In recent years, critical thinking skills have been recognized as a necessary component of nursing education. There’s an obvious reason for this: health care today is a complex, high-tech environment, and bedside nurses have to make complex decisions in order to deliver safe, effective patient care.
But by far, the most effective way to expand critical thinking skills is through education.[/caption]
But there’s been a lot less discussion about the critical thinking skills needed by nurse managers, who also must function in a highly complex environment. Many nurse managers have risen to their current positions based on their competence in a clinical role, without any formal training or experience in leadership and management skills. They somehow have to learn to think critically about unfamiliar areas like finance, budgeting, staffing, strategic planning, and quality assurance. Without critical thinking skills, nurse managers can’t make day-to-day decisions strategically, with an eye toward advancing the goals of the organization.
Through critical thinking skills, a nurse manager can become a transformational leader. She or he can challenge assumptions, develop a more robust understanding of a problem’s underlying causes, and generate more creative solutions when using critical thinking. Without these skills, a manager may fall back on reactive, automatic responses to problems – and miss the opportunity to make changes that are visionary and goal-driven.
In 2010, a group of nurse researchers designed a study that would allow them to measure the effects of a manager’s critical thinking skills on the attitude of the floor nurses that person was managing. They concluded that nurse managers with stronger critical thinking skills were better able to create positive practice environments that correlated with higher job satisfaction and better retention of staff nurses. Nurses who work in a positive environment are thought to be less susceptible to the effects of burnout, putting them in a better position to deliver high-quality care and keep patients safe.
A Medscape article about critical thinking skills for nurse managers illustrated, with a hypothetical example, the difference a strong leader can make. It presented a case study about a manager facing a scheduling conflict over the holidays. In the past, staff nurses with seniority were given first choice of days off, leaving more junior nurses dissatisfied. The reactive way of thinking would be continue on with this same policy – without challenging current assumptions about seniority, fairness, and staff satisfaction. Yet a manager with critical thinking skills might look at alternatives that improve staff satisfaction and enhance the goal of self-governance – and then form a unit committee to produce a holiday schedule with sufficient staffing.
To further develop critical thinking skills outside of clinical areas, nurse managers can adopt the following habits:
- Suspend judgment, and demonstrate open-mindedness for other departments and other views. This allows you to work as a team with other leaders, and to balance the goals and interests of various departments – which benefits the organization as a whole.
- When confronted with a problem or situation, seek out the truth by actively investigating a problem or situation.
- Ask questions about anything you may not fully understand and never be afraid to admit to a lack of knowledge. Gathering data in this way is crucial to making informed decisions, and to building a full understanding of both your organization and the current industry environment.
- Reflect on your own thinking process and the ways in which you reach a conclusion. Identifying a personal bias is the first step toward eliminating it, allowing you to move toward more objective or multi-dimensional ways of thinking.
- Look for a mentor with more experience than you have and join professional organizations, in order to gain experiential knowledge and build a network of colleagues whom you could turn to for advice when needed?
The Medscape article mentioned above also describes this innovative way to further develop critical thinking skills:
One way nurse managers can develop critical thinking is to start writing in a reflective journal. Establishing a consistent routine of writing at least weekly in a journal can improve critical thinking (Profetta-McGrath, 2005). Writing about critical incidents, complex situations that require decision making, as well as emotions and feelings about interactions and events stimulate analysis, synthesis, judgment, and creativity that are components of critical thinking. Through the process of writing, connections are made between theory and practice. Patterns of behaviors are recognized and a hypothesis may be formed that can lead to a change in practice (Profetta-McGrath, 2005).
But by far, the most effective way to expand critical thinking skills is through education. When you acquire a broader view of health care, from a systems and policy perspective, you equip yourself to make strategic decisions at the managerial or executive level. Highly effective nurse leaders know this, and have made education their ally.
