Professional Liability Insurance Program for AALNA Members
The Importance of Critical Thinking Skills Nursing

The Importance of Critical Thinking Skills Nursing

The Importance of Critical Thinking Skills Nursing

By Megan Ruesink

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 over-looked: the ability to think critically.

Critical thinking is defined in a number of ways but perhaps it’s easiest to comprehend when you understand all that it encompasses. Critical thinking includes identifying a problem, determining the best solution and choosing the most effective method of reaching that solution. 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, there’s a lot more that goes into critical thinking than one might think. It’s a transferrable skill that can be leveraged in several facets of your life. But why is critical thinking in nursing so critical? Keep reading to find out.

Why are critical thinking skills in nursing important?

You’ll notice in the list above that critical thinking is embedded in a nurse’s everyday routine. You’ll learn all sorts of practical skills in nursing school that you’ll put to use at the clinic, but without the ability to think clearly and make rational decisions; those skills alone won’t get you very far.

You may be able to flawlessly dress a wound, take vitals like a pro or give an IV without flinching, but without the ability to make quick and efficient decisions under pressure, you’ll struggle as a nurse, according to LeeAnn Andronico, Rasmussen College nursing program coordinator. Some critical thinking skills come naturally and others can be acquired and developed during nursing school.

How are critical thinking skills acquired in nursing school?

As a future nurse you have probably heard about the intensity of nursing courses, if not yet experienced it firsthand. There is a multitude of material to master and 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. Andronico says in reality, the answer won’t always be black and white.

Your critical thinking skills will be put to the test during nursing exams. Andronico explains that you’ll quickly discover that questions may have multiple “right” answers—though one answer may be “the most right” for that particular situation. This may sound confusing, but it is intentionally done in order to help prepare you for real-life nursing scenarios. You will often find yourself in situations where there are few “correct” forms of care, but one that is most appropriate.

How can you develop your critical thinking skills?

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.

“Critical thinking skills apply not only to thinking, but also to reading, writing, speaking and listening.”

Changing your mindset will help you gain the practical knowledge from which you’ll draw upon throughout your entire career. Hold on to your past exams, review the answers and reflect on any areas you didn’t quite grasp the first time.

Borrowing or purchasing an NCLEX review book is another way you can sharpen your critical thinking skills. Not only are the questions directly related to the career you’re pursuing, but the book explains the rationale behind the answers, exposing you to solutions you may not have found on your own.

It’s helpful to practice thinking about a problem in a different way or from a new perspective. It sounds silly, but you essentially have to think about thinking! Andronico stresses the importance of spending time developing clear and rational thoughts and surveying all of the evidence available to you before making a decision.

How are critical thinking skills applied in the real world?

Andronico believes the critical thinking skills you acquire in nursing courses and during clinicals will be invaluable throughout your nursing career and the rest of your life. 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. But critical thinking goes beyond the clinic and is a skill the will be transferable into the rest of your life as well. Your ability to make sound decisions in high pressure situations will surely come in handy at home as well.

“Critical thinking skills apply not only to thinking, but also to reading, writing, speaking and listening,” Andronico explains. “You must be able to translate a thought clearly and accurately, quickly and logically so that others understand what you are saying without any confusion.”


*This article was originally published in July 2012 by LeeAnn Andronico. It has since been updated to include information relevant to 2015. Insight included from Andronico was preserved from the original article

CEAL and CGNO 2014 Annual Reports Available Now
GAO to Focus on Antipsychotic use in Assisted Living

GAO to Focus on Antipsychotic use in Assisted Living

GAO to Focus on Antipsychotic use in Assisted Living


Anpsycotics in dementiaSince 2006, the number of skilled facilities cited by CMS for the use of unnecessary medications (F 329) increased nearly 75%.  In response, the Centers for Medicare and Medicaid Services (CMS) identified reducing the off-label use of antipsychotics among patients/residents of skilled nursing centers as one of its priorities and set goals for a 15% reduction of off-lable and other uses of antipsychotic medications.

In September of 2014 The National Partnership to Improve Dementia Care announced that it met its initial goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 15.1 percent. It also announced a new goal of a 25 percent reduction by the end of 2015, and a 30 percent reduction by the close of 2016 using the prior baseline rate (fourth quarter of 2011).

The goal of antipsychotic drug use reduction is the improved care of residents and viable alternatives to antipsychotic medication. CMS is emphasizing non-pharmacological alternatives for nursing home residents, including potential approaches such as consistent staff assignments, increased exercise or time outdoors, monitoring and managing acute and chronic pain, and planning individualized activities.

Over the 21 months since the inception of these initiatives the national prevalence of antipsychotic use by long-stay nursing home residents was reduced by 17.1 percent (from 23.8 percent to 19.8 percent). While some states showed much more improvement than others. All 50 states and every CMS region showed at least some improvement. (Data on all states is available at under media release Fact Sheets). Short-stay incidence rates improved as well.

