Helping new nurses base their actions on evidence
New graduates entering the nursing world may breathe a sigh of relief that their classes are done. But according to Shelley Cohen, RN, BS, CEN, and Kelly A. Goudreau, DSN, RN, CNS-BC, when it comes to critical-thinking skills, school is just getting started.
"When we really begin this critical-thinking process, we get these new grads into a position where they can make some good decisions based on actions that are validated through evidence," said Cohen, who is an educator and consultant for Health Resources Unlimited, a company in Hohenwald, TN, that she founded in 1997.
Both Cohen and Goudreau spoke during the recent HCPro audioconference "Critical Thinking in Nursing: Evidence-based methods for new graduates."
During the audioconference, listeners were asked to indicate whether their facility currently used a method to assess the critical-thinking capability of their new staff members.
Although 44% answered yes to the question, 56% said that they did not currently use a method.
"I find that's pretty much average from the facilities that I work with," said Cohen. "And I think a lot of it is that people aren't really sure how to introduce critical-thinking skills to the new grad."
Strategies for instituting critical thinking
One of the main questions to ask when assessing a new graduate's critical-thinking capacities, said Cohen, is to look at Dorothy Del Bueno's principles of critical thinking.
When analyzing a new graduate's ability to think critically, Del Bueno identified the following four questions that one should ask:
Can the nurse recognize that the patient has a problem?
Can the nurse manage the problem safely and effectively, recognizing his or her scope of practice?
Does the nurse have a relative sense of urgency?
Does the nurse take the right action for the right reason?
After evaluating where students are currently at in terms of critical-thinking skills, said Cohen, look at the attributes of a critical thinker. (See the sample pocket card on p. 4 of the PDF of this issue, which you can copy, laminate, and distribute to attendees of a critical-thinking class.)
"When a preceptor or the educator is working and meeting with the new grad, I think these attributes be
come absolutely critical on making a decision on how well this new grad is working with your patient plan, your patient assignment, and incorporating critical thinking," said Cohen.
The card also contains examples of when it is advisable to call a physician (such as when there is risk-management potential).
"[Nurses] so often feel they need a permission slip to pick up the phone and call the doctor," said Cohen.
Staff educators are in a unique position to truly assist new graduates in critical thinking on a more personal level, said Goudreau. "The staff development specialists really will focus on an individual development plan with the individual nurse and will help to grow, develop, and nurture [him or her]."
The dollars don't say it all
One of the biggest reasons why facilities hesitate to invest in teaching critical-thinking skills, said Goudreau, is finances.
However, she urges managers to look at other numbers besides the start-up dollar figures.
"This is not just a money issue," said Goudreau. "This is a retention issue."
She said that 15%-50% of new nurses who go through a program that provides a high level of support and intensity in addressing their critical thinking abilities will be retained.
"Think about the dollars involved in that, and the time that is involved," she said. "It really is a very strong argument."
When time and money are invested in critical-thinking programs, new nurses will truly reap the benefits, said Cohen. There is no better feeling for new nurses, she said, than:
Being accepted by their peer group
Feeling confident in their delivery of nursing care
Knowing there is a process to support staff members when errors occur
These items, said Cohen, are "absolute essentials in helping to hang onto these folks." And it goes beyond the new nurses. "Our job is to nurture and encourage not just critical thinking in a new grad, but in everybody who's delivering nursing care to your patient," she said.
Del Bueno, D. (2005). "A crisis in critical thinking." Nursing Education Perspectives 26(5): 278-282.