The Critical Thinkers Have Left the Building

How patients suffer from healthcare worker mandates.

Guest post by Sharon Bautista, RN, Legal Nurse Consultant:

My goal is twofold: First, to scare you, not because I enjoy scaring people, but because I am a patient advocate and feel everyone should know what is happening and what will worsen without a course correction. Second, I want to show how many experienced critical thinkers were driven from patient’s bedsides after the heavy-handed government mandates leaving dependent follower types to fill the gap. Although I was pressured, shamed, and threatened to comply by employers, colleagues, and the uninformed public, my goal is not to garner sympathy or insult anyone, but to shed light on the quality of care lost by purging unvaccinated healthcare workers.

The great resignation.

The nursing shortage, critical before the pandemic, is now worse due to “the great resignation.” Most nursing journals blame this on “post-COVID burnout” and/or “retiring nurses.” They willfully ignore that the staffing deficit worsened dramatically due to healthcare worker terminations and resignations forced by the mandate.

Critical Thinking.

Critical thinking skills are essential for safe and competent patient care, and those fired over mandates have critical thinking skills. That may ruffle a few feathers, but facts don’t care about feelings, and neither do patients who have been harmed and continue to be harmed. Medical decision making should be a risk/benefit analysis. Those who make careful decisions, about their own health and that of their patients, are the safest clinicians and practitioners. “The term critical thinking is often used interchangeably with problem-solving, clinical decision-making, and creative thinking in the nursing literature.” (Simpson & Courtney 2002).

The followers…

The followers were led by dependence, fear, and panic. They did not weigh risk vs. benefit or wait for more data. They compliantly defaulted to government rescue and employer pressure without considering whether the Covid shots were medically or scientifically sound. We can only ascertain that they did not factor in their body’s acquired natural immunity from exposure to the virus on the job. Large numbers of healthcare workers followed the crowd and fell prey to the media narrative that this was going to “save other people” and to not take the shots would harm patients, family, and friends. They believed those of us who abstained from the shot were selfish and irresponsible, and deserved to lose our licenses. This attitude prompted workplace bullying, pressure, and coercion, making a high stress work environment hostile and dreaded.

Kelley identified five followership styles--exemplary, conformist, passive, alienated and pragmatist. (Kelley, 1992). “Dependent uncritical thinkers accept information that is provided to them at face value without any evaluation or questioning. Independent critical thinkers do not accept information without questioning, rather, they evaluate and analyze information to identify consequences and opportunities (Latour & Rast, 2004).” Given widespread evidence of harm from the shots, which healthcare worker would you prefer--one who weighs risks and benefits and fully informs you, or a compliant follower type who performs tasks without question while accepting limited information from sources with conflicts of interest?

Informed Consent.

The dependent follower types did not ask for your “informed consent” because there was no information to impart at the time, which should have triggered the ethical standards for those with discernment. Some humans are more susceptible to media narrative, fear, propaganda, and pressure than others. The stronger minds always reject haste when making medical decisions for themselves and their patients. Patients have lost great healthcare workers mandated out of most healthcare facilities.

There is a cascade of problems with this increased staffing shortage.  I want to emphasize how patients are suffering and will continue to suffer from having:

·       Contracted travel nurses.

·       Foreign trained nurses and National Guard Nurses.

·       New grads thrust into critical care areas meant for experienced practitioners.

Contracted travel nurses.

I have worked with many great ones and have one but there is no substitute for full-time staff and employees. Their service is transitory, they lack loyalty to the hospital, and some are mainly concerned about money. Their higher pay causes resentment and animosity on units where staff nurses must orient them to the facility. Patients notice this.

Foreign trained nurses and National Guard members.

            I have not seen, but am aware of, units staffed with many foreign trained nurses.  However, standards of care differ around the world, as does competency. I tutored Japanese nurses to prepare for the NCLEX RN and PN exams at one time. They were brilliant, polite students; however, their training was focused on the accomplishment of tasks than taking initiative in decision making. They were more dependent upon the doctors. These global differences in nursing roles should not be underestimated.

The national guard is probably well trained, but they are also temporary and that they are needed in the first place should prompt the end of mandates.

New nursing grads in critical care areas.

Having guided student nurses and nurses in transition to practice during my time as clinical educator, watching them being thrust into ER and ICU situations was devastating. They don’t know what they don’t know. The critical thinking necessary in these areas can be attained only with years of experience.  I went straight into the ICU after graduation in 1991.  I remember feeling overwhelmed, anxious, and lacked confidence. This exception is now the norm.

In 2009, a study of new graduate nurse competency was studied by Journal of Advanced Nursing, and it found 26% were deficient and unable to measure up to the standards for safe practice. Here are the categories in which they were deficient:

Initiating independent nursing interventions:

• 97.2% could not do this due to inability to quickly analyze data and use knowledge, experience, and critical thinking to formulate a plan).

Differentiation of urgency:

• 67% lacked prioritization skills with list of tasks and patients in front of them, unable to identify most critical tasks, therefore delay in attending to emergent items and/or missing them altogether).  

Reporting of essential clinical data:

• 65.4% did not tell providers about issues in timely manner which may cause unnecessary adverse events or even death/lawsuits.

Anticipating relevant medical orders:  

• 62.8% were not adept at knowing what may be ordered ahead of time saves nurses vital time and can only develop this with experience.

Providing relevant reasoning to support decisions:

• 62.6% were too task oriented to the detriment of critical thinking.

Problem recognition: 57.1%

My question for all Healthcare Consumers is: Are you alright with the absence careful critical thinkers who research first and make decisions using evidence-based medicine, or will you settle for continued low staffing with those who must follow the dictates of their domineering masters?

References

Critical thinking ability of new graduate and experienced nurses. J Adv Nurs. 2009 Jan;65(1):139-48. doi: 10.1111/j.1365-2648.2008.04834.x. Epub 2008 Nov 14. PMID: 19032517; PMCID: PMC2729546. Fero LJ, Witsberger CM, Wesmiller SW, Zullo TG, Hoffman LA., 2009.

The power of followership: How to create leaders people want to follow, and followers who lead themselves. New York, NY: Doubleday. Kelley, R. E., 1992. 

Dynamic followership: The prerequisite for effective leadership. Air & Space Power Journal, 18(4), 102-110. Latour, S. M., & Rast, V. J., 2004.

Critical thinking in nursing education: literature review. International Journal of Nursing Practice. 2002;8(2):89–98. Simpson E, Courtney M., 2002.

She is now posting on substack at: Sharon’s Newsletter.