The new goals are to:


Programs and initiatives have been in place on the CMS, state HealthCare Associations, AHCA, NCAL and ALFA web sites for use by skilled nursing facilities for two to three years. Initiatives, interventions, culture change tools, etc. are available for your use. The Alzheimer’s Association also has programs and alternative interventions, available on their web site.

A large number of the individuals in skilled nursing centers are living with some type of dementia. For these individuals behavior often becomes a key form of communication. This can be challenging for families and staff, and too often antipsychotic medication is used in an attempt to modify behavior. The use of antipsychotic medication to treat behavior associated with dementia is not supported clinically and is considered off-label by the FDA, which issued a “black box” warning for the elderly with dementia

Why are we discussing this today?

The General Accounting Office (GAO) announced on March 3, 2015 they will be focusing on Assisted Living residents with dementia receiving too many antipsychotics:

Assisted living residents with dementia receiving too many antipsychotics, GAO says.

As an organization and a profession we need to set the pace for others. Many of our communities have already begun to monitor and reduce the use of the inappropriate use of antipsychotics in our general and dementia populations.

In response to the GAO announcement,  if you have not begun to examine this issue in your community it is suggested you begin to do so as soon as possible. We can take responsibility and make adjustments to our care models and interventions prior to receiving additional oversight or federal or state regulatory requirements.

As stated, many resources are available to assist you in changing the way residents utilizing antipsychotic medications are monitored and managed. Some of those resources are listed below:

Through active communication with physicians, families, staff and residents we can reduce antipsychotic use. As a profession Assisted Living can improve our approaches to dementia care and improve the quality of life for our residents.

Merrill Gardens Joins AALNA as Corporate Member

Merrill Gardens Joins AALNA as Corporate Member

Merrill Gardens Joins AALNA as Corporate Member

Merrill GardensDevoted to going above and beyond to keep its residents living the best life possible, Merrill Gardens Senior Living has joined the American Assisted Living Nurses Association (AALNA). By aligning with AALNA, the only nurses association focused on promoting effective nursing practices in the assisted living industry, Merrill Gardens is further exemplifying their commitment to quality care and ongoing staff development.

“Our nurses should have the support of a professional organization focused on the unique aspects of caring for seniors in this setting,” said Wendy Gardner, Vice President of Quality Services at Merrill Gardens. “Merrill Gardens is committed to being the premier provider and employer.  We feel that membership in AALNA will give our nurses access to a broad range of resources and networking opportunities that will enhance their skills and professional satisfaction when working with this population.”

Read the Full Press Release

Florida Become the Newest AALNA State Chapter
Remember Antiviral Drugs for Flu, CDC Tells Clinicians

Remember Antiviral Drugs for Flu, CDC Tells Clinicians

Remember Antiviral Drugs for Flu, CDC Tells Clinicians

flu-shot-for-seniors-617x416Source: Long-term Living Magazine

In the battle against influenza, clinicians aren’t prescribing antiviral medications as much as they should, Centers for Disease Control and Prevention (CDC) Director Tom Frieden, MD, MPH, told members of the media this afternoon in a press call. The CDC issued new recommendations this morning to encourage use of the drugs, which the CDC considers an important adjunct to vaccination, he noted.

The antiviral medications can help prevent hospitalization, a transfer to the intensive care unit for those who are hospitalized, and even death, Frieden said. Use of the medications is even more important than usual, he added—especially in those aged more than 65 years, those with chronic conditions such as asthma or diabetes, and other vulnerable populations—given that the prominent strain of flu this season is H3N2, which leads to severe illness.

“One recent study showed that fewer than one out of five high-risk outpatients who clearly should have gotten treatment…with antivirals actually did,” Frieden said. Several factors may explain why doctors, nurse practitioners, physician assistants and other healthcare professionals are not prescribing antiviral drugs to fight the flu, he added:

  • They may not be aware of CDC recommendations.
  • They may not be aware of the drugs’ effectiveness.
  • They may be waiting for the results of tests confirming flu in patients/residents. (“Don’t wait,” he said. “Early treatment is essential and keeps the benefit higher.”)
  • The two-day window of the drugs’ optimal benefit, during which the medications are most likely to reduce the intensity and duration of illness, may have passed.

Flu season typically lasts 13 weeks, and this season’s outbreak is in week seven, Frieden noted. The flu is widespread across the country but seems to be declining in areas of the country that experienced the earliest cases of illness, he added, although “it’s too soon to say if we’ve peaked.”

Frieden said the CDC continues to recommend vaccination for those who haven’t yet received a flu shot, even though this year’s vaccine wasn’t formulated to fight the H3N2 virus. Vaccination is especially important for those aged 65 or more years, who tend to be hospitalized or die more than others due to the flu, he said. “Despite the likelihood that vaccine effectiveness will be lower this year…vaccination may still offer some protection, and there are other strains out there as well,” he said.

