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Critical Thinking in Nursing: Tips to Develop the Skill

4 min read • February, 09 2024

Critical thinking in nursing helps caregivers make decisions that lead to optimal patient care. In school, educators and clinical instructors introduced you to critical-thinking examples in nursing. These educators encouraged using learning tools for assessment, diagnosis, planning, implementation, and evaluation.

Nurturing these invaluable skills continues once you begin practicing. Critical thinking is essential to providing quality patient care and should continue to grow throughout your nursing career until it becomes second nature. 

What Is Critical Thinking in Nursing?

Critical thinking in nursing involves identifying a problem, determining the best solution, and implementing an effective method to resolve the issue using clinical decision-making skills.

Reflection comes next. Carefully consider whether your actions led to the right solution or if there may have been a better course of action.

Remember, there's no one-size-fits-all treatment method — you must determine what's best for each patient.

How Is Critical Thinking Important for Nurses? 

As a patient's primary contact, a nurse is typically the first to notice changes in their status. One example of critical thinking in nursing is interpreting these changes with an open mind. Make impartial decisions based on evidence rather than opinions. By applying critical-thinking skills to anticipate and understand your patients' needs, you can positively impact their quality of care and outcomes.

Elements of Critical Thinking in Nursing

To assess situations and make informed decisions, nurses must integrate these specific elements into their practice:

• Clinical judgment. Prioritize a patient's care needs and make adjustments as changes occur. Gather the necessary information and determine what nursing intervention is needed. Keep in mind that there may be multiple options. Use your critical-thinking skills to interpret and understand the importance of test results and the patient’s clinical presentation, including their vital signs. Then prioritize interventions and anticipate potential complications. 
• Patient safety. Recognize deviations from the norm and take action to prevent harm to the patient. Suppose you don't think a change in a patient's medication is appropriate for their treatment. Before giving the medication, question the physician's rationale for the modification to avoid a potential error. 
• Communication and collaboration. Ask relevant questions and actively listen to others while avoiding judgment. Promoting a collaborative environment may lead to improved patient outcomes and interdisciplinary communication. 
• Problem-solving skills. Practicing your problem-solving skills can improve your critical-thinking skills. Analyze the problem, consider alternate solutions, and implement the most appropriate one. Besides assessing patient conditions, you can apply these skills to other challenges, such as staffing issues . 

How to Develop and Apply Critical-Thinking Skills in Nursing

Critical-thinking skills develop as you gain experience and advance in your career. The ability to predict and respond to nursing challenges increases as you expand your knowledge and encounter real-life patient care scenarios outside of what you learned from a textbook. 

Here are five ways to nurture your critical-thinking skills:

• Be a lifelong learner. Continuous learning through educational courses and professional development lets you stay current with evidence-based practice . That knowledge helps you make informed decisions in stressful moments.  
• Practice reflection. Allow time each day to reflect on successes and areas for improvement. This self-awareness can help identify your strengths, weaknesses, and personal biases to guide your decision-making.
• Open your mind. Don't assume you're right. Ask for opinions and consider the viewpoints of other nurses, mentors , and interdisciplinary team members.
• Use critical-thinking tools. Structure your thinking by incorporating nursing process steps or a SWOT analysis (strengths, weaknesses, opportunities, and threats) to organize information, evaluate options, and identify underlying issues.
• Be curious. Challenge assumptions by asking questions to ensure current care methods are valid, relevant, and supported by evidence-based practice .

Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills.

Images sourced from Getty Images

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A critical look at critical thinking

Bodin, Susan J. EdD, RN-BC

Susan J. Bodin is a dean at Bon Secours Memorial College of Nursing in Richmond, Va.

What are RN perceptions of leadership skills?

The author has disclosed that she has no financial relationships related to this article.

Explore the connection between direct care nurses' critical thinking skills and how these skills affect their perceptions of nurse manager leadership behaviors.

The Institute of Medicine (IOM) views transformational leadership as essential for the creation of work environments that promote and support patient safety practices. 1 Transformational leadership creates an environment that empowers direct care nurses not only to make decisions, but also to be trusted for any decisions made. 1 – 4 One precondition for patient safety identified by the IOM is a knowledgeable and skilled workforce. 5 The ability to recognize patterns of clinical data, analyze, and act appropriately is necessary for safe patient care. 1 , 6 , 7 RNs must be able to synthesize information based on their knowledge and identify patterns of patient responses. 7 These abilities are components of critical thinking. 8 , 9

National nurse leaders have raised concerns regarding the competency levels of RNs and their degree of critical thinking skills. 6 , 7 , 10 , 11 The inability to correctly identify, manage, and report patterns of patient responses or symptoms is one leading cause of failure to rescue, or the inappropriate management of a patient condition before a crisis. 10 RNs with strong critical thinking skills respond appropriately to complex patient-care situations. 7 , 12

The purpose of this quantitative, correlation study was to explore whether there's a relationship between RNs' perceptions of their nurse managers' transformational leadership behaviors and direct care nurses' critical thinking skills in a four-hospital health system in Virginia.

Understanding critical thinking

A review of the literature features the importance of effective nurse manager leadership skills and their influence on several aspects of patient care, including patient safety and staff characteristics. 1 , 13 The national problem of patient safety in hospitals is clearly illustrated in the literature, as are multiple factors that affect the ability of direct care nurses to practice safely: an aging workforce, nurse shortages, experience levels, and practice setting. 4 , 5 , 14 , 15 Complex factors influencing patient safety include an aging and more acutely ill patient population, staff reduction (due to increased healthcare costs), complex technology, and a shortage of professional nurses to care for patients. 13

Researchers described factors that influence patient safety, including nurse leadership and the ability of direct care nurses to use critical thought processes when providing patient care. 1 , 13 There's clear evidence that identifies the positive outcomes transformational leadership has on subordinate employees. 2 , 4 , 16 – 18 The literature also suggests that transformational leadership has a positive influence on patient safety. 1 , 5 , 19 Little has been written about the relationship between transformational leadership behaviors and direct care nurses' critical thinking skills, supporting the necessity for this study.

Several definitions and theories of critical thinking, as related to nursing, have been described; however, an agreement on a single explanation doesn't exist. 11 , 20 , 21 Also missing was a nursing-specific tool to measure critical thinking. Most studies reviewed focused on measuring critical thought in nursing students and new graduates, indicating a need to measure critical thought in experienced RNs. 22 – 25

Deciphering RN observations

Using a convenience sample, RNs licensed in Virginia with at least 1 year of experience in an acute care setting and at least 6 months of working for the same manager completed the Leadership Practices Inventory (LPI)–Observer and the California Critical Thinking Skills Test (CCTST). The LPI measures transformational leadership skills by asking leaders, and others who observe them, to rate leadership behaviors. 26 These behaviors represented the qualities of transformational leadership: challenging the process, inspiring a shared vision, enabling others to act, modeling the way, and encouraging the heart. 26 , 27

The study used the following definition of critical thinking: “A purposeful, self-regulatory judgment, which results in interpretation, analysis, evaluation, and inference as well as the explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based.” 28

A letter of invitation was sent to staff RNs employed at one of the four participating hospitals. The letter included a consent form explaining the purpose of the study, the risks and benefits, the voluntary nature of participation and confidentiality, and a demographic questionnaire. Demographic information was used for descriptive statistics.

