Promote Critical Thinking Skills - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

An experienced nurse was bemoaning the lack of critical thinking skills demonstrated by novice nurses. So what are you doing about this I asked? The ability to be an astute critical thinker does not happen over night. It is a skill that grows when novices receive good coaching. This has become very challenging recently as there are fewer and fewer experienced preceptors. New nurses are often oriented by staff with less than one year of experience themselves. Additionally, the frantic pace of healthcare today has led many nurses to become very task oriented as a survival mechanism. Reflection on one’s work is rare although experts advise that it is necessary for professional growth. So the challenge for nurse leaders is how to promote critical thinking so it becomes integrated into everyday nursing practice.

What is Critical Thinking?

A simple definition of critical thinking is that it is reasonable, reflective thinking focused on deciding what to believe or do. In nursing, critical thinking for clinical decision-making is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process used to ensure safe nursing practice and quality care (Heaslip). A key concept in critical thinking is the art of reflection. Dr. Robert Ennis at Illinois State University has identified key behaviors of critical thinkers. These include:

A critical thinker:

Is open-minded and mindful of alternative
Desires to be, and is, well-informed
Judges well the credibility of sources
Identifies reasons, assumptions, and conclusions
Asks appropriate clarifying questions
Judges well the quality of an argument, including its reasons, assumptions, evidence, and their degree of support for the conclusion
Can well develop and defend a reasonable position regarding a belief or an action, doing justice to challenges
Formulates plausible hypothesis
Defines terms in a way appropriate for the context
Draws conclusions when warranted – but with caution

The above are skills that we would like to see in our nursing staff. Some nurses are intuitively better critical thinkers than others but there are strategies that nurse leaders can use in their environments to promote these skills.

Creating a Learning Environment to Promote Critical Thinking

Judith Ross in a 2009 Harvard Business Review Blog suggested that the most effective questions create value. Here are some examples of the value that can be built and the sample questions that can be asked:

1. To create clarity – Can you explain more about this situation? What do you think the issue is here?

2. To help staff think analytically and more critically – What are the consequences if you take this action? If our organization does not take action to decrease our financial costs, what will happen when reimbursements decline?

3. To inspire reflection – Why do you think you were successful in that situation? What is different about today’s healthcare environment that when you initially began your career?

4. To encourage breakthrough thinking – Is there another way that we could do this? If you were redesigning care today with a blank slate, what type of delivery system would you develop?

5. To challenge assumptions – What would happen if we fail to take action in view of what is happening with health reform? Do you think that this type of care needs to be delivered in a hospital setting?

6. To create ownership of solutions – Based on your nursing experience, what do you suggest that we do here? What changes would be in the best interest of your patients? How would you deal with the dilemma of the 12-hour tour?

With the focus today on evidence-based practice, nurse leaders need to promote a culture of critical thinking and inquiry. A culture of inquiry begins by valuing the use of questions in one’s own leadership practice. Without asking questions, you may falsely assume you have consensus or that staff understand an issue or problem. Moving from telling to asking may be challenging but it is the way to help staff grow.

Read Rose Sherman’s new book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave

Read to Lead

Critical Thinking and Nursing. The Critical Thinking Website