Those who have the flu should cover their cough and stay home and away from others to prevent the spread of illness. Those who are prescribed antiviral medications should be sure to take the full course, he added. Those who care for the sick should ensure that they receive the full course.

The CDC also recommends two pneumococcal vaccinations for those aged 65 or more years, Frieden said. “The best way to prevent pneumococcal disease is by getting vaccinated,” he added.

Top 5 Takeaways from HIPPA Audits
Four Issues that will Determine the Future of Assisted Living

Four Issues that will Determine the Future of Assisted Living

Four Issues that will Determine the Future of Assisted Living

CEAL Four issues will determine what the future of assisted living will look like, according to participants in a recent round table sponsored by the Center for Excellence in Assisted Living (CEAL). Those issues include:

  1. Personnel.
  2. Data.
  3. State regulations.
  4. Affordability.

“The Future of Assisted Living: Consumer Preferences and the Era of Healthcare Reform,” took place in October and was attended by 35 assisted living stakeholders representing:

  • Residents and their family members.
  • Assisted living providers.
  • Health care professionals.
  • State Medicaid staff.
  • Accountable Care Organizations (ACO).
  • Managed care organizations (MCO).
  • The disability community.

CEAL will release a white paper in early 2015 based on the information and data shared by panelists, attendees, and keynote speaker David Grabowski, Ph.D., professor of health care policy at Harvard University.

The round table was designed to help identify ways in which assisted living must evolve so it remains a viable service of choice in the changing pay-for-performance health reform landscape. Within this landscape, assisted living providers will be more attractive partners for ACOs and MCOs if they address the following 4 issues.


Round table participants identified several steps to developing and increasing assisted living staff competencies. These steps include:

  • Elevate professionalism by creating tools to document, measure and demonstrate competencies, including credentialing standards.
  • Provide personal and professional development by creating ladders, lattices and life skills resources for all personnel.
  • Engage the support of family, care partners, volunteers, and others to work with personnel as a team that respects each other’s knowledge and skills.
  • Provide training to counteract ageism in current and new personnel.
  • Develop training strategies to address assisted living care trends, personnel shortages, diversity among personnel and care recipients, staff retention, and staff engagement and wellness.


Assisted living has some work to do to ensure that data is collected and shared across settings so assisted living communities can participate in MCOs and ACOs. The data collection should:

  • Include quality measures/outcomes.
  • Focus on individual preferences, goals and psychosocial needs, in addition to medical and health care related data.
  • Feature better communication and data sharing among stakeholders.

State Regulations

While round table participants supported continued regulation of assisted living at the state level, they also recommended that these regulations should:

  • Be evidence-based and reflect best practices in assisted living, including credentialing for key personnel, person-centered care, and innovation.
  • Focus on person-centeredness and allow individuals to age in place through evolving community-based models like assisted living without walls.
  • Support state/provider collaboration.
  • Feature a survey process that emphasizes education and collaboration rather than correction or punishment.


The costs associated with assisted living should be comparable to skilled nursing and should provide affordable private-pay options for middle class individuals. To meet this goal, stakeholders should take steps to:

  • Ensure that regulations create the potential for Medicaid reimbursement through ACOs and MCOs.
  • Create models, like assisted living without walls, to fill the need for affordable senior living.
  • Develop partnerships with existing advocates for affordability, including AARP.
  • Educate consumers about their responsibility to fund their own care.

Additional Themes

During their discussions, round table participants identified 14 emerging themes in the field of assisted living. Those themes underscore the need to:

  • Include a full spectrum of services, from hospitality through health care, in the assisted living model.
  • Provide services in a wide variety of settings to individuals who are increasingly diverse in their age, culture, lifestyle, level of disability, preferences and care needs.
  • Focus less on real estate and more on providing person-centered services in homes and communities.
  • Partner with home health organizations and community researchers to create new models that satisfy evolving consumer preferences.
  • Use technology to foster quality, care coordination, access, affordability, and an enhanced work life for staff.
  • Keep the “Home” in assisted living by focusing on the individual without disturbing the home environment.
  • Support regulations that foster freedom of choice and managed risk as well as evidence-based practices that promote risk reduction.
  • Educate consumers about a variety of topics, including privacy of personal information, informed decision making, the role of long-term care navigators in decision making, advance care planning, and planning ahead to fund long-term care.
  • Accommodate ongoing changes in operating models and physical environments.

Source: LeadingAge

CDC Unveils Flu Toolkit for Long-Term Care Providers

CDC Unveils Flu Toolkit for Long-Term Care Providers

CDC Unveils Flu Toolkit for Long-Term Care Providers

CDCThe Centers for Disease Control and Prevention has released a long-term care toolkit with resources for senior living communities to provide access to flu vaccines for their workforce. It’s also designed to help employers in long-term care understand the importance of the flu vaccine for employees.

The toolkit was developed by the Health and Human Service Department’s National Vaccine Program Office and is available on the CDC website.