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Why Do New Grads Lack Critical Thinking Skills?

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by Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

New grads often lack critical thinking and it's a gap that preceptors can help with. You are reading page 3 of Why Do New Grads Lack Critical Thinking Skills?. If you want to start from the beginning Go to First Page.

2 hours ago, Emergent said:

There are so many snot-nosed, whiney, entitled baby-boomers, it's unreal. Yep, my generation. 

I know all 6 of my adult offspring stand on their own 2 feet very well. I wasn't a smother-mother at all, but could get a little fierce at times if someone messed with us. It worked out. 

I wasn’t at all implying that you fell into that category. I know not everyone is raising children without a resilient bone in their body because of coddling. It’s just an observation from working with many new grads. I have to think it’s not completely their fault they struggle with problem solving as a life-skill. 

On 8/20/2021 at 8:34 AM, JKL33 said:

This is interesting. I think that the nursing process and formulating care plans and all of that does help with, and represent, critical thinking.

We basically wash that out, negate it, bury it....with utter pettiness in nursing school. Every task that needs to be learned is a set of steps from which one must never deviate, and we'd rather watch people nervously shake their way through them than realize that "A" needs to be done and as long as you adhere to X, Y and Z principles you're good. All through our training it is like there is one right way to do every single thing and if you deviate it's like falling off a tightrope straight onto concrete, or the world is going to burn or someone is going to die. Well....we neither produce nor enable critical thinking with these methods that have long plagued this profession. And every time it is rumored that someone somewhere did something completely negligent....the rules pile up all the more.

How many "rights" of medication administration are there now? Nobody knows. It is whatever someone with a personality disorder said it is; that's how many.

We follow EBP so the clinical procedure steps in the nursing procedure books are written down in the order the experts decide reflects the latest, best, evidence, as I understand it.  I believe this is necessary, as, without it, new nurses and nurses who are unfamiliar with the most current way to perform clinical procedures wouldn't have a reference to guide them.  While, arguably, for some procedures it's not critically important for patient safety reasons that every step of the procedure is performed in the exact specified order, for some procedures it is very important for patient safety reasons that they are done in the order specified.  

Having to follow the specified sequence of doing procedures wasn't something I found bothersome in nursing school; I was mostly concerned about knowing the procedure well enough to perform it safely and correctly on patients.  I trusted that the sequence of steps was there for good patient safety/clinical reasons.

Edited by Susie2310
Add info.

17 minutes ago, Susie2310 said:

We follow EBP so the clinical procedure steps in the nursing procedure books are written down in the order the experts decide reflects the latest, best, evidence, as I understand it.  I believe this is necessary, as, without it, new nurses and nurses who are unfamiliar with the most current way to perform clinical procedures wouldn't have a reference to guide them.  While, arguably, for some procedures it's not critically important for patient safety reasons that every step of the procedure is performed in the exact specified order, for some procedures it is very important for patient safety reasons that they are done in the order specified.  New nurses and nurses who aren't familiar with the current way to perform the relevant procedures are guided in safe practice by following the sequence of steps in the order written.

Having to follow the specified sequence of doing procedures wasn't something I found bothersome in nursing school; I was mostly concerned about knowing the procedure well enough to perform it safely and correctly on patients.  I trusted that the sequence of steps was there for good patient safety/clinical reasons.

I added the above in bold.

On 8/21/2021 at 11:43 AM, JKL33 said:

Educational institutions want to make money flooding the market with more of us. They don't seem to have an interest in providing true high-quality education and there are no forces holding them to task on that. In fact the standards are so low that dubious entities have been able to get in on the nursing education action. If the program stinks, no problem, just curate board pass rates by making people pass an exit exam at the very end of the program as a condition of graduation/authorization to test (after their tuition dollars have been collected). Things like this happen not just in mail-order degree programs but even well-regarded and sometimes prestigious universities.

I think I answered your question in my reply to Nurse Beth.

I disagree with you that there are no forces holding educational institutions to task on providing high quality education.  As far as I know, the BONs' in different states vary as to the standards that are set for nursing education, but they are tasked with regulating the practice of nursing in order to protect the public.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

4 hours ago, Salesforce said:

We appreciate you. One of a kind Nurse Beth 🙂

Awww...thank you!

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 45 years experience.

On 8/20/2021 at 8:21 AM, Hannahbanana said:

The banner in the original said they should be trained more like “the medical model.” Fortunately for this NURSING community, that was not the focus of the actual discussion here. Better to have made an explicit case for better, longer orientations paired c expert nurses and keep the focus on nursing. Yes, I know that’s what happened, but why bring “medical” into it at all?

There is ample room for new nurses to grow and question in these examples— the temp, the K+, the drowsiness—but the last thing new nurses need is to have nurse experts imply that the “medical model” is the gold standard for nurse training and the critical thinking. 

YES! 👇🏻

Quote

Let’s just continue to call it critical thinking in the nursing process and do all we can to promulgate that.

