Picture this: you've only been on the floor a few months. Today, your congestive heart failure patient is scheduled for pacemaker implantation first thing in the morning. The doctor orders two units of blood before transfer to the OR. You 
start the first bag with no problem but after beginning the second bag, your patient's O2 saturation drops from 95% to 90%. You decide to administer oxygen, but this only brings your patient's O2 level back up to 91%.
Stop and think. What could be going on with your patient? You pull your patient's chart to investigate further and notice his I&Os. It turns out that your patient has a positive fluid balance of 2 full liters. You also hear crackles while performing a respiratory assessment. Now what? What intervention is appropriate to raise his O2 level?
It takes critical thinking to determine what could be going on with your patient and what you should do about it. But many novice nurses aren't skilled in critical thinking, and many flounder with the concept when they get on the floor.
Developing critical thinking skills takes time
Critical thinking skills are vital to keeping patients safe while maintaining an efficient nursing practice. In general, five components represent each aspect of critical thinking:
- Problem recognition
- Prioritization
- Clinical decision making
- Clinical implementation
- Reflection
Your critical thinking skills begins to develop in nursing school, where you're exposed to increasingly complex problems, case studies, and, eventually, real patients. But a nurses' critical thinking ability isn't fully formed until years after he or she enters clinical practice.
As a nurse advances from novice to expert, his or her critical thinking skills progress. Instead of only theoretical knowledge gained in school, real world experience enhances a nurse's ability to predict and respond to the unique challenges of patient care. Experience is accrued over time, and each experience boosts a nurse's proficiency in their chosen specialty. Eventually, critical thinking becomes second nature.
What can you do to develop your critical thinking skills?
As a new nurse, you can develop your critical thinking abilities, even if you've struggled in the past.
- Ask your preceptor: Nurse preceptors are invaluable for helping novice nurses transition from student to bedside practice. But beyond the precepting duties you may already know, nurse preceptors are in prime position to help you think critically. Asking your preceptor to reflect on and talk with you about your patients helps you better understand the big picture. This also gives your preceptor an opportunity to see how your critical thinking skills are progressing based on your past experiences.
- Use tools: Some tools, such as concept maps, can continue to be used when you enter practice as a way to connect the dots. Concept maps help develop critical thinking skills by linking new information to existing knowledge in a viewable, easy-to-understand format. You may have already used this tool in nursing school - now, use it to help you connect the dots in patient care.
- Write it down: Some research indicates that journaling and other forms of writing helps newer nurses develop their critical thinking skills by introducing them to new developments and broader perspectives in health care. Online journal clubs where others can review your work, chat rooms, and even some message boards can help you bounce ideas off your colleagues and gain insight from unbiased sources.
- Simulate a patient care experience: It's not available in all facilities, but many health care organizations host simulation laboratories to give nurses of all experience levels a chance to develop their skills. Simulation labs provide a safe environment for hands-on experience with complex patient care cases. What you learn in the lab can easily be transferred to your daily nursing practice.
- Get an attitude: One of the best ways to develop your own critical thinking skills is by consistently challenging your own knowledge base. Instead of taking everything for granted, develop an attitude of closer inspection and questioning. Asking why you're doing something helps enhance your critical thinking skills using rationales and evidence, not just “because we've always done it that way".