American Sentinel’s online MSN, nursing management and organizational leadership specialization degree is designed for experienced nurse professional who seek to develop both management and leadership skills. Through case studies and hands-on course work, nurses examine the various human resource challenges facing an organization as well as the dynamic nature of the strategic planning and management processes.Tagged as leadership, MSN
Critical thinking can seem like such an abstract term that you don’t practically use. However, this could not be farther from the truth. Critical thinking is frequently used in nursing. Let me give you a few examples from my career in which critical thinking helped me take better care of my patient.
The truth is, that as nurses we can’t escape critical thinking . . . I know you hate the word . . . but let me show you how it actually works!
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Critical Thinking in Nursing: Example 1
I had a patient that was scheduled to go to get a pacemaker placed at 0900. The physician wanted the patient to get 2 units of blood before going downstairs to the procedure. I administered it per protocol. About 30 minutes after that second unit got started, I noticed his oxygen went from 95% down to 92% down to 90%. I put 2L of O2 on him and it came up to 91%. But it just sort of hung around the low 90’s on oxygen.
I stopped. And thought. What the heck is going on?
I looked at his history. Congestive heart failure.
I looked at his intake and output. He was positive 1.5 liters.
I thought about how he’s got extra fluid in general, and because of his CHF he can’t really pump out the fluid he already has, let alone this additional fluid. Maybe I should listen to his lungs..
His lungs were clear earlier. I heard crackles throughout both lungs.
OK, so he’s got extra fluid that he can’t get out of his body.. What do I know that will get rid of extra fluid and make him pee? Maybe some lasix?
I ran over my thought process with a coworker before calling the doc. They agreed. I called the doc and before I could suggest anything, he said.. “Give him 20 mg IV lasix one time.. I’ll put the order in.” CLICK.
I gave the lasix. He peed like a racehorse (and was NOT happy with me for making that happen!). And he was off of oxygen before he went down to get his pacemaker.
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Critical Thinking in Nursing: Example 2
My patient just had her right leg amputated above her knee. She was on a dilaudid PCA and still complaining of awful pain. She maxed it out every time, still saying she was in horrible pain. The told the doctor when he rounded that morning that the meds weren’t doing anything. He added some oral opioids as well and wrote an order that it was okay for me to give both the oral and PCA dosings, with a goal of weaning off PCA.
“How am I going to do that?” I thought. She kept requiring more and more meds and I’m supposed to someone wean her off?
I asked her to describe her pain. She said it felt like nerve pain. Deep burning and tingling. She said the pain meds would just knock her out and she’d sleep for a little while but wake up in even worse pain. She was at the end of her rope.
I thought about nerve pain. I thought about other patients that report similar pain.. Diabetics with neuropathy would talk about similar pain… “What did they do for it?” I thought. Then I remembered that many of my patients with diabetic neuropathy were taking gabapentin daily for pain.
“So if this works for their nerve pain, could it work for a patient who has had an amputation?” I thought.
I called the PA for the surgeon and asked them what they thought about trying something like gabapentin for her pain, after I described my patient’s type of pain and thought process.
“That’s a really good idea, Kati. I’ll write for it and we’ll see if we can get her off the opioids sooner.”
She wrote for it. I gave it. It takes a few days to really kick in and once it did, the patient’s pain and discomfort was significantly reduced. She said to get rid of those other pain meds because they “didn’t do a damn thing,” and to “just give her that nerve pain pill because it’s the only thing that works”.
And that we did!
She was able to work with therapy more because her pain was tolerable and was finally able to get rest.
Critical thinking is something you’ll do every day as a nurse and honestly you probably do it in your regular non-nurse life as well. It’s basically stopping, looking at a situation, identifying a solution and trying it out. Critical thinking in nursing is just that, but in a clinical setting.
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Date Published - Sep 30, 2016
Date Modified - Jun 12, 2017
Written by Jon Haws RN
Jon Haws RN began his nursing career at a Level I Trauma ICU in DFW working as a code team nurse, charge nurse, and preceptor. Frustrated with the nursing education process, Jon started NRSNG in 2014 with a desire to provide tools and confidence to nursing students around the globe. When he's not busting out content for NRSNG, Jon enjoys spending time with his two kids and wife.