RNs were asked to complete three sections. One required a demographic tool, the second used the LPI, and the third was the CCTST. Nurses were asked to complete the forms and return them to the investigator's office. Data were numerically coded to maintain anonymity. A reminder postcard was sent 1 week after mailing the packets to encourage completion and return. Nurses who returned the signed informed-consent form and demographic questionnaire were sent the LPI and CCTST. Participants who returned everything and met the criteria for inclusion were included in the study.

Statistical power of analysis identified a sample size of 60. Multiple attempts were made to solicit data to obtain the sample size; however, several leadership changes were made during the data-collection period, disqualifying otherwise qualified participants. The final sample size was 36. A minimum sample size of 30 is acceptable for correlation research. 29 , 30

Are leaders truly transformational?

Demographic characteristics of the sample closely mirrored the national and state characteristics of RNs. Nurses ranged in ages from 24 to over 50, with the majority (78%) over age 40. Ninety-four percent of respondents were female. Fifty-eight percent reported more than 10 years of RN experience. Thirty-one percent to 36% had a diploma, associate's degree, or bachelor's degrees. Forty-four percent had an associate's degree as their highest educational attainment.

Most of the respondents (43%) reported working for their current nurse managers for 1 to 3 years. The largest group to respond (42%) worked in a critical care/step-down patient-care unit. A significant majority (72%) of the respondents worked 33 to 40 hours each week, with the majority (72%) working 12-hour shifts. Although the sample couldn't be generalized, the limited size was closely representative of the RN population in Virginia. 31

The first variable in the quantitative portion of this study was the perceptions RNs had of transformational leadership behaviors. The behavioral dimensions of transformational leadership included: (a) challenging the process, (b) inspiring a shared vision, (c) enabling others to act, (d) modeling the way, and (e) encouraging the heart. 26 , 32 The mean score and standard deviation were calculated for each of the leadership dimensions.

The highest rated leadership dimension was enabling , with a mean score of 47.3. The dimensions of inspiring , modeling , and encouraging were closely rated with a mean score ranging from 41.3 to 44.6. The lowest rated leadership dimension was challenging , with a mean score of 37.3. Standard deviations for all dimensions ranged from 8.5 to 12.3.

The second variable in the study was the RNs' critical thinking skills. Measures of critical thinking skills included: (a) analysis, (b) evaluation, (c) inference, (d) deductive reasoning, and (e) inductive reasoning. 33 According to the analysis, “the average test taker in this group scores between the 68 th and 74 th percentile compared to an aggregated sample of four-year college students.” 34

Pearson's correlation coefficient was utilized to determine the relationship between each leadership dimension of the LPI and the total score of the CCTST. The results indicate there are no significant relationships between the dimensions of the LPI and the CCTST total score. This study failed to reject the null hypothesis because the Pearson's correlation coefficient didn't detect an association between the means of each dimension.

Study limitations included the use of self-reported data and changes during the data-collection process. The additional data obtained from self-reporting and peer observation might have provided stronger evidence of the managers' transformational leadership skills. The design of the data-collection process may have influenced the sample size and subsequently the results. The small sample size may not have had adequate power to detect diminutive but significant relationships between variables. The population was limited to RNs employed at a four-hospital healthcare system.

Influencing future competencies

The importance of the current study relates to issues of transformational leadership and its influences on employees. Previous research indicated that managerial transformational leadership behaviors have positive influences in the areas of employee satisfaction, staff retention, resilience, and productivity. 2 , 4 , 16 – 18 , 35

Although the current study wasn't able to detect a relationship between manager's transformational leadership behaviors and critical thinking, it did measure the dimensions of transformational leadership behaviors of nurse managers as perceived by direct care nurses. Results from this study raise the question whether organizational dynamics may inhibit a manager from fully developing all dimensions of transformational leadership. Previous research indicated that organizational influences could affect leadership style, for example, executive leadership behaviors influence subordinate managerial leadership behaviors. 36 , 37 Organizational climate and support for nursing care delivery models were identified as determinates of patient outcomes, staff satisfaction, and nurse retention. 38

Critical thinking is an aspect of competency; RNs must be competent in the provision of safe patient care, yet within nursing, there are also multiple and conflicting definitions of competency. 8 , 39 Nurse leaders must be able to define competence and critical thinking as related to the profession. The American Nurses Association is currently attempting to classify competence and critical thinking within the framework of nursing practice. 39 Without a unifying, singular definition, professionals won't be able to develop meaningful measures of competence and critical thinking.

The positive effects of transformational leadership on employees have been well established in previous research. 2 , 4 , 16 – 18 , 36 Leaders play a significant role in shaping an environment that promotes quality of care through staff development. 1 , 5 , 7 , 19 , 40 Although the current study didn't detect a relationship between transformational leadership and critical thinking, anecdotal observations by nurse educators and managers indicate that nurse managers' leadership behaviors influence direct care nurses' problem-solving abilities. Further exploration of the influences these leadership behaviors have on critical thinking is warranted.

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What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What is Critical Thinking in Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

43.2 Developing Critical Thinking

Learning objectives.

By the end of this section, you will be able to:

• Analyze the types of thinking used in nursing
• Recognize when to use the different types of thinking in nursing
• Explore the application of knowledge to thinking in nursing
• Appy Critical Thinking Indicators (CTIs) to decision making

Thinking is something we usually do subconsciously, because we are not usually “thinking about thinking.” However, with the ever-increasing autonomy being afforded to nurses, there is also an increased need for nurses to be able to critically think effectively and intentionally. Being able to critically think helps nurses’ problem solve, generate solutions, and make sound clinical judgments that affect the lives of their patients. Keep reading to learn more about how nurses use critical thinking in practice and how you can develop your own critical thinking skills.

Types of Thinking Used in Nursing

Nurses make decisions while providing patient care by using critical thinking and clinical reasoning. In nursing, critical thinking is a broad term that includes reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” On the other hand, clinical reasoning is defined as a complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions. Each of these types of thinking is described in more detail in the following sections.

Cognitive Thinking

The term cognitive thinking refers to the mental processes and abilities a nurse uses to interpret, analyze, and evaluate information in their practice. Basically, it encompasses how nurses think about the practice decisions they are making. Cognitive thinking and critical thinking go hand in hand because nurses must be able to use their knowledge and mental processes to devise solutions and actions when caring for patients. Using critical thinking means that nurses take extra steps to maintain patient safety and do not just follow orders. It also means the accuracy of patient information is validated and plans for caring for patients are based on their needs, current clinical practice, and research. Critical thinkers possess certain attitudes that foster rational thinking:

• confidence: believing in yourself to complete a task or activity
• curiosity: asking “why” and wanting to know more
• fair-mindedness: treating every viewpoint in an unbiased, unprejudiced way
• independence of thought: thinking on your own
• insight into egocentricity and sociocentricity: thinking of the greater good and not just thinking of yourself. Knowing when you are thinking of yourself (egocentricity) and when you are thinking or acting for the greater good (sociocentricity)
• integrity: being honest and demonstrating strong moral principles
• intellectual humility: recognizing your intellectual limitations and abilities
• interest in exploring thoughts and feelings: wanting to explore different ways of knowing
• nonjudgmental: using professional ethical standards and not basing your judgments on your own personal or moral standards
• perseverance: persisting in doing something despite it being difficult

Cognitive thinking is significant to nursing because it provides a foundation on which nurses can make rapid and accurate decisions in clinical practice. Nurses must be able to think quickly and make informed decisions to promote optimal patient outcomes.

