Helping New Nurses With Critical Thinking Skills

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Onboarding new graduates this year will take a village. A nurse manager recently shared her concerns, “I am shocked at how underprepared our new nurses are this year. While doing leader rounding, I asked a new graduate about her patient, and her assessment of the priorities for care was genuinely concerning. Preceptors are coming to me to say – “even the basics need to be taught because their critical thinking skills are so limited.”

Preceptors need guidance on assessing new graduates’ skills and promoting critical thinking. Many of the preceptors themselves have limited experience. But neither preceptors nor managers can do this alone. Everyone who interacts with new graduates should help them think through situations they are confronted with. This will not happen through osmosis. We become better critical thinkers when good open-ended questions (which can’t be answered with a yes or no) are asked, forcing us to stop and think before we answer them. Critical thinking is crucial in a fast-paced turbulent environment, so understanding what it is and how it can be developed is essential.

What is Critical Thinking?

Critical thinking is reasonable; reflective thinking which is focused on deciding what to believe or do. In nursing, critical thinking for clinical decision-making is the ability to think systematically and logically. Evidence shows that new nurses can be effectively coached to become better critical thinkers. A strong critical thinker can do the following:

Remain open-minded and mindful of different alternative actions.
Prioritize what matters most in clinical situations.
View themselves as a continuous learner and seek out new knowledge.
Effectively judge the credibility of the evidence.
Ask appropriate clarifying questions.
Explain reasons for actions that were taken.
Seek second opinions when unsure about clinical judgment.

Coaching Questions to Promote Critical Thinking

To Organize Care – How you will organize care for these six patients? What should your first actions be? What is the WIN here – most important now? If you begin here with the end in mind, what should that goal for the patient be? If you fall behind in your care, what will you do? What team members can be your backup buddy on this shift?

To Clarify Thinking – Can you explain more about this situation? What do you think the issue is here? What action will you be taking? What do you think will happen if you take that action? Are there other alternatives that you have considered? If you are unsure about something today, who will you ask?

To Inspire Reflection – Why do you think you were successful or unsuccessful in that situation? Could you have used another approach? What will you do differently the next time?

To Challenge Assumptions – How do you know that your assumptions are correct in this situation? Is there another way to view this problem? What are two other possible explanations for what happened here?

To Build Accountability – Based on your nursing experience, what do you suggest we do here? What changes would be in the best interest of your patients right now? How could you have managed this situation differently? What would great look like with this patient/family (if a service recovery issue with a patient)?

To Develop a Growth Mindset – What would you do here if you knew you could not fail? How could this situation help you to grow? What have you learned about yourself as a professional? When you have encountered challenging situations in the past – what strengths have you used to get through them.

If there was ever a need for nurse leader coaching, it is now. Every nurse interacting with new graduates is part of this village that will help new graduates assimilate into practice settings and the professional. Helping them with critical thinking is a good beginning point.

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