How to Start Critically Thinking for the NCLEX®

While teaching nursing students as a faculty person, I often found that students wanted to know what was on the test. To the students, no other information was necessary! However, thinking that way will only hurt you in the long run. When you only want to know what is going to be on the test, you are learning to the test. But to be a competent, safe nurse you need to know more than what your teacher will put on a test for you to pass.

Nurses need to critically think, but it is difficult to learn this skill. In order to learn in a way that will help you become a competent nurse, you have to do more than memorize information. You must be able to apply nursing knowledge. On NCLEX, the answer will not always be black and white. Your critical thinking skills will be tested. Multiple correct answers may be identified, but only one is the “best” or the “priority” answer. Why? To ensure you are prepared for real-life nursing where you will find that you have to make quick decisions about proper nursing care of clients.

Critical thinking is the ability to recognize problems and raise questions, gather evidence to support answers and solutions, evaluate alternative solutions, and communicate effectively with others to implement solutions for the best possible outcomes. Critical thinking involves multi-logical thinking. Although you may be learning by body systems, you will be taking care of clients who have numerous problems to consider. For instance: A 15-year-old pregnant client who is going into heart failure because of eclampsia. Critical thinking takes practice to acquire. So what can you do now to improve your critical thinking skills?

1. Challenge yourself in class to go beyond memorizing content. You need to get nursing knowledge and proper nursing skills into your long-term memory.
2. One method of getting information into your long-term memory is through repetition. You cannot read something one time and expect the information to get into your long-term memory. It takes time and repetition. This goes beyond memorizing. It involves moving information from your short-term memory, as done with memorization, into your long-term memory. And guess what? Memorizing will not help you much when you are practicing in real-life nursing situations!
3. Talk it out. If you can say it out loud, you can pass it! After you study, make a skimpy outline with just keywords. Then see if you can lecture from it. If you cannot, then you need to study more.
4. One of the BEST ways to develop critical thinking skills and to get information into your long-term memory is understanding the “WHY” question. Understanding “why” behind disease causes, “why” behind signs and symptoms, and “why” behind interventions will keep you from having to memorize. If you do not understand “why” the healthcare provider has prescribed medication or intervention, should you be doing it? No. You do not want to be an inferior nurse who blindly follows orders. You have to always be asking why. Questioning what you are doing. So start while you are in nursing school. Make sure you understand why. If you don’t understand the why then you need to ask your faculty or look it up.
5. Find a role model to emulate. There is a lot of nursing faculty and clinical nurses who are expert nurses who critically think.

Here is an example for you to consider. How does heart failure lead to fluid volume excess? In order to answer this question, you must know what is happening when someone goes into heart failure. This requires you to answer the “why” question.

When the client is in heart failure, the heart muscle is weak. When the heart muscle is weak, it cannot pump effectively, so cardiac output just went down. When the cardiac output goes down, perfusion to the vital organs goes down. So perfusion to the kidneys goes down. So urinary output goes down. If urinary output goes down, where is all the fluid staying? In the vascular space, throwing the client into fluid volume excess. Now, can you determine the “why” behind signs and symptoms of left and right-sided heart failure?

Learn to critically think while you are in nursing school. Start with these tips for improving critical thinking skills so that you can become a competent, safe nurse!

December 20

Debra S. McDonough, RN, MSN, EdD