Effective Thinking

To make sound judgments about patient care, nurses must generate alternatives, weigh them against the evidence, and choose the best course of action. The ability to clinically reason develops over time and is based on knowledge and experience. Inductive and deductive reasoning are important critical thinking skills. They help the nurse use clinical judgment when implementing the nursing process. Effective thinking in nursing involves the integration of clinical knowledge and critical thinking to make the best decisions for patients. For example, if a nurse was caring for a patient who presents with hypertension and new-onset left-sided weakness, it is important that the nurse be able to quickly consider potential causes for the weakness and implement immediate stroke protocols. Without the ability to critically think, the nurse may overlook the weakness as being unrelated to the hypertension and not consider the possibility of stroke, leading to a poor patient outcome. Thus, it is imperative that nurses develop effective thinking skills.

Inductive Reasoning

The term inductive reasoning involves noticing cues, making generalizations, and creating hypotheses. Cues are data that fall outside of expected findings and give the nurse a hint or indication of a patient’s potential problem or condition. The nurse organizes these cues into patterns and creates a generalization. A generalization is a judgment formed on the basis of a set of facts, cues, and observations and is similar to gathering pieces of a jigsaw puzzle into patterns until the whole picture becomes clearer. On the basis of generalizations created from patterns of data, the nurse creates a hypothesis regarding a patient problem. Remember, a hypothesis is a proposed explanation for a situation. It attempts to explain the “why” behind the problem that is occurring. If a “why” is identified, then a solution can begin to be explored. No one can draw conclusions without first noticing cues. Paying close attention to a patient, the environment, and interactions with family members is critical for inductive reasoning. As you work to improve your inductive reasoning, begin by first noticing details about the things around you. Be mindful of your five primary senses: the things that you hear, feel, smell, taste, and see. Nurses need strong inductive reasoning patterns and be able to act quickly, especially in emergency situations. They can see how certain objects or events form a pattern (or a generalization) that indicates a common problem.

Consider this example: A nurse assesses a patient who has undergone surgery and finds the surgical incision site is red, warm, and tender to the touch. The nurse recognizes these cues form a pattern of signs of infection and creates a hypothesis that the incision has become infected. The provider is notified of the patient’s change in condition, and a new prescription is received for an antibiotic. This is an example of the use of inductive reasoning in nursing practice.

Deductive Reasoning

Another type of critical thinking is deductive reasoning ; it is referred to as “top-down thinking.” Deductive reasoning relies on using a general standard or rule to create a strategy. Nurses use standards set by their state’s Nurse Practice Act, federal regulations, the American Nursing Association, professional organizations, and their employer to make decisions about patient care and solve problems.

Think about this example: On the basis of research findings, hospital leaders determine patients recover more quickly if they receive adequate rest. The hospital creates a policy for quiet zones at night by initiating no overhead paging, promoting low-speaking voices by staff, and reducing lighting in the hallways. The nurse further implements this policy by organizing care for patients that promotes periods of uninterrupted rest at night. This is an example of deductive thinking, because the intervention is applied to all patients regardless of whether they have difficulty sleeping or not.

Identify the Purpose of Thinking

Rationalizing the purpose of thinking is probably not something you do often, but it is the foundational first step in critical thinking. To effectively use critical thinking in practice, the nurse must first identify the purpose of thinking. For example, the nurse is caring for a patient who presents with fever, tachycardia, and shortness of breath. The patient also has an open, infected wound on the left foot that is not healing. The nurse must recognize that the patient is exhibiting signs and symptoms that may be indicative of an underlying problem. At this point, the nurse must be able to identify that the purpose of thinking with regard to the patient is to consider what might be happening with the patient and formulate a plan of care. This begins the process of critical thinking, which involves several steps: thinking ahead, thinking in action, and reflection on thinking.

Thinking Ahead

Thinking ahead in nursing involves considering what may be going on with the patient to anticipate potential outcomes and complications that may arise. Remember competent nurses are proactive versus reactive. Reactive nursing is letting situations arise and then responding to the change, but proactive nursing is recognizing cues behaviors and patterns that are leading up to a complicated event. Additionally, the nurse will formulate goals of care and must try to anticipate specific needs the patient will have. Considering the patient discussed in the preceding paragraph, the nurse should begin the process of thinking ahead about potential outcomes and complications. The nurse may hypothesize that the patient is starting to develop sepsis from the open wound on the foot so severe sepsis and/or septic shock could be a complication to begin preparing for. The nurse thinks ahead about goals of care for the patient and determines that wound care to prevent infection spread and sepsis is the priority goal at this time.

Thinking in Action

Thinking in action encompasses the thought processes occurring while the nurse is performing interventions. So, if the nurse in our example begins performing wound care, they are thinking about the best dressing to use, how to clean the wound, and if antibiotics should be considered. All of these thoughts are likely occurring as the nurse is providing the care; thus, they are examples of how the nurse is using thinking in action.

Reflection on Thinking

After performing interventions or making decisions, the nurse should reflect on the thinking that occurred. The nurse will use this thinking process to determine if the decision was reactive or responsive. Reactive decision-making involves responding to situations after they have occurred, often in a hurried or unplanned manner. These decisions tend to be impulsive and are driven by immediate needs or crises. Responsive decisions, on the other hand, involve careful deliberation about how to address a situation based on careful consideration of information. In our example, the nurse’s decision appears to have been responsive. The patient was exhibiting some altered vital signs, but nothing indicated that the situation had become emergent yet. The nurse was able to think carefully about the patient’s situation and determine that wound care was the highest priority and begin to implement care in a calm, deliberate manner. In an ideal world, all nursing decisions would be responsive, but in a lot of cases, they must be reactive because of situation severity and medical emergencies.

Application of Knowledge

During the outset of the critical thinking process, nurses must judge whether their knowledge is accurate, complete, factual, timely, and relevant. This can be done by applying knowledge to nursing practice in a multitude of ways, including drawing from past education and experience in nursing and using professional resources and standards. Each of these is discussed in more detail in the following sections.

Knowledge Base

Becoming a nurse requires years of schooling, which contributes to the development of a robust knowledge base. Nurses receive formal education and training that provides them foundational knowledge in anatomy, physiology, pharmacology, and patient care techniques, among many others. Additionally, nurses are required to complete continuing education courses specific to their chosen practice setting, further developing their knowledge base. When applying knowledge in practice, nurses can draw from their knowledge base and make informed decisions about patient care.

Experience in Nursing

Nursing is considered a practice. Nursing practice means we learn from our mistakes and our past experiences and apply this knowledge to our next patient or to the next population we serve. As nurses gain more experience, they can use what they have learned in practice and apply it to new patient situations. Each new encounter with a patient presents unique challenge and learning opportunities that contribute to the development of clinical expertise. Reflecting on these experiences allows nurses to recognize patterns, anticipate patient outcomes, and refine their decision-making processes. Whether they are identifying effective nursing interventions for common conditions, adapting care plans to individual patient needs, or navigating complex situations with compassion, nurses draw upon their accumulated knowledge base from clinical experience to provide high-quality, patient-centered care. Through reflection and continuous learning from past experiences, nurses enhance their clinical skills, ultimately improving patient outcomes.

