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Use expert techniques to boost new graduates’ critical thinking skills

Nurse Leader Weekly, November 13, 2006

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If you spend any time on a nursing unit, you probably become familiar with the all-too-common complaint that "new nurses just don't know how to think critically."

Critical thinking is one of the core components of nursing, but with growing demands being placed on the profession, inexperienced nurses are increasingly expected to just pick up these skills along the way, or develop them naturally.

The truth is that such an expectation is not only dangerous but also unrealistic. In a 2005 study published in Nursing Education Perspectives, only 35% of new RN graduates in the study-regardless of educational preparation-met the entry expectations for clinical judgment.

Identify strengths and weaknesses

Before developing a plan of action, it's important for educators and nursing staff to know how far along-or behind-students are on the critical-thinking scale.

"It's good to realize where undergraduates are coming from, and it doesn't do any good to complain that we wish they were coming from a different place," said Polly Gerber Zimmerman, RN, MS, MBA, CEN, an assistant professor of nursing at the Harry S. Truman College in Chicago, IL, during the recent HCPro audioconference "Developing Critical Thinking Skills in New Graduate Nurses."

According to her, most inexperienced nurses fear committing the error of commission (e.g., giving the wrong drug or saying the wrong thing) when, in reality, their errors tend to be acts of omission (e.g., not looking or forgetting to do something).

To coax students out of their shells, Zimmerman recommends incorporating several strategies into teaching practice, one being prioritization principles.

Prioritization principles

One of the biggest challenges that new graduates face is determining their top priorities and organizing their actions around them.

"Universally, across the country, new graduates tend to have problems with prioritization," said Zimmerman. As an example, she cites that new nurses struggle with identifying which patient and patient needs should be taken care of first.

To address this issue, Zimmerman now conducts a two-hour class for her students on prioritization principles, and gives them the following tips:

• Focus on patients before paperwork
• Pay attention to trends (e.g., progressive decline, minor systems recurring repeatedly)
• Life before limb
• Rule out the worst-case scenario
• Consider patient demographics (e.g., the very young/old)
• Remember that known conditions can develop a new problem
• Avoid distractions
• Focus on the "what" rather than the "who"

Editor's note: This excerpt was adapted from Recruitment & Retention Monthly, November 2006, HCPro, Inc.

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