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Thousands of hospitalized patients die every year and the cause is directly attributed to nurses and their “failure to rescue” the patients within their care. We’ve all heard about that one patient that came in with one issue and died of another. Those of us who have reviewed charts for malpractice cases refer to it as the “snowball effect”—reading the progress notes of a patient who died due to failure to rescue will make you cringe at the glaring errors.

Patients may have one clinical issue, however minor, that if overlooked by the nurse, cascades into a huge mess of concurrent errors and oversights that often leads to the injury or needless death of a patient. Did you ever wonder why this occurs? Short staffing? Maybe. Nurse burnout? Could be. The main contributing factor, though, is that unfortunately there are many nurses who don’t think creatively or innovatively. They don’t act on their assessment findings nor do they follow up on a change in patient condition. They fail to act as advocates for their patient. Nurses who fail to rescue use “traditional thinking” rather than critical thinking.

Failure to rescue always includes four key elements: (1) Omission of care; (2) a failure to recognize a change in patient condition; (3) a failure to communicate a change in patient condition to medical or other staff; and (4) poor or lack of clinical decision making.

Preceptors and nursing instructors, no matter the level of nursing taught (RN, BSN, MSN, NP, or DNP), should review the below list. It contains elements of traditional thinking. Promoting traditional thinking stifles critical thinking.

Nurses who don’t think critically:

  • Don’t learn from their mistakes or the mistakes of other nurses.
  • Demand that nothing changes and have a “but we’ve always done it this way” attitude.
  • Treat each patient interaction in isolation.
  • Fail to “connect the dots” from one interaction to another.
  • Fail to learn about cause and effect.
  • Do not connect new events with prior knowledge.
  • Do not see what is possible in the future.
  • Solve problems in isolation.
  • Demand that all things be done their way and not any other.
  • Allow personal dislikes and prejudices to cloud judgement.
  • Lack self-confidence.
  • Have poor verbal and written communication skills and do not interact well with others.
  • Do not further their education or promote education for others.
  • Force others to make decisions quickly or set time limits on when decisions can be made.

The behavior and clinical actions of nursing preceptors and instructors affect a student or new nurse long after their clinical rotation or orientation has ended. In fact, the actions of a preceptor or instructor will influence the new nurse far into their nursing careers.

The following statements, said by a preceptor or any nurse to another nurse, will stifle critical thinking:

  • “That’s a dumb idea.”
  • “I can’t believe your school didn’t teach you __________.”
  • “Your idea is good, but it won’t work here.”
  • “It’s too complicated so I’ll just do it and you can watch.”
  • “You spend too much time talking with your patients.”
  • “We tried that here on our unit and it didn’t work.”

How do you teach critical thinking to your preceptees and students? Let us know in the comments!

Maggie Ciocco, MS, RN, BC

Maggie Ciocco, MS, RN, BC, has over 25 years of experience in nursing education, including as a preceptor, mentor, staff development instructor, orientation coordinator, nursing lab instructor, and clinical instructor. Ms. Ciocco received her master of science in nursing from Syracuse University, her bachelor of science in nursing from Seton Hall University, and her associate degree from Ocean County College in Toms River, New Jersey. She has been an American Nurses Credentialing Center board-certified medical-surgical nurse for over 20 years. Throughout her years as an educator, she has established preceptorship programs in acute, subacute, and long-term care settings. She is a member of the National League for Nursing. Ms. Ciocco was awarded the Sigma Theta Tau-Lambda Delta chapter Hannelore Sweetwood Mentor of the Year award in 2012. As a nursing program advisor, she works with Registered Nurses and student nurses as they continue their education, mentoring and advising them as to career and nursing degree choices. She is the author of Fast Facts for the Medical-Surgical Nurse: Clinical Orientation in a Nutshell, Fast Facts for the Nurse Preceptor: Keys to Providing a Successful Preceptorship in a Nutshell, and Fast Facts on Combating Nurse Bullying, Incivility and Workplace Violence: What Nurses Need to Know in a Nutshell, which was awarded second place in the 2017 AJN Book of the Year Awards in the Professional Issues category.


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