Professional Resources and Standards

In addition to foundational knowledge bases and experience, nurses can also use professional resources and standards to gain and apply knowledge in practice. Nurses can refer to clinical practice guidelines that have been established by professional organizations and healthcare institutions to help provide a framework for implementing nursing interventions based on the best evidence. By following the guidelines, nurses are ensuring that their care aligns with established standards and promotes optimal patient outcomes. Additionally, nurses should remain up to date about new and emerging research in their practice area, which can be obtained by reading professional journals and publications and attending conferences, workshops, and other trainings. Nurses can use the information learned from these resources to influence practice and ensure the highest standards of care are being performed in their practice setting. By staying informed about the latest developments in nursing and health care, nurses enhance their knowledge base and can adapt their practice to incorporate new evidence and innovations. Along with professional development and staying current with professional practices, nursing students should actively seek and join professional organizations such as critical care nursing or oncology nursing societies because this will lead the student to become expert in that subject and stay relevant with current evidence and practice guidelines.

Clinical Safety and Procedures (QSEN)

Qsen competency: evidence-based practice.

Definition: Providing quality patient care based on up-to-date, theory-derived research and knowledge, rather than personal beliefs, advice, or traditional methods.

Knowledge: The nurse will describe how the strength and relevance of available evidence influences the choice of intervention in provision of patient-centered care.

Skill: The nurse will:

• subscribe to professional journals that produce original research and evidence-based reports related to their specific area of practice
• become familiar with current evidence-based clinical practice topics and guidelines
• assist in creating a work environment that welcomes new evidence into standards of practice
• question the rational for traditional methods of care that result in sub-par outcomes or adverse events

Attitude: The nurse will appreciate the importance of regularly reading relevant professional journals.

Critique of Decision

After determining the best course of action based on the application of knowledge, the nurse can critique the decisions that were made. Specifically, the nurse will use self-reflection to review their actions and thoughts that led them to the decision. The nurse will consider the outcomes of their chosen interventions, reflect on the effectiveness of their approach, and identify areas of improvement. Additionally, the nurse may seek feedback from colleagues to obtain different perspectives about decisions made. Soliciting input from others helps the nurse gain insight and learn from their peers to further inform their future practice. Reflection questions that the nurse may ask themselves to critique their decision include the following:

• Was the patient goal or outcome met?
• Could the intervention have been done differently? Could it have been done better?
• What are alternative decisions that could have been made? What are the merits of each?

Critical Thinking Indicators

Certain behaviors that demonstrate the knowledge, skills, and attitudes that promote critical thinking are called critical thinking indicators (CTIs) . Critical thinking indicators are tangible actions that are performed to assess and improve your thinking skills.

4-Circle CT Model

There are many models and frameworks within nursing and other disciplines that attempt to explain the process of critical thinking. One of the most popular is Alfaro-LeFevre’s 4-Circle CT Model (Alfaro-LeFevre, 2016). This model breaks critical thinking into four components: personal characteristics, intellectual and cognitive abilities, interpersonal abilities and self-management, and technical skills. These four components overlap, forming interconnections in critical thinking.

Link to Learning

Learn more here about the 4-Circle CT Model and see an illustration of it.

Personal Critical Thinking Indicators

Personal CTIs are behaviors that are indicative of critical thinkers. Some of these behaviors that are most relevant to nursing include:

• confidence and resilience: showing ability to reason and learn and overcoming problems
• curiosity and inquisitiveness: asking questions and looking for the “why” behind things
• effective communication: listening well, showing understanding for others thoughts and feelings, and speaking and writing with clarity
• flexibility: changing approaches as needed to obtain the best results
• honesty: looking for the truth and demonstrating integrity while adhering to moral and ethical standards
• self-awareness: being able to identify one’s own knowledge gaps and acknowledge when thinking may be negatively influenced by emotions or self-interests.

Personal Knowledge and Intellectual Skills

Personal knowledge and intellectual skills encompass the knowledge gained from nursing school and clinical experiences. Examples of each of these kinds of skills are listed in Table 43.3 .

Interpersonal and Self-Management Skills

Interpersonal and self-management skills encompass the knowledge and skills needed for effective collaboration. These include:

• addressing conflicts fairly
• advocating for patients, self, and others
• dealing with complaints constructively
• establishing empowered partnerships
• facilitating and navigating change
• fostering positive interpersonal relationships and promoting teamwork
• giving and taking constructive criticism
• leading, motivating, and managing others
• managing stress, time, and energy
• promoting a learning and safety culture
• upholding healthy workplace standards
• using skilled communication in high-stake situations

Technical Skills

Technical skills in nursing refer to the practical abilities and competencies that nurses use in the delivery of patient care. These skills are typically learned through education, training, and hands-on experience. Some common technical skills in nursing include:

• administering medications
• assisting with personal hygiene and activities of daily living
• documentation and charting
• inserting intravenous catheters
• inserting urinary catheters and nasogastric tubes
• performing tracheostomy care
• performing wound care
• taking vital signs

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• Location: Houston, Texas
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Why Critical Thinking Skills in Nursing Matter (And What You Can Do to Develop Them)

By Hannah Meinke on 07/05/2021

The nursing profession tends to attract those who have natural nurturing abilities, a desire to help others, and a knack for science or anatomy. But there is another important skill that successful nurses share, and it's often overlooked: the ability to think critically.

Identifying a problem, determining the best solution and choosing the most effective method to solve the program are all parts of the critical thinking process. After executing the plan, critical thinkers reflect on the situation to figure out if it was effective and if it could have been done better. As you can see, critical thinking is a transferable skill that can be leveraged in several facets of your life.

But why is it so important for nurses to use? We spoke with several experts to learn why critical thinking skills in nursing are so crucial to the field, the patients and the success of a nurse. Keep reading to learn why and to see how you can improve this skill.

Why are critical thinking skills in nursing important?

You learn all sorts of practical skills in nursing school, like flawlessly dressing a wound, taking vitals like a pro or starting an IV without flinching. But without the ability to think clearly and make rational decisions, those skills alone won’t get you very far—you need to think critically as well.

“Nurses are faced with decision-making situations in patient care, and each decision they make impacts patient outcomes. Nursing critical thinking skills drive the decision-making process and impact the quality of care provided,” says Georgia Vest, DNP, RN and senior dean of nursing at the Rasmussen University School of Nursing.

For example, nurses often have to make triage decisions in the emergency room. With an overflow of patients and limited staff, they must evaluate which patients should be treated first. While they rely on their training to measure vital signs and level of consciousness, they must use critical thinking to analyze the consequences of delaying treatment in each case.

No matter which department they work in, nurses use critical thinking in their everyday routines. When you’re faced with decisions that could ultimately mean life or death, the ability to analyze a situation and come to a solution separates the good nurses from the great ones.

How are critical thinking skills acquired in nursing school?

Nursing school offers a multitude of material to master and upholds high expectations for your performance. But in order to learn in a way that will actually equip you to become an excellent nurse, you have to go beyond just memorizing terms. You need to apply an analytical mindset to understanding course material.

One way for students to begin implementing critical thinking is by applying the nursing process to their line of thought, according to Vest. The process includes five steps: assessment, diagnosis, outcomes/planning, implementation and evaluation.

“One of the fundamental principles for developing critical thinking is the nursing process,” Vest says. “It needs to be a lived experience in the learning environment.”

Nursing students often find that there are multiple correct solutions to a problem. The key to nursing is to select the “the most correct” solution—one that will be the most efficient and best fit for that particular situation. Using the nursing process, students can narrow down their options to select the best one.

When answering questions in class or on exams, challenge yourself to go beyond simply selecting an answer. Start to think about why that answer is correct and what the possible consequences might be. Simply memorizing the material won’t translate well into a real-life nursing setting.

How can you develop your critical thinking skills as a nurse?