I agree with this wholeheartedly.  I can't imagine an expert saying that, unless they're talking about 4-year medical school vs a 4-year BSN program.

I can't imagine medical training including haphazard matches of students and floor nurses they're supposed to shadow, or new grads and preceptors who actually resent the assignment, or an intern bursting into the attending's office to report that 3rd-year resident was so mean to them.

I find it disturbing to see graduate APRNs scrambling to find their own preceptor. 

There's a caveat to this, though.  In the medical model, it is more or less accepted that you'll be worked like a dog at first, and the hierarchy is fairly rigid and loosens up each year of your residency you manage to survive.

In nursing it's a bit different in that so many students and new grads seem to expect to be treated as a peer from day one, and this creates a whole lot of inner turmoil, oftentimes labeled as bullying.

I think the problem might be that the legitimate desire for nurses to be respected as professionals translates as disrespect when in reality the behavior exhibited by others is caused by your status as a student or new  grad.

This is somewhat related, but there will also be the issue of new graduates whose education started, or was in progress, during the pandemic: March 2020 and still ongoing.  The majority were taken away from a full floor experience and thrust into the world of virtual simulation, online skills training, and minimal to no clinical experience.  Even up until today, programs are struggling to find spots for their students due to restrictions from placement hospitals.

I just wanted to bring this up because it will require even more patience and time, to work with new grad nurses due to the monkey wrench the pandemic threw into education.  It may take a little longer for new nurses to build those critical thinking skills up and apply them.

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

7 minutes ago, Mergirlc said:

This is somewhat related, but there will also be the issue of new graduates whose education started, or was in progress, during the pandemic: March 2020 and still ongoing.  The majority were taken away from a full floor experience and thrust into the world of virtual simulation, online skills training, and minimal to no clinical experience.  Even up until today, programs are struggling to find spots for their students due to restrictions from placement hospitals.

I just wanted to bring this up because it will require even more patience and time, to work with new grad nurses due to the monkey wrench the pandemic threw into education.  It may take a little longer for new nurses to build those critical thinking skills up and apply them.

I agree, due to the pandemic, new grads are even less prepared

Emergent, RN

Specializes in ER. Has 28 years experience.

I don't understand the rationale of denying nursing students access to clinical sites. They are a vital part of the fabric of our medical system. That was very short-sighted of the rule makers to ban them from caring for real patients. 

Didn't people at all anticipate that people like me might make an early exit from nursing after year-and-a-half of this madness? I really wonder at the intelligence of the people in charge. This is a predictable outcome and you'd better have a back-up plan. It's not just the risk of contracting Covid itself, healthcare workers' mental health is being compromised. And there are no programs or help being implemented for the many health care workers who are experiencing this. The government is too busy handing out needles to drug addicts to care about us.

 

vintagegal, BSN, RN

Specializes in Geriatrics. Has 2 years experience.

I think in any form of nursing a balance between book smarts and common sense Is needed. Many programs focus on one or the other. For example, the local community college providing Associates degree prepared RN education focuses more on common sense. The state university focuses more on care plans and book smarts. You can see where each has its deficits. 

speedynurse, ADN, RN, EMT-P

Specializes in ER, Pre-Op, PACU.

On 8/21/2021 at 10:01 AM, Emergent said:

A lot of young people have grown up in a pressure cooker. The millennial generation has had challenges that my generation definitely didn't. I think it's a generalization to paint all younger people with the same brush.

Correct. Any generation can be entitled and any generation can be hardworking with critical thinking. It often depends on what they have gone through in life, how they responded to it, family support, etc.

19 hours ago, Susie2310 said:

We follow EBP so the clinical procedure steps in the nursing procedure books are written down in the order the experts decide reflects the latest, best, evidence, as I understand it.

Well....we'll see how this goes over 😬: We must understand that evidence-based practice also has its weaknesses. The fact that something is evidence based doesn't speak to what the goal was in studying it in the first place. For example, numerous healthcare studies were designed to find out if something is "as safe" or "more cost effective," and are not as much about whether the studied item is superior in other ways. *I am not advising anyone ignore evidenced based recommendations and practices. But I also don't think every step that is taught to a nursing student is taught because it is a superior thing to do.

I do think learners can manage principles and be asked to think about how they might be applied in a real situation, sort of like what Hannahbanana posted about. If we're saying that we want to produce critical thinkers then teaching principles as well as basic sequences is a valid idea.

I remember I was once in one of my patient rooms while a nursing instructor was there with a few students, one of whom was about to insert a foley cathether. The clincial instructor was a charge nurse and overall a fairly good nurse in my department. So I was pretty surprised when she declared that it's too hard to pick up cotton balls with plastic tweezers so the student was to simply hold them with her fingers to cleanse the patient. There is a case of someone who apparently knew sequences but threw important principles right out the window. 🤷🏽‍♀️

I don't know, I don't have all the answers but I like Wuzzie's approach and it is what I do as well. I think it's really important for learners to think through what needs to happen and not become stymied with steps and rules (the ones which are extraneous).