Critical thinking in nursing can be described as the ability of an individual to use logic, reasoning and judgment when faced with clinical decision-making.
In essence, critical thinking is about problem-solving and involves doing more than just accepting the information given and immediately making a decision. In this article we will discuss what critical thinking in nursing entails.
- Case-Based Approach
- Practice With a Questioning Attitude
- Assess Evidence-Based Research Carefully
- Strive For Clarity Within Nursing Documentation
- Developing a Closer Relationship With Your Nursing Colleagues
- How are critical thinking skills applied in nursing?
- Why are critical thinking skills important for nurses?
- How are critical thinking skills acquired in nursing school?
Critical Thinking: A Vital Trait for Nurses
Critical thinking is a specific way of coming a decision from an objective and balanced, place rather than taking everything you are told at face value and making a quick decision. It also encompasses considering implications of decisions to prevent further issues.
Critical thinkers question the information given to them, evaluating it by looking for supporting evidence and ensuring data points are accurate.
EXAMPLE: The blood pressure in the chart might be 84/44. A critical thinker would not immediately call a physician to notify and get an order for a fluid bolus. He or she would go to the patient’s room, re-check the blood pressure to ensure it is accurate, and assess the patient (dizziness, shortness of breath, etc.) before calling the medical team.
Being able to think on this level is imperative for patient safety, but not something that can be immediately learned simply by looking at a textbook or listening to a lecture. It takes repetition and practice in the clinical setting, with skilled clinicians aiding the novice in developing these skills. Nursing students will pass exams about the theory behind critical thinking, but that merely provides information about the skill and does not mean that they are able to deploy these skills during intense clinical situations immediately.
(So, students, given yourself a little grace here as you’re learning how to become a critical thinker!)
What Is Critical Thinking?
As mentioned earlier, critical thinking entails more than just accepting facts blindly without questioning them. Although this may work within certain situations, there are many cases where nurses are expected to use good judgment when making clinical decisions.
This occurs often in hospitals, so critical thinking skills are so crucial for healthcare professionals. It’s not just about intelligence.
Examples of Critical Thinking
- Deducing information from what you have been told
- Their MAP is 61 … their end-organs are not adequately perfused
- Making assumptions based on logic or reason, without being swayed by emotion
- I feel really nervous, but that does not mean this is an emergency
- Drawing appropriate conclusions based on the evidence available at any given time
- They are cold and clammy, have been NPO for 6 hours, and their blood sugar is 42. They are likely hypoglycemic.
- Avoiding distractions and focusing clearly while using your mind to its best potential
- While I’m dealing with an unstable blood pressure, I will ask the family who is loudly talking about lunch plans in hallway to go to the visitor’s lounge
- Gauge level of urgency accordingly, exercising the ability to work as autonomously as possible
- Their blood sugar is 42. I will check our hypoglycemia policy before calling the physician, and only call if I really need to. Just because this is a new situation to me and I feel scared does not mean it is worth notifying the physician about.
Naturally, functioning at this level takes time, experience, and reflecting upon that experience to build this knowledge and wisdom.
Critical Thinking Skills in Nursing
This can be difficult to implement in practice, especially since clinical decision-making can often be stressful and difficult. It involves thinking logically, objectively, and critically about a situation to arrive at an appropriate course of action that will benefit the patient. Critical thinking skills are frequently utilized when nurses provide care for patients in hospitals due to the complex nature of clinical setting decision-making.
Critically analyzing your thoughts before you act upon them can help you avoid falling into common traps of flawed reasoning. Better yet, arming yourself with the best possible information will allow you to make better decisions that can positively influence patient outcomes.
Critical thinking skills are not limited to nurses providing care in hospitals. Nurses working in community settings often face complicated situations which are best navigated by using critical thinking skills.
This skill is positively correlated with solid communication and interpersonal skills, so it can be said that without these abilities, a nurse would have trouble applying critical thinking skills effectively.
How Do Nurses Use Critical Thinking?
We use critical think skills constantly throughout a shift:
- Performing an assessment on a patient, deciding what is worrisome and worth exploring further
- Speaking with a family member who is voicing concerns
- Deciding what to delegate
- Deciding what nursing interventions are necessary
- Deciding what changes that occurred during a shift are worth reporting in hand-off
- Figuring out how to address a customer service issue (patient very upset incorrect meal delivered, wants to speak with management)
- Navigating when a process has broken down (patient arrived from PACU, no orders, can’t find family)
- Deciphering what feelings come up that should be explored vs. emotional reactivity (something seems “off” with the patient vs. I feel nervous today something must be wrong with my patients – and this can be really difficult to make sense of sometimes!)
- When what the patient wants is different from the medical team’s plans
- When the patient is scheduled for a procedure and is not ready
- Quelling a sense of overwhelm to enable you to think logically and rationally
Nurses with exceptional critical thinking sills tend to be more efficient with their time and interventions, as they are not distracted by red herrings in assessment findings or placating emotions.
The Best Ways Nurses Can Improve Critical Thinking Skills
To get better at critical thinking, you have to work at it. It’s much like going to the gym; the first few times are clunky and feel weird, but the more you go the easier it gets and the more improvement you will see in your physical health. Let’s discuss ways to flex your critical thinking muscle so that you can bear a heavier load in the future.
A case-based approach going through a clinical situation from start to finish. Think back to specifical clinical experiences (even smaller situations) and how you mentally worked through your decision-making at the time. What happened? What decisions did you make? What conclusions did you arrive to? How did it go? Now that you’ve gone through the experience and saw the outcome, what did you do well and what did you miss?