As you know, learning doesn’t stop with graduation from nursing school. Good nurses continue to soak up knowledge and continually improve throughout their careers. Likewise, they can continue to build their critical thinking skills in the workplace with each shift.

“To improve your critical thinking, pick the brains of the experienced nurses around you to help you get the mindset,” suggests Eileen Sollars, RN ADN, AAS. Understanding how a seasoned nurse came to a conclusion will provide you with insights you may not have considered and help you develop your own approach.

The chain of command can also help nurses develop critical thinking skills in the workplace.

“Another aid in the development of critical thinking I cannot stress enough is the utilization of the chain of command,” Vest says. “In the chain of command, the nurse always reports up to the nurse manager and down to the patient care aide. Peers and fellow healthcare professionals are not in the chain of command. Clear understanding and proper utilization of the chain of command is essential in the workplace.”

How are critical thinking skills applied in nursing?

“Nurses use critical thinking in every single shift,” Sollars says. “Critical thinking in nursing is a paramount skill necessary in the care of your patients. Nowadays there is more emphasis on machines and technical aspects of nursing, but critical thinking plays an important role. You need it to understand and anticipate changes in your patient's condition.”

As a nurse, you will inevitably encounter a situation in which there are multiple solutions or treatments, and you'll be tasked with determining the solution that will provide the best possible outcome for your patient. You must be able to quickly and confidently assess situations and make the best care decision in each unique scenario. It is in situations like these that your critical thinking skills will direct your decision-making.

Do critical thinking skills matter more for nursing leadership and management positions?

While critical thinking skills are essential at every level of nursing, leadership and management positions require a new level of this ability.

When it comes to managing other nurses, working with hospital administration, and dealing with budgets, schedules or policies, critical thinking can make the difference between a smooth-running or struggling department. At the leadership level, nurses need to see the big picture and understand how each part works together.

A nurse manager , for example, might have to deal with being short-staffed. This could require coaching nurses on how to prioritize their workload, organize their tasks and rely on strategies to keep from burning out. A lead nurse with strong critical thinking skills knows how to fully understand the problem and all its implications.

• How will patient care be affected by having fewer staff?
• What kind of strain will be on the nurses?

Their solutions will take into account all their resources and possible roadblocks.

• What work can be delegated to nursing aids?
• Are there any nurses willing to come in on their day off?
• Are nurses from other departments available to provide coverage?

They’ll weigh the pros and cons of each solution and choose those with the greatest potential.

• Will calling in an off-duty nurse contribute to burnout?
• Was this situation a one-off occurrence or something that could require an additional hire in the long term?

Finally, they will look back on the issue and evaluate what worked and what didn’t. With critical thinking skills like this, a lead nurse can affect their entire staff, patient population and department for the better.

Beyond thinking

You’re now well aware of the importance of critical thinking skills in nursing. Even if you already use critical thinking skills every day, you can still work toward strengthening that skill. The more you practice it, the better you will become and the more naturally it will come to you.

If you’re interested in critical thinking because you’d like to move up in your current nursing job, consider how a Bachelor of Science in Nursing (BSN) could help you develop the necessary leadership skills.

EDITOR’S NOTE: This article was originally published in July 2012. It has since been updated to include information relevant to 2021.

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Hannah Meinke

Posted in General Nursing

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Emerging Nurse Leader

A leadership development blog

Helping New Nurses With Critical Thinking Skills

August 4, 2022 by rose

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.

©  emergingrnleader.com 2022

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Evidence-Based Decision-Making for Nurse Leaders

Coronavirus 2019 (COVID-19) is challenging nurse leaders to adopt new decision-making practices. Nurse leaders who support evidence-based nursing practice create a culture of inquiry and lay the foundation for the use of evidence to inform management decisions. This article uses a case study to describe the evidence-based management process. The authors provide strategies for nurse leaders to develop evidence-based management competencies and build a culture to support the use of evidence to inform decision-making in leadership and management.

• • Nurse leaders must build on their knowledge of evidence-based practice to cultivate a broader use of evidence in their management decision-making.
• • There are a variety of strategies that can be accessed to support nurse leaders in reinforcing their competence in accessing, appraising, and applying evidence to their management decision-making.
• • By creating a culture of inquiry that utilizes the best available evidence, nurse leaders can participate in delivering successful outcomes that support the practice environment, organizational success, and health care outcomes.

Another executive planning meeting, but this time, the executive team in a hospital in the Midwest is looking to develop plans to address the increased costs incurred from the influx of COVID-19 patients. Operational revenues are far outpaced by the expenses incurred for the second consecutive quarter. Nurse retention has become problematic due to furloughs incurred in ambulatory and specialty care areas because they are no longer seeing their usual patient volumes. Inpatients are requiring critical care services, and the cost for agency staffing to supplement the organization’s critical care nursing staff is contributing to the operational loss. The chief nursing officer (CNO) of this hospital needs to develop a plan for the last quarters of the fiscal year to address the current and projected staffing resources needed to ensure safe, patient care. She also needs to include strategies that will support staff recruitment and retention despite fluctuating volumes, as well as plan for a potential surge of coronavirus 2019 (COVID-19) patients. Does she attempt to explore strategies to safely redeploy her own staff to manage unpredictable caseloads rather than continuing to access temporary staff, or seek out best practices to guide her decision-making? What strategies are needed to ensure competency of deployed staff? What are the best approaches to support staff during this challenging period of change?

Like so many of her executive colleagues, this CNO is facing challenges requiring different and alternative ways for resource planning. The current health care system requires strategies for decision-making in an uncertain and unpredictable future. Failures in strategic decision-making often result from a leader’s “failure to anticipate a reality different than what is prepared or willing to see.” 1 In this case, this CNO recognizes the dilemma arising from recent events and needs to plan for moving forward toward whatever may be construed as a “new normal,” an environment unlike the familiar. Until this point in time, the CNO has been relying on whatever information she receives through organizational sources to see that her patients received safe care. Now it is time to look past the initial curve and plan for that next phase. One approach to the problem is to apply an evidence-based management (EBM) approach to make the decisions necessary for an uncertain future.

Evidence-Based Management Decision-Making

EBM is a growing practice among business leaders and is much more nascent among nurse leaders. Evidence-based management has its foundation in evidence-based nursing practice (EBNP), which has evolved to reflect the use of the best scientific evidence in combination with the nurse’s professional judgment and the patient’s preferences. 2 Like EBNP, EBM decision-making is the systematic application of the best available scientific evidence in combination with organizational evidence, leaders’ professional experience, and stakeholder evidence to decision-making. 3 Nurse leaders have been cited as 1 of the prevailing determinants in the adoption of EBNP. Nurse leaders who set a vision and create a culture to support EBNP are more successful in realizing the goal of quality patient outcomes. 4 , 5 Leaders who do not understand EBNP are less likely to cultivate a broader culture of using evidence informed management decision-making. The Center for Evidence-Based Management 6 offers a 6-step process to guide EBM decision-making ( Figure 1 ).

• 1. The asking step is when a question is developed—often in response to an organizational problem. The question is then used to guide a search of evidence. As noted, evidence is acquired from multiple sources. Scientific evidence is the external evidence gathered from a search of the published literature. Organizational evidence may include performance improvement results, quality outcomes, and financial metrics. Stakeholder evidence includes the perspectives of those who will be impacted by the decision. Examples may include employees or patients and families. And last, the leader’s professional experience can be factored into the decision process as well. This is the most variable in terms of reliability depending on depth of the leader’s past experiences.

EBM Decision-Making Process.

