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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 7 of Why Do New Grads Lack Critical Thinking Skills?. If you want to start from the beginning Go to First Page.

"I agree with the medical model of training. New grads need progressive responsibility and supervision."

My nursing program basically threw us into our clinicals and it was "survival of the fittest". Why are medical students allowed to make mistakes and nursing students are not? I would have learned a lot more by observing a really competent nurse.

HarleyvQuinn, MSN, RN, NP

Specializes in Primary Care, Military. Has 14 years experience.

20 minutes ago, 2BS Nurse said:

"I agree with the medical model of training. New grads need progressive responsibility and supervision."

My nursing program basically threw us into our clinicals and it was "survival of the fittest". Why are medical students allowed to make mistakes and nursing students are not? I would have learned a lot more by observing a really competent nurse.

I mean, that's what we're saying. Trial by fire is a terrible way to train healthcare professionals. For both the professional and the patient. While simulation is an excellent learning tool, it does not translate perfectly to actual human beings. I wouldn't trade the time I had learning with the professional models (gynecological and digital rectal/urological examinations) or the standardized patients during NP school for anything. More than observation is needed to learn the skills necessary to practice. You need to be familiar and comfortable with performing the assessment, identifying normal versus abnormal, prioritizing, medication administration, etc. It should all come together in stages, of course, but you aren't going to learn it by just watching someone else do it well. It's also vital to remember that your prerequisites, especially your sciences, are going to be a baseline of the knowledge that you will need to know what is normal versus abnormal. If you don't understand anatomy and physiology, you're not going to understand pathophysiology. If you don't grasp the basic organic and biochemistry, you're going to have more trouble in pharmacology and even in your biologies. Knowing your standard math is necessary for drug calculations and statistics for handling and reviewing research. 

 I do caution, however, regarding mistakes. Always remember that safety is paramount. Mistakes that threaten safety are those that even medical students or Residents can be dismissed over. Always be alert and aware of your surroundings. 

Thanks HarleyQuinn, I should have mentioned that I'm no longer a student, I was just reflecting back. Sadly, most of my classmates hated their clinicals. 

Yes, safety is paramount.

In reality, we could never have practice to the unrealistic expectations placed on us back then, especially during this current Covid situation.

It's because school doesn't prepare us. When you are thrown into an emergency situation in the real world that's when you learn.

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

On 8/25/2021 at 10:16 PM, Julius Seizure said:

In my program, first year nursing students took Chemistry.  But not the regular Chemistry class, oh no.  This was a special Chemistry class specifically for nursing students to fill their pre-requisite.  I guess they didn't want to bore/confuse us with any extra stuff beyond the basics that we needed to check the box.

I had to take three semesters of Chemistry in college, and we sat alongside everybody else that took Chemistry- premed, chem majors, biochem … two semesters of basic chem and one of organic chem. 

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

On 9/1/2021 at 9:38 AM, 2BS Nurse said:

"I see new grads orienting new grads.  How does a person who hasn't been a nurse long enough to develop critical thinking skills themselves teach critical thinking skills to anybody else?"

Is anyone else afraid to be a patient in a hospital?

I have had two big ortho surgeries in two different hospitals in the last year. One, in Elsewhere Community Hospital, was not a good experience. Leaving aside anything but nursing, here. My nurses didn’t check to see if my analgesia was effective (it wasn’t), didn’t offer oral care or a face cloth after I vomited (thanks for not listening to me about that crap, anesthesiology!), didn’t get me anything to eat the next day for breakfast, and after I asked three times, I got lunch but them they took it away because they gave the wrong info to X-ray and said I was NPO for some gastric study (uh, no, that would be somebody else). I got no postop teaching on wound care even though I asked. Forget the concept of even a pits-and-pubes wash. Call light? Clearly optional here. 
Second one was at another hospital specializing in ortho work. I understand the nurses are ortho specialists too, but they were good beyond that. Well-staffed c RNs only, great patient teaching, helpful when I couldn’t move much, always attentive to mental and psych comfort.

Husband was in ECH for PEs and I though they were going to let him die of neglect. Understaffed, few RNs, not clear on why a bubble in the IV wouldn't cause a stroke, left him to get OOB with an IV and off oxygen when he desatted on any activity at all… I would be afraid to go back there again. 

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

On 9/2/2021 at 9:07 AM, Nurse Beth said:

I agree with the medical model of training. New grads need progressive responsibility and supervision.

I agree with that. I just don’t think we need to call it a “medical model” when it’s the rule for bus drivers, musicians, football players, heavy equipment drivers, and bank tellers. 

Nurse Beth, MSN

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

On 9/2/2021 at 4:29 PM, HarleyvQuinn said:

 Trial by fire is a terrible way to train healthcare professionals.

While simulation is an excellent learning tool, it does not translate perfectly to actual human beings.

 You need to be familiar and comfortable with performing the assessment, identifying normal versus abnormal, prioritizing, medication administration, etc. It should all come together in stages, of course, but you aren't going to learn it by just watching someone else do it well.

 you will need to know what is normal versus abnormal. If you don't understand anatomy and physiology, you're not going to understand pathophysiology. 

So well put

Nurse Beth, MSN

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

6 minutes ago, Hannahbanana said:

I agree with that. I just don’t think we need to call it a “medical model” when it’s the rule for bus drivers, musicians, football players, heavy equipment drivers, and bank tellers. 

I'm referring to the long and progressive clinical path (student, intern, resident, attending) of training as opposed to the almost immediate full responsibility expected of new grad nurses.

New nurses are overwhelmed.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

6 minutes ago, Nurse Beth said:

I'm referring to the long and progressive clinical path (student, intern, resident, attending) of training as opposed to the almost immediate full responsibility expected of new grad nurses.

New nurses are overwhelmed.

I agree, but sadly, with experienced nurses leaving in droves (bedside and nursing both), it's usually recent grad training new grad in some locations 😳 sometimes, there is no one but new nurses, and that just scares me to no end!

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

4 hours ago, Nurse Beth said:

I'm referring to the long and progressive clinical path (student, intern, resident, attending) of training as opposed to the almost immediate full responsibility expected of new grad nurses.

New nurses are overwhelmed.

In part I think this also harkens back to the bad old days (Faulkner says the past is never dead, it’s not even past) when physicians had full responsibility for everything, so their training reflected that to protect the profession from accusations of error. Nurses were largely discounted so there wasn’t that assumption that they had to be excellent practitioners when turned loose on an unsuspecting public.

If nursing were seen to deserve respect for our expertise the way popular wisdom sees physicians’, this would change. We have an effing loooooong way to go in that one.