot - if it isn't pushing blood through the filter, you're not going to get any coffee).

It's kind of like trying to remember right sided heart failure vs left sided heart failure - right gets from the body and gives to the lungs, if it's failing it's backing up. Into the body. So they swell. Left gets from the lungs and gives to the body, if it's failing it's backing up. Into the lungs. So they fill with fluid. Not as much body swelling. No memory necessary, just A&P.

HTH

Steph

ETA: Clinicals and SIMS kicked my butt the first 3 semesters. Now, in the final semester, I feel something that strongly resembles competence. It's a pleasant experience.

Annaiya, NP · Mar 28, 2010

This is in response to what Editor2RN was saying about her clinical experience. I think you should tell your clinical instructor most of what you said here. My guess is she doesn't know how her questions are making you feel. Also, you said she is only asking some of the students all of these questions, are they all very good students like you? She may be harder on you, because she sees more potential and thinks you can handle it.

Aside from that, I think the hardest thing for any acedemically good student in clinicals is trying to bring it all together. You know so many pieces of the puzzle, but it's hard to bring them together because you learn just one piece at a time in class. It wasn't until my last semester in school that I felt like I was able to do that at all.

There are some bad clinical instructors out there, but presumably they are there because they want to teach. It certainly isn't for the money. So don't be afraid to talk to them about how you are feeling in clinical. It is good to be pushed and put on the spot, because you will learn from those experiences, even if they aren't pleasant. NCLEX is a lot of pressure too and learning how to think under stress is an important part of being a good nurse. But if you aren't learning from how they are trying to teach you then tell them. It is their job to make sure you learn and if they need to adapt their teaching style to fit your needs, they should be willing to. Nursing school is a challenge, but you will get through it!