In this case, the CNO has begun her planning with these questions:

• a. Is there an effective means of redeploying staff safely across services while ensuring maintenance of competency to reduce cost?
• b. What other options exist to maintain adequate staffing to manage surge situations?
• c. What are the best practices seen to support and retain staff during this difficult time of complex system change?
• In this case study, the CNO will begin by systematically gathering whatever internal organizational data are available. Despite the difficulties of the last months, she can evaluate patient outcomes in departments in which redeployments have occurred. She can collaborate with human resources to obtain staff input regarding needs for additional training and concerns for personal safety. Patient and family feedback may be available for review as well as input from other members of the professional health care team. These internal data will provide information to the CNO about what may have worked well and where opportunities for improvement remain. Although external evidence may be sought from literature, the CNO may find that little has been published in recent months regarding her questions. In evaluating external evidence, she knows it is preferable to seek high quality research studies.

Sources and Evaluation of Evidence.

• However, much of the current research has focused on epidemiological studies rather than the process of care, required resources, and impact on staff. Still, many sources of expert opinion based on experiences in managing disasters and the current pandemic have been made available through professional nursing organizations such the American Organization of Nurse Leaders and the American Nurses Association.
• In this case, the CNO evaluates the quality of the internal and external evidence. Although not always the strongest evidence, webinars provided by professional organizations delivered by experienced nurse executives may very well constitute the “best available evidence” to inform the problem. The quality of the internal stakeholder data is also evaluated to provide direction to the CNO.
• 4. Once satisfied that she has sufficient evidence, the CNO will move to the aggregating step. In this step, the evidence from the various sources are synthesized to identify contributing factors to the problem and relevant options for resolving the problem.
• 5. The applying step includes an analysis of the various options identified through the review of the evidence. The CNO might consider using a decision matrix to evaluate each option against a few key criteria. The criteria may include the strength of the evidence, fit with the organization, financial resources, feasibility, cost, and effectiveness or impact.
• The CNO should determine indicators of success for the selected plan. The initial stakeholder data may also serve as evaluation criteria throughout the implementation phase. In addition to evaluating the implementation process and outcomes of the decision, the CNO may want to identify measures to monitor for potential unintended consequences of a practice change. For example, staff dissatisfaction and stress may be possible unintended consequences of the decision and should be monitored . Evaluation is clearly a critical step that needs to be planned as carefully as the implementation of the decision.

Developing Evidence-Based Management Competencies

Although EBM may be perceived to be a relatively new process for nurse leaders, it shares its roots with EBNP. In a national assessment of EBNP in the United States, identified deficiency in EBNP competencies as the third most common barrier to establishing a culture supporting EBNP. 7 Furthermore, many nurse leaders and clinical nurse educators do not have a strong foundation in the competencies necessary to support EBNP. 4 It stands to reason that a lack of competence in EBNP would also indicate a weak foundation for EBM. A nurse leader competent in EBNP, will challenge traditional nursing practices by asking, “what is the best available evidence?” The same competencies required for EBNP apply to EBM: the ability to question practice then search, appraise, and apply evidence acquired through education and experience in leadership form the foundation for EBM competence. 8 The challenge often presented is in developing and maintaining the competencies needed to apply the 6-step process to inform their actions.

Developing competencies for the practice of EBM may take many approaches. For the individual nurse leader, personal development may begin with the pursuit of further formal graduate education that will increase depth of knowledge in EBNP and its application to management and leadership decision-making. Graduate nursing programs include the fundamentals of EBNP in their curricula. Nurse leaders prepared at the graduate level are needed to support staff in the delivery of transformed healthcare systems of the future. 9 Web-based continuing education modules provide another source to learn EBM competencies. In addition to the many EBNP websites, the Center for Evidence-Based Management provides training and resources specific to EBM competencies. 6

Creating an Organizational Culture of EBM

Creating an organizational culture requires strategic planning and action. Organizational structures and processes are important steps that a leader must take to support a transition to EBM. Many of the same structures needed to support EBM are common to creating a culture supporting EBNP. First and foremost, create a climate that encourages questioning the status quo. 10 , 11 The EBM process begins by asking questions about current practices and identifying best approaches to solving organizational problems. Second, resources to support searching the evidence are needed. 4 , 10 These resources include librarians, research support staff, or partnerships with academic facilities to develop unique models such as fellowships. Health care organizations with structures in place to support knowledge development and transfer can assist leaders in clarifying questions to be asked, and acquiring, appraising and aggregating the best available evidence. 12

Third, create processes to reinforce skill development. Forming or joining journal clubs that may already exist within the organization will open opportunities for practice of the application of EBM decision-making. 10 By creating a learning environment, leaders can practice evaluating evidence in a safe environment. Academic faculty are experts in understanding research literature and may be willing to assist organizational leaders in developing EBM competencies. Fourth, leaders familiar with EBM practice can develop templates or other tools to support EBM decision-making processes. To create an organizational culture requires consistent education and reinforcement over time. 10

One last strategy for creating competence and a culture of EBM is to engage in management research. 13 Opportunities to engage in research are plentiful given the growing number of PhD and DNP programs. DNP students bring expertise in evidence-based practice and through their projects, role model the steps of EBNP and EBM to the organization.

How Can EBM Be Relevant to Nurse Leaders?

Using EBM decision-making, nurse leaders may access internal data, external data, and stakeholder information in the evaluation of the nursing practice environment. Because many nurse leaders participate in the National Database of Nursing Quality indicators (NDNQI) surveys of their nurses, through a survey of these key stakeholders, nurse leaders identify strengths and opportunities for improving their work environment. By comparing the organization’s performance to national benchmark organizations, priorities for growth and improvement can be incorporated into the strategic plan. Commonly, opportunities to improve the nurse practice environment are identified though evaluation of an extensive evidence base of interventions to create healthy work environments. Reviewing and evaluating evidence for its relevance to the specific organization is an important step in selecting interventions to implement. Once the evidence is appraised, a decision can be made by nurse leaders to select appropriate strategies to improve the work environment and incorporate them into the organizational strategic plan. Evaluation of the effectiveness of the selected decision, once implemented, will occur because NDNQI benchmark data continue to be gathered on an ongoing basis.

Return on Investment?

Resources are costly and time-consuming, and require commitment from all leaders within the organizational hierarchy. So, why invest into the process and build an open, questioning culture? The rationale for using an EBM approach in decision-making is similar to that of EBNP. The same wide variations in practice found in clinical care are found in managerial practice. 11 Use of EBM helps to close the research-to-practice gap. 3 By using evidence to guide decision-making, leaders stand to realize greater returns on their investment. Using an EBM approach encourages the examination of evidence from multiple sources and yields better outcomes. Lessons can be learned from the available evidence to improve the work of nurse leaders and support the decisions they make or bring to the table. The goal that evidence will guide 90% of health care decisions was set nearly 20 years ago. One of the critical barriers to realizing this goal has been the competence and support of nurse leaders. By using EBM practices, nurse leaders will create a culture of inquiry that supports the practice environment, organizational success, and health care outcomes.

Joan Sevy Majers, DNP, FACHE, CENP, CCM, is Assistant Professor and now as the Coordinator for the graduate nursing administration programs for the College of Nursing, University of Cincinnati, in Cincinnati, Ohio. She can be reached at [email protected] . Nora Warshawsky, PhD, RN, NEA-BC, CNE, FAAN, is a Professor at the College of Nursing, University of Central Florida in Orlando, Florida.

Note: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors acknowledge no conflicts of interest.

