July 1, 2008 | American Society of Registered Nurses®
Nursing Today

Does nursing require critical thinking?

I had planned to write an article about when, why, and how nurses should challenge doctors' orders.  But once I embarked on a search of material relevant to what I thought would be thought-provoking topic, I came up with nothing more than a few self-aggrandizing editorials and some dull, overly academic socio-behavioral study results.  Yet, in the midst of my Internet exploration I stumbled upon something which did rather pique my interest: a chat-room called MomMD Women in Medicine Forums and a thread therein entitled "Doctor Nurse Relationships and Perceptions".  This innocuous-sounding virtual venue held court for a no-holds-barred discussion between nurses, doctors, nurse-students, and residents about whether or not nurses employ "critical thinking" in the normal course of their working day. 

The voices in the chat-room sounded eerily familiar.  There was the pseudonym-disguised resident who bemoaned 3 a.m. pages by an insecure nurse with questions the doc considered inane.  Nurses responded with comments along the lines of, "If orders are written correctly in the first place, we don't need to call at 3 a.m."  All of these heated rebuttals were spawned by one trouble-maker calling herself PremedRN, who wrote, "Hey docs, nurses, and all others, what do you perceive a nurse does and a doc does...  Why are there animosities between those two positions?"

I got caught up in the repartee.  Who doesn't like a lively debate?  I read through reply after reply, cheering for my favorites.  Score one for the nurses.  Oh, nice retort!  Fires of righteousness ignited left and right.  One intern had the nerve to write, "I perceive doctors as the "order-givers" and nurses as the "order-doers".  I don't understand what requires such "critical thinking" with regard to nursing duties. Doesn't the nurse just do what she's told?"  Some tender-hearted, patient nurse (I can only guess how wonderful she is with her clients) enlightened this misguided intern about the more intellectually challenging aspects of nursing, issuing forth a tactful version of "doctors aren't the only ones who save lives, honey."

> We are offended by the idea that our jobs consist of merely following the directives of others.  We rankle at the suggestion that once we don our scrubs, we disengage our gray matter.  But somehow I'd also gotten ensnared in preconceived notions.  While reading the commentary, I realized that if we nurses are actively employing critical thinking skills, we definitely do not need guidance about how to challenge doctors' orders.  Convinced that our nursing educations and our positions as RNs demanded nothing else, we would simply take our physician colleagues to task when the situation called for it.

Stereotyping is still alive and well, especially in medical professionals' student years.  But what happens afterward, through experience on the job, works away at these misinformed beliefs.  We are well past that ingratiating, pressed-white-dress-and-prim-hat thinking of our nurse-mothers' generation.  Now, not only is challenging doctors' orders un-newsworthy, but it is entirely acceptable for a bunch of strangers, some physicians and others nurses, to amuse, engage, and cajole through the equalizing power of the Internet.  It's about time that these important and productive dialogues took place. 

 

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