Nurses not shy when asked how they think

Nurses rarely talk about how they think through what they do. They’re too busy doing it.

But when you ask them, “What does it mean to think like a nurse?” they have plenty to say, we discovered.

In an increasingly complex health care system, critical-thinking skills are indispensable for nurses. Nursing students learn to sharpen those skills through simulation exercises. Working nurses take seminars and attend association meetings to learn new research and practices. And, of course, experience is a constant teacher.

Patricia Benner, RN, Ph.D., FAAN, is a professor emerita at the University of California, San Francisco. She introduced the idea that expert nurses develop skills and their understanding of patient care over time through a sound educational base and a multitude of experiences. Her landmark book, “From Novice to Expert: Excellence and Power in Clinical Nursing Practice,” won the 1984 American Journal of Nursing Book of the Year award.

In the book Benner described five levels of nursing experience: novice, advanced beginner, competent, proficient and expert. Nurses move from relying on past abstract principles (theory) to perceiving each situation as a complete whole in which certain parts are relevant. She espoused the then-revolutionary notion that the practice itself could and should inform nursing theory — what nurses now call evidence-based practice.

“Nurses want to know why, and then they work to cure, to fix or to comfort,” said Karen Brenner, RN, BS, CCRN, who works in the intensive care unit and is a member of the Medical Response Team (MRT) at Gwinnett Medical Center. “The MRT is called when a nurse has a gut feeling about a patient, but can’t quite put her finger on what is wrong.”

A nurse has to think of many things at once, Brenner said. “She must think holistically and outside the box to put all the pieces together for the best possible outcome for the patient.”

Susan Joy Allen, an emergency department nurse at Emory University Hospital Midtown, likened nursing to a new mother caring for her first baby. Her thought processes and actions are part learned and part instinctive, with a touch of intuition.

“As a nurse, I carry the tools of my trade with me every time, every day and every encounter. My toolbox is my mind and my heart,” Allen said.

Amy Knight, RN, BSN, shift nurse manager for medical cardiology at Emory University Hospital Midtown, used an example. Patients come from the catheterization lab hungry, but Knight knows from clinical experience that they shouldn’t eat while they still have a sheath in their femoral arteries. She must acknowledge a patient’s needs, while explaining the medical situation to him or her.

“Communicating best practice for the patient into language they can understand, delivered with caring — now that is thinking like a nurse,” Knight said.

“Instinctual, yet scientific; simple, yet complicated,” is how Linda Brown, BSN, RN, nurse scholar and charge nurse in the renal/nephrology unit at Emory University Midtown, described a nurse’s thinking.