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Examining the Qualities of an Effective Nurse Leader

October 14, 2021  |  14 Min Read

In the field of nursing, good leadership is both a science and an art: In the former category, observation, data collection, critical thinking, planning and implementation are all vital components of the practice; but in the latter, caring for patients and forging and nurturing personal relationships are equally essential to success. Thus, the importance of leadership in nursing demands that one cultivate attributes and skills from both the scientific and artistic disciplines, which can be acquired and developed through education, experience and mentorship.

The qualities of an effective nurse leader span governance of oneself, one’s subordinates and, in certain roles, the department or larger organization in which the nursing personnel function. While proficiency in direction and management is integral to the success of any operation in any industry, it takes on an even greater level of importance when the health and wellness of patients are at stake.

What are the qualities of an effective nurse leader?

Leading oneself.

Much has been said about how crucial it is for those in charge to lead by example in order to have a positive influence on those who are working under and learning from them. That has to begin with good self-governance, which is equally important whether the leader is a patient care coordinator, clinical research nurse, head nurse, case manager, nurse manager or nurse executive. The skills and characteristics that fall into this area include the following:

Nurses in leadership roles must have the ability to read themselves well and accurately perceive their own personalities, behavior, emotions, motivations and thought processes. Additionally, they have to possess the honesty and modesty to admit their mistakes, learn from them and move on.

Dr. Kathy Scott, a former bedside nurse who has also held various C-level positions in healthcare organizations, says nurses generally have certain qualities or ways of thinking that can hinder their leadership at times. These include perfectionism and the tendency to demand that same characteristic in others, as well as micromanagement and “super leader syndrome” — a lack of trust in others that causes nurse leaders to try to do too much themselves instead of delegating more responsibilities to their teams. It’s essential for professionals to be self-aware enough to recognize these traits and moderate them appropriately.

The capacity to master one’s emotions, impulses and thoughts is also among the most important qualities of an effective nurse leader. If mastery has yet to be achieved, one needs to at least be able to control one’s mind well enough to maintain a high level of functioning, even in stressful situations like medical emergencies.

Self-care is a critical but often neglected part of this equation. In nurse leadership education and training, there’s often too much emphasis placed on managing others and creating schedules — and not enough on taking care of oneself through things like exercise, adequate sleep and meditation, and thus expanding one’s capacity to lead others.

Professionals in these positions must demonstrate flexibility, including the potential to change their approaches to certain procedures or aspects of patient care when necessary.

It’s essential for nurse leaders to be cooperative with others and open-minded to their ideas, while also having the humility to accept constructive criticism and apply it to help patients, subordinates and colleagues

At no time is it more crucial to be focused, disciplined, hardworking and determined than when providing medical care to patients. An effective head nurse must also have the ability and willingness to take initiative, rather than always waiting to be told what to do.

All nurses are required to be well-educated and well-informed about medicine, best practices and the responsibilities of their jobs, but those in leadership roles must also have a good understanding of how to coach, manage and direct people. Since learning is a lifelong process, they need to possess the ability to acquire new information and skills quickly and apply those to both patient care and their supervisory duties.

Since technology is an essential part of healthcare, having a good technical knowledge base is very useful for nursing leaders. Many medical centers now depend on electronic health records and state-of-the-art digital equipment, so professionals in managerial positions must stay updated on the different technologies and train new hires in them as well.

The capacity to make important and often difficult decisions based on myriad factors in patient care is common to all nurses. Those who are supervisors must also be able to extend this personal skill to decision-making at the team level, weighing numerous pieces of information to make choices in a timely fashion, even when under pressure.

Trust, faith and belief in oneself and one’s skills and intellect are also qualities of an effective nurse leader.

People in these positions need to be able to exude such confidence in order to command the respect and trust.

Healthcare professionals overseeing and guiding others have to show trustworthiness, credibility and consistency of character in the way they carry out their job functions and treat people, in order to earn and preserve everyone’s trust and respect. They must be honest, as even seemingly small lies can be enough to break trust and drive wedges between nurse leaders and staff or patients, potentially jeopardizing the team’s operations or the quality of care they provide. All of those working under head nurses, along with patients and their families, depend on them to be steadfast in their integrity.

Leading Others

Nurses in supervisory or managerial roles are responsible for building and maintaining adept, synergistic teams as well as a strong sense of community. The success of their mission depends on their ability to steer the ship well, even through waves of adversity and change. In order to produce great results, leadership requires the following characteristics and expertise:

A nurse leader demonstrates tireless devotion to providing the best care. They also foster the same passionate commitment in new trainees and all team members, while conducting performance reviews on a regular basis to ensure that the highest standards of quality and safety are consistently met.

Being highly compassionate and empathetic aids head nurses greatly in understanding and helping both patients and other nurses. These qualities enhance training and team communication, while enabling those in managerial or directorial positions to recognize, comprehend and minimize job-related stressors.

Dr. Scott preaches what she calls “ kindness before rightness .” If one begins with blunt criticism devoid of courtesy, empathy and respect, others sometimes just shut down and stop listening. Leaders should think about how they would feel if they were receiving the feedback they are giving, in order to ensure that they are putting the emphasis on being kind and constructive and not on proving their team members wrong.

Communication Skills: Essential for any good leader, the ability to clearly articulate one’s ideas and convey information to others is vital for a nurse leader, especially when it comes to patient care.

Great communicators understand how to tell people everything they need to know without being too verbose, which is of particular importance in medical emergencies where time is of the essence.

Nurses in those managerial or supervisory roles must also perceive and reflect on how what they’re saying is being received and interpreted by those working under and alongside them. They need to be able to clarify or change their words — or alter their way of communicating — quickly in the moment if the message is being misunderstood. Checking in and asking others what they just heard is a good way to make sure that the information, opinions, concerns or directives that one is expressing are coming across as intended.

Another important aspect of communication is transparency . Leaders are sometimes not as open and forthcoming with information as they should be, thinking that sharing certain things with staff who are outside the executive or management circle would create chaos. But what happens instead is that nurses are less equipped to solve some problems and more apt to make poor decisions, because they have not been given all the information that would have allowed them to implement the right solutions. Keeping knowledge from people also sows rumors and mistrust.

Knowing how to handle tough problems tactfully and without wasting time is another of the qualities of an effective nurse leader. Whether it’s having to confront or discipline an insubordinate, irresponsible or dangerous employee; lay off good, loyal staff due to downsizing or restructuring; or deal with a difficult or even hostile patient, one must be able to act decisively to do what needs to be done while maintaining professional conduct.

In order to keep team morale high, a nurse manager or executive should be a good listener who carefully considers what subordinates have to say and thinks about the best way to address these staff members’ concerns and needs. Frequently, leaders are so focused on productivity that they don’t make enough time to gather the group together for authentic, in-depth conversations where they can fully hear and consider the ideas and thoughts of others.

Such meetings can be integral to working through difficult problems successfully and efficiently. Instead of so often thinking that they have to have all the answers, leaders should set aside their egos and open their minds to potential solutions from colleagues and subordinates.

Active listening is also a crucial part of patient care, allowing head nurses to ensure that the needs of everyone under their care are being met. They must really hear and concentrate on what patients are telling them directly and indirectly, instead of assuming that they already know all the relevant information needed to treat these people.

Professionals in healthcare leadership roles have to respect and work well with employees of different genders, races, ethnicities, cultures, backgrounds, beliefs, sexual orientations and ages. They must promote policies that protect and fulfill the needs of a diverse workforce. Additionally, it’s to the benefit of everyone from themselves to their staff to their patients that they know how to productively leverage the unique abilities and perspectives of those working under them.

