critical thinking skills – JRM Nurse Consultants

In some managed care organizations, there are several factors that inhibit critical thinking skills to be utilized. Some of these factors are contract led and others are management style. Long term care programs are mandated by the state to follow a certain protocol on managing their cases for the members that are seen. The care part for the member is not an issue, however the reports and assessments that are required to be filled out, keep the case manager from adequately spending appropriate time with the member. If there is one item not completely filled out, the assessment will be returned by the state. The assessment is at times sent back late from the state, forcing the case manager to redo the entire assessment that can easily take two hours. This in turn causes a high turnover of staff because the demands on their time as salaried employees working 12 plus hours and 6-7 days per week are not what they want to do.

These company cultures do not lend themselves for new implementations for a better way to manage the staff and their time. The industry has seen some of the staff say that they have PTO (it should be paid time off) but at times they are still checking emails and phone messages for fear of getting behind, so one has to ask themselves are they on paid time off or pretend time off? One manager cannot implement changes in the entire company, but with their own team they can apply evidence based nursing and critical thinking skills to make a difference internally.

Some ideas that a manager can work on with their team can be, discussing best practices for different aspects of the job. It seems that all team members and managers have to address emails, projects and reports, these will always interrupt the flow of the day. The team however, can control when they see their patients, make phone calls and when notes are entered in the system. When a manager is preparing to discuss the best practices, some things to consider can be based on the issues that the staff come up with ahead of time during the week or audits on their files. This can help the morale of the staff as well as their performance, decreasing the amount of turnover. (Marchionni & Ritchie, 2007)

In conclusion, every manager has their own style of managing. The best style of management is always going to be one that empowers employees to do their job based on examples and positive reinforcement. If all the employee ever hears is what they did wrong and never a word of praise, the employee will not strive after a while to grow and better themselves.

” A word aptly spoken is like apples of gold in settings of silver.” Proverbs 25:11

Written by Rosie Moore, RN, BSN , LNC

Professionals use critical thinking and problem solving strategies daily in their work environment. Take for instance a health plan managing their member’s health, consisting of a staff of social workers, RN’s and LPN’s they will manage all kinds of medical conditions. The case manager is expected to apply critical thinking skills to each case and prioritize what that individual member needs. As an organization in healthcare they are to effectively encourage behavior change in members towards a healthier life that will avoid gaps in their healthcare treatment. The case manages are also required to achieve the business goals of the company by submitting state required forms timely to AHCA (Agency for Healthcare Administration). With each member that the case manager interacts with, they will be advising them of what care is covered under their plan, how they can best utilize the health plan to empower them to live a healthier lifestyle by complying with such things as attending their doctor’s appointments, taking their medications and reporting changes in their health, socioeconomic status or if their living arrangements are no longer safe for them.

Every organization can improve the critical thinking of their staff, but the reality is that it is the staff member that needs to utilize their critical thinking skills to make that change. One thing I learned is that “To provide quality care in this environment, nurses need to develop critical thinking (CT) skills that will provide them with expertise in flexible, individualized, situation-specific problem-solving.” (Brunt, 2005, p.60) When I think of how some case managers use critical thinking skills, I become concerned. For example, I will share a story of a time that a social worker went out on a field visit with a nurse to a nursing home. The social worker had already informed the accompanying nurse that the member was non responsive and she will either sleep through the visit or have a blank stare. One of the first things the nurse noticed when she came in the room was that she had slipped in her hospital bed to the side. It is noted that the insurance company case managers do not do hands on care, so the social worker will have to let the nursing home staff know to readjust her.

Second the nurse accompanying the social worker noticed that she had a big bump on her forehead, she questioned the case manager but she did not know where that came from. The nurse quickly used her critical thinking skills to scan the situation and see that the member probably had slipped. During the nurse’s visit, she noticed that the member had too many pillows behind her back; she was a light weight and was slipping to the side about ready anytime to hit her head on the same spot with side rail. This led the nurse to believe that this was not the first time this had happened to this member. The nurse and social worker let the staff know on the way out of the member’s room.

However, in thinking about the list of 17 Dimensions of Critical Thinking in Nursing, a few critical thinking skills stand out in my mind for this situation that I was hearing about. When analyzing a situation, if the case manager is not a nurse who is used to doing head to toe assessments, would she have known that bump on her head was the result of the member falling sideways and hitting it on the side rail in the very same position that she was found in? If the social worker did not seek information from the nursing staff to ask about the bump on the member’s forehead and was only concerned for what is in the member’s chart, then she would not have the correct information to formulate a plan of care that will benefit that member. If the social worker could predict what would happen if the member continued sleeping sideways on the bed propped by pillows, then she would be using her critical thinking skills to avoid an incident. Transforming knowledge can only happen when you have a working knowledge on any subject. If you have not been taught how to do a physical assessment on someone, then you are not able to transfer what you were taught in a book to a real life situation that will require critical skills thinking to resolve a problem. (Rubenfeld & Scheffer, 2005, p. 2)

Rubenfeld, M. G., & Scheffer, B. K. (2005). Critical Thinking TACTICS for Nurses: Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

Written by Rosie Moore, RN, BSN, LNC

Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

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Organizational Culture and Critical Thinking