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Seeing the big picture: Facilitating critical thinking in new nurses


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Seeing the big picture: Facilitating critical thinking in new nurses

After reading this article, you will be able to:

  • Describe strategies to facilitate critical thinking in new nurses

Nurses beginning their first job after graduation need help developing critical thinking skills. Pamela Schubert Bob, MHA, RN, CPN, NE-BC, nurse manager at Children’s Hospital Boston, wanted to facilitate critical thinking in new, or as she refers to them, “novice” nurses. 

“I overheard one of my nurses tell a doctor, ‘I don’t know anything about that because I wasn’t here yesterday,’ ” says Schubert Bob. “I cringed because this was an unacceptable response. I felt that younger, newer staff weren’t seeing the big picture. They were looking at taking care of patients for a shift instead of taking care of a patient as a whole.

“I wanted to create an environment in which it was okay for the staff to ask and answer critical thinking questions.” 

Creating a critical thinking program

Schubert Bob began by approaching a newly hired nurse whose patient had a history of seizures. “I asked her what she would do if her patient had a seizure. She wasn’t sure how to respond. We worked through things like what equipment should be at the bedside, what actions to take during a seizure, etc. At the end of those five minutes she felt much more confident.”

Schubert Bob continued these informal critical thinking exercises. After each report, she would interact with new nurses, asking critical thinking questions and sometimes using worst-case scenarios as a starting point. 

The impact on nurses’ critical thinking skills was almost immediate. To help with mentoring, she developed a critical thinking program that relied on the expertise of available senior nursing staff. These experienced nurses were trained to interact on a one-to-one basis with new nurses in five-minute sessions. 

Training nurses to stimulate others’ critical thinking skills

Schubert Bob points out that “not every experienced nurse can mentor and teach others. You really have to want to do it.” Most staff nurses “jumped at the chance,” she says.

Schubert Bob provided the initial training, which included an explanation of critical thinking and its importance to nursing practice, the kinds of questions to ask new nurses for the purpose of improving critical thinking, and how to formulate and ask open-ended questions such as the following:

  • What is the worst-case scenario for your patient?
  • What are your plans for patient education?
  • How will your documentation help your peers to maintain continuity of care?  

These critical thinking sessions were designed to take about five minutes. After training, each senior nurse listened to a critical thinking session between a new nurse and Schubert Bob or another trained facilitator. 

“Regular sessions for questions, direction, and support were offered until the senior nurses were comfortable facilitating critical thinking sessions,” says Schubert Bob.

Once the program started, either senior or new nurses could initiate sessions. A list of trained critical thinking mentors was posted so new nurses could easily approach trained facilitators. Both new and experienced nurses felt that this program improved critical thinking skills.

Source

Briefings on Evidence-Based Staff Development (formerly The Staff Educator), August 2010, HCPro, Inc.