Understanding how to be a good mentor and foster growth in one’s direct reports is a requirement for nurses directing or managing others. They have to be supportive, give constructive feedback and delegate significant responsibility to aid in the advancement of employees’ skills and add to the depth of their experience. They should also identify and offer guidance to nurses who could advance to nursing leadership roles in the future.

No discussion of the qualities of an effective nurse leader would be complete without mentioning the importance of forging and nurturing positive relationships with coworkers and subordinates. Part of their job is to identify their group’s common purpose, keep everyone focused on working together and create a strong sense of community.

Especially for nurse executives and administrators, it’s crucial to know how to utilize research and data to make improvements to clinical practice and inform decisions about patient care. These leaders must have a solid understanding of how clinical practice affects patient care and be dedicated to delivering the highest levels of safety and quality possible.

Dr. Scott points out that nurses in executive, managerial or supervisory positions need to be able and willing to discuss conflicting goals with their staff. One prime example is efficiency versus quality: Both have to be achieved and worked on simultaneously, but they sometimes compete with one another. And when that occurs, teams must have real discussions about it instead of denying that it’s happening, as that denial can lead to cynicism and burnout.

Leading the Department or Organization

An increase in authority and control comes with a commensurate increase in responsibilities, expectations and requirements. When one’s department or organization is responsible for treating and caring for sick and injured people, the stakes are as high as they could be. Here are the necessary qualities of an effective nurse leader in charge of a unit or medical center:

Nurse managers and executives in particular require a broad base of business skills and knowledge that comprises products and services, recruitment, training, scheduling, strategy, risk management, budgeting and financial analysis and marketing. Although some of these disciplines don’t typically come to mind when one envisions the job of a nurse, having such well-rounded education and experience in the business side of healthcare is one of the many nursing leadership qualities that will serve professionals well and keep operations running smoothly.

Even for experienced professionals, change can be difficult.

Nurse leaders have to be able to accept, adapt to and lead their staff and patients through times of change. They need to take the concerns of these people into account and figure out how to overcome their resistance. It’s also vital that head nurses involve key personnel in the process of designing and implementing any significant changes.

According to Dr. Scott, this involves rethinking the conventional organizational structure to create forums where staff can come together quickly, identify problems, propose solutions, test them on a small scale and then roll them out to the broader department or hospital in general. Introducing and navigating the right changes in the proper way requires a culture of trust in which people are comfortable learning, contributing and taking risks, and in which they have adequate feedback available to them.

Being the one in charge of making big, consequential decisions is not easy, but for nurse executives, it’s part of the job description. They need to be comfortable efficiently assessing situations and making choices without hesitating or freezing due to doubt or anxiety. While critical thought has to be exercised in many cases, it’s also important that nurse leaders trust their instincts and experience and don’t overthink things when decisions have to be made quickly.

Another of the useful leadership skills in nursing is expertise in investigating, analyzing and solving problems. This requires the ability to process large amounts of information, identify and concentrate on the most important data, figure out the source of the issue and formulate and execute a solution.

Effective problem solving for head nurses requires good organization and a methodical, rational approach, to ensure that the process can be completed efficiently and without becoming overly complicated.

Prioritizing and keeping track of tasks and projects is part of any healthcare operation, and this responsibility falls under the purview of many nurse leaders. They need to make sure all objectives are completed and requirements met within the allotted time frames, which means they have to understand the strengths and capacities of their staff, in order to assign the appropriate tasks and workload to each person. Then, they must keep a watchful eye on the progress of each project or item on the schedule and make any necessary adjustments to ensure successful completion of each goal.

While the moment-to-moment grind for healthcare workers is consistently busy and demanding, one of the critical leadership skills in nursing is the ability to plan ahead. Those who can strategically create ambitious but realistic goals for patient care and operations, as well as feasible plans for achieving them, are in a position to do well as nurse managers or executives, provided that they can strike that delicate balance between long-term goals and immediate needs.

Considering a future in nursing leadership?

If you have many of the qualities of an effective nurse leader discussed above, or you are interested in learning how to develop them, explore the online Master of Science in Nursing – Education & Leadership program from Carlow University. Designed for ultimate flexibility, the MSN allows you to study on your own schedule while still giving you the ability to interact with your professors and classmates.

Whether you’re thinking about transitioning to nursing from a different path or advancing the career you’ve already been building in the field, earn your degree in as little as 15 months and begin an extremely rewarding job as a patient care coordinator, clinical research nurse, head nurse, case manager, nurse manager, nurse executive or other leader in the space.

To learn more, call 1-855-511-6450 or email [email protected] .

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Critical thinking in nurse managers

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• 1 Ambulatory Patient Care Services and Quality, North Shore Long Island Jewish Health System, Long Island, NY, USA.
• PMID: 19492771

Formal education and support is needed for nurse managers to effectively function in their role in the current health care environment. Many nurse managers assume their positions based on expertise in a clinical role with little expertise in managerial and leadership skills. Operating as a manager and leader requires ongoing development of critical thinking skills and the inclination to use those skills. Critical thinking can have a powerful influence on the decision making and problem solving that nurse managers are faced with on a daily basis. The skills that typify critical thinking include analysis, evaluation, inference, and deductive and inductive reasoning. It is intuitive that nurse managers require both the skills and the dispositions of critical thinking to be successful in this pivotal role at a time of transformation in health care. Incorporating critical thinking into education and support programs for the nurse manager is necessary to position the nurse manager for success.

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Critical Systems Thinking: A Practitioner's Guide

ISBN: 978-1-394-20359-8

Digital Evaluation Copy

Michael C. Jackson

Understand the full range of systems approaches and how to use them with this innovative overview.

Leaders and managers face increasing complexity and uncertainty because technical, organizational, socio-cultural, political, and environmental issues have become intensely interconnected. Systems thinking is recognized as the essential competence for managing complexity. As the demand for systems thinking grows, however, the fragmentation of the field into different methodologies has become a potential liability. Critical systems thinking (CST) shows how this diversity can be a strength rather than a weakness by revealing how different systems methodologies address various aspects of complexity and how they can be used in combination to resolve the messiest of wicked problems.

Critical Systems Thinking offers, in a single volume, an account of the value of systems thinking and CST in the modern world, an explanation of the pragmatic philosophy and expansion in mindset necessary to embrace CST, and detailed instructions on how to undertake critical systems practice (CSP) using the variety of systems approaches to navigate multi-dimensional complexity.

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• An accessible introduction to systems thinking and CST.
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Critical Systems Thinking is ideal for leaders and managers in government, business, the public sector, the professions, and beyond who want to understand the potential of systems thinking and use it in their work. It is essential for systems researchers and practitioners who want a deeper understanding of the field.

Dr Michael C. Jackson is an established expert in systems thinking and the major figure in the development of CST. He is Emeritus Professor, and former Dean of the Business School, University of Hull, UK, and Managing Director of Systems Research Ltd. He has served as President of the International Federation for Systems Research and the International Society for the Systems Sciences. He was awarded an OBE by Her Majesty the Queen (2011) for services to business and higher education, the Beale Medal of the UK Operational Research Society (2017), and the Pioneer Award of the International Council on Systems Engineering (2022). His previous book for Wiley, Critical Systems Thinking and the Management of Complexity (2019), is regarded as the definitive account of the history of systems thinking and the different systems methodologies.