These personal experiences are invaluable. But they are a bit of a hidden gem, right in plain sight. The way you develop wisdom from situations is by actively processing them and reflecting upon them afterwards. Extract as much value as possible. Learn your lessons. Because nursing is so fast-paced, you have to actively pause and reflect to get this value.
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There are people who never do this who have been in the field for many years. They unconsciously hope to passively learn important lessons as they fly through them every shift. What could have been learned through 1-2 occurrences followed by reflection and consideration requires many more instances to arrive at similar conclusions that would potentiate a change in behavior.
Practice With a Questioning Attitude
If you would like to use critical thinking in your nursing career, you must develop a questioning mind. It can be tempting to accept what has been offered to you at face value when starting in the industry, but this method does not encourage you to think beyond the information given.
Here’s an important caveat: At the beginning, you’ll drive yourself crazy questioning every thing. We are not developmentally to a point where you can begin to really do that quite yet. You need to get your sea legs first before you can command the ship.
There is a difference between verifying your data points and never accepting anything as accurate. If your blood pressure seems off, go re-check it and ensure that the cuff is sized correctly. Do a manual BP if necessary. Once you get the number, accept it and move forward.
Don’t obsess over triple and quadruple checking data points; this will waste valuable time and you will be focusing on the wrong things.
Assess Evidence-Based Research Carefully
Nurses who use critical thinking in their everyday nursing role should always make sure that they assess the quality of evidence-based research before using this information to inform their practices. By doing so, you will become more aware of where your information comes from and why it would be best suited to the situation you are currently working with. It also means that your chances of making an error when deciding which facts are relevant decrease significantly.
Your hospital policies are reviewed regularly, and at the beginning it is perfectly fine to accept them as is while you’re learning how to be a nurse. But soon, we should be regularly questioning practices and ensuring whatever the hospital policy states is reflective of the latest evidence. Consider sitting on a policy review team. And if you encounter a policy that doesn’t seem appropriate, it might not be! You may be the change agent needed.
Example: A physician at a hospital just had her baby and was off of maternity leave and breastfeeding. While documenting, she would use a hands-free breast pump under her clothes. A coworker complained, and she was told that it was a medical device, inappropriate, and against policy. She pushed back and said that it is fully concealed and under her clothes, stating that it is no different than diabetics wearing insulin pumps or any other medication pump, and that this was not inclusive to breastfeeding mothers. The hospital administration brought her concern up the chain of command, who agreed with her and asked her to assist in writing the updated policy to prevent this from happening again!
Strive For Clarity Within Nursing Documentation
Another method that nurses can use to use critical thinking effectively is striving for clarity within the documentation. What is written in the chart will enable you to better deduce the best course of action. Many times we have to look back to the documentation of previous shifts ensure what we’re at this very moment truly is appropriate.
As you look at charts, notice when it’s difficult to tell what the previous nurse was doing/ thinking during a clinical situation. Also notice when it’s very easily to tell what the heck happened. Note the differences and emulate the characteristics of the nurse who made it much easier on you.
Developing a Closer Relationship With Your Nursing Colleagues
By developing a closer relationship with their colleagues, nurses can ensure that they can engage in more productive discussions about their everyday work problems and how these could best be solved. Being aware of other people’s perspectives on any given topic allows you to understand better why they would support certain decisions over others.
Not only does this help inform your own decisions, but you will also be able to work better with your colleagues as you are aware of what they would expect from the decision-making process.
Critical Thinking FAQ’s
How are critical thinking skills applied in nursing?
Using critical thinking skills in nursing requires nurses to carefully go through every step of the decision-making process during your shift. These skills are used when deciding to escalate care, when to notify providers, what is appropriate to delegate, how to prioritize responsibilities, how to gauge your level of urgency, what interventions are appropriate, as well as how/what to communicate.
Why are critical thinking skills important for nurses?
Nurses who use critical thinking skills are less likely to make mistakes or take unnecessary risks because they have gone through the decision-making process in a logical order with appropriate rationale. This also equates to being more efficient with your time.
How are critical thinking skills acquired in nursing school?
Nursing students are first introduced to the concept of critical thinking in nursing school, often in a fundamentals class. Students may also read about this in a textbook, but it is not something that can be learned by reading or listening. Student should be given examples of critical thinking and a structure, then see situations unfold at clinical, and then process them with an instructor.
We have a course that can help develop a strong critical thinking foundation to enable students and experienced nurses alike strengthen this vital skill. Learn more about it here.
(Psst – This course is also part of our VIP membership, along with Preceptor Pro and Charge Nurse Jump Start! Get access to three courses for only $29/month. Click here to learn more about becoming a VIP.)
Ending Thoughts & My Ultimate Critical Thinking Resource for Nurses
Nurses are under constant pressure to provide high-quality care care for patients in hospitals and community settings, making critical thinking skills ever-more relevant. Learning how to think critically will equip you to make sound decisions based on evidence that you can speak to.
Have any questions? Let us know in the comment section.
And don’t forget! We have our FreshRN Critical Thinking for Nurses course now available. If you want to learn more about how to think critically though-out your shift, sign-up below.
MARY ROSE L. BATOY says
I LOVE THIS ARTICLE. WILL BE SHARING THIS TO MY NURSES IN ONE OF OUR MEETING. Thank you for sharing.
MARY ROSE L. BATOY says
I LOVE THIS ARTICLE. Thank you for sharing.