Critical Thinking and the GPS Mentality

By | September 17, 2018

Katie Foster, System Director, Provider Informatics, OhioHealth

If you’re part of the medical community, you’ve probably seen your fair share of MEMEs. Some are funny and some over-exaggerate, but there’s a little truth lying within the MEME. Some of them deal with patients and some deal with the physician/nurse relationship. There’s one that reads, “Be Nice to Your Nurse… We Keep Your Doctor from Killing You.”

Although this is a bit overstated, it captures the checks and balances system that occurs when a physician places an order in the system, and a nurse double checks the order before acting on it. This MEME captures the importance of critical thinking when it comes to nursing.

Technology can be extremely helpful, but when we take the person and their critical thinking out of the equation, it can be dangerous. Case in point: I’ve been driving for 28 years now. I know how to drive and consider myself a pretty good driver. When I’m in an unfamiliar area, I rely on my GPS to get me around. Recently, I discovered I rely on it a bit too much. I was leaving a parking garage and the GPS told me to turn right, so I did — right into oncoming traffic. Thankfully I was able to cut down another street and avoid a head-on collision.

My first thought was to blame the GPS. The GPS wasn’t to blame though — I was. I allowed my reliance on technology to trump my 28 years of driving experience, which taught me to look both ways and check signage before blindly pulling out.

I’ve been part of go-lives where seasoned nurses didn’t check glucose on patients with insulin drips, nor potassium on patients with potassium drips, nor check post op orders on patients arriving to the floor. When these nurses were asked why these things were missed, their response was that the order wasn’t in the computer, so they didn’t realize it needed to be done. They threw their critical thinking out the window and blamed technology, just as I blamed the GPS.

July. This one simple word, and one simple month can strike fear in the heart of any nurse that has worked in a hospital with residents. July is the month that all newly graduated residents begin their training. When I worked in the ER of a pediatric hospital, I dreaded July; especially in a pediatric ER. As a nurse, I knew to double check every order. In July, I might see orders like weight-based Ativan on a 16 year-old male patient with seizures (way too much Ativan), an order to wrap the ribs on a patient with rib fracture (old-school approach that can cause pneumonia), and head-to-toe labs and radiology on a patient with a sore throat (way over-ordering). All nurses knew to double check every order for accuracy and not simply rely on technology to guide our practice.

How do we teach our nurses that all the training, all the hours of clinical practice can and should be relied on when treating patients? We all conduct downtime exercises to ensure patient care can continue in the event the system goes down unexpectedly. We all have business continuity plans and drills. But, in order to ensure we don’t have a nursing culture of blindly relying on technology, we have to ask the question, how do we create “July” for our nurses?

Katie Foster is System Director of Provider Informatics for Ohio Health, where she has held various roles since 2012. Previously, she worked as an ER Nurse for Nationwide Children’s Hospital and Licking Memorial Health Systems.

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