Monday, February 18, 2019

Metacognition: Thinking About Your Thinking About Your Nursing Career

In the world of nursing and non-nursing education, metacognition is a common pedagogical concept for nurse educators to consider when working with students on the path to becoming licensed healthcare professionals. Metacognition is at its most basic the act of thinking about your thinking. Aside from its commonplace setting of education, metacognition can be also considered in terms of how we approach our nursing careers and professional lives. So let's stop and think about our thinking, shall we?

Thinking about your thinking: nurse metacognition
Photo by Ricards Zalmezs on Unsplash

Metacognition and the Earnest Nurse

When you think about your nursing career, what do you think about? Is it how unhappy you are or how you're mistreated by a particular colleague or supervisor? Are you confused about what might be the next best career move for you? Does the next chapter of your life feel completely unfathomable? Do you actively examine your thoughts or do you get stuck in moments you just can't get out of (like the old U2 song)?

In my work as a career coach for nurses and healthcare professionals, I often hear stories from clients who feel caught in circular thinking wherein they cogitate about the same ideas or problems over and over again, ad nauseum. When thinking becomes habitual or reactive in this way, additional stress is put on the thinker if he or she isn't making any progress in what is perceived as the "right" direction.

For those who practice meditation, the goal is generally not to stop your thoughts, which is a great misinterpretation of meditation (and essentially impossible, anyway). In most traditions, I perceive the idea as watching your thoughts dispassionately without latching on to them, as if they're just clouds moving across the sky of your mind. Not my happy place, honestly.

In terms of metacognition for examining the state of your nursing career, I'm encouraging almost the opposite of what a meditation instructor might teach: I want you to watch your thoughts carefully and then watch how you think about your thoughts, and then how you react to them emotionally. This is a big difference and quite a powerful exercise, especially when you then use cognitive strategies to deescalate any negative emotions, fear, or stress that surfaces.

For nurses who want to dig deeper beyond nursing being just a job and a career with a financial means to an end (e.g.: putting food on the table, paying the rent, etc.), consciously engaging in metacognition can truly help move you beyond habitual thinking and rumination that can bog you down in negativity and dissatisfaction.

Start With Your Thinking

The first step is to simply realize that your thoughts are running rampant, even if you're often not paying that much attention to them. You may soon realize that your thoughts about your nursing career (and perhaps your current job) can be pretty negative and have a great deal of power to bring you down. Talk about a buzzkill.

Once you're aware of your thinking -- especially habitual negative thinking -- the next step is to convince yourself that there's another way, and that may be in the form of purposefully engaging in metacognition.

According to some sources, metacognition allows you to engage in critical thinking about how your mind works and how and why you do things the way you do. For instance, if you always walk through the door of your workplace, sigh deeply, and think, "This is going to be a really hard day; I just don't want to be here," how will that thought impact your performance, attitude, and level of satisfaction during your shift?

In some New Age philosophies, it's often said that your thoughts create your reality. While this may not be as ironclad a truth as some of those groups of people purport, there's some truth to the notion that thinking negatively can impact your behavior and your perceptions. After all, you can wear rose-colored glasses, feces-colored glasses, or something in between -- how and why do you choose your particular metaphorical glasses when you're preparing for a work shift?

Metacognition for nurses: thinking about your thinking.

Engage Your Metacognitive Brain


In terms of how you approach your nursing career, engaging your metacognitive brain may not be an easy habit to develop, but the risks of not doing so are potentially high because what you don't try to change will only solidify as time goes by.

Do you have a colleague who always seems unhappy about her work life and/or personal life? Does she almost always verbalize the same old complaints time after time, almost like a broken (nurse) record? She's mired in negative thinking, and changing her own mind and short-circuiting those thoughts can be a heavy lift if such thoughts are deeply ingrained and she's habituated to thinking them.

Enter metacognition. If the above-mentioned nurse can engage in metacognition and identify the thoughts that are keeping her in a highly negative state with regards to her work or career, she can then choose to manage her thoughts in order to change the tone of her thinking vis-a-vis her career.

We all tell ourselves stories about our lives and the world around us, for better or worse. To wit, "I can't start IVs and I never will -- I just don't have the touch", or, "My nursing career is going nowhere and I think I should just give up." These thought messages delivered with great conviction to your sensitive mind can trip you up time and time again, thus, this could be where your work is cut out for you and the most attention is needed for change to occur.

Critical Thinking About Your Thinking

The purpose of metacognition for your nursing career is to be aware of your habitual thought patterns, make choices about which thoughts are most helpful, reject the thoughts that trap you, and then work to create a new reality for yourself. Most of us spend time thinking all sorts of things without critically examining our thoughts, and that's where the rubber can hit the road when we begin to do so.

Here's some homework:
  • During the course of a few days -- or an entire week -- closely watch your thoughts about nursing, being a nurse, your workplace, your career, your colleagues, etc.
  • Write down the negative or critical thoughts that you notice (the list may be quite long!) 
  • Examine each thought you've recorded and consider if it's truly helpful to you in any way
  • Next write down a thought that could counterbalance the original negative thought. 
For example:

You notice that a recurring thought is, "My nursing career sucks, and I'm totally unhappy. I'm trapped and there's nowhere else for me to go."

So, what could the counterbalancing thought be? Maybe something like this: "My career may feel tough right now, but I have the capacity to change my situation. I'm free to act, move, change, grow, or find a new job or career path. Now I need to snap into action and take some positive steps in the right direction."

We can all get addicted to our thought patterns; in fact, sometimes our ways of thinking help us to solidify and quantify the negative opinions we have.

We may also get secondary gain from feeling bad or thinking negatively: perhaps our friends show us great sympathy and see us as a "martyr nurse" who they respect for our many daily sacrifices. If we were totally happy in our work, would our friends be as supportive as when they think we're miserable? Of course they would, but we may be addicted to complaining and receiving sympathy. It's up to us to change our very own way of being and thinking.

Metacognition and Critical Thinking

As noted above, metacognition is often used in the context of education. And as we've already learned it can also be helpful in changing our mindset and altering the course of our negative thinking and rumination.

Beyond these powers of metacognition, we can also conclude that metacognition can aid us in strengthening our critical thinking when we're engaged in the actual work of nursing. If critical thinking is as central to or work as nurses as we were taught in nursing school, then we can use metacognition as a means to think about our critical thinking and dig deeper into our motivations and reasoning when making crucial clinical choices.

As stated in a study on metacognition in education published on the website of the National Library of Medicine: "At its core, a critical thinker is one in charge of their thinking processes, while metacognitive strategies enable such control to take place."

So, while you're thinking about your thinking about your nursing career, you can also utilize similar strategies and techniques at the bedside.

Think, Think, and Think Again

Nursing practice is powered by the engine of critical thought. Likewise, the trajectory and direction of your nursing career are also powered by thought, not to mention how you think about your thinking about your career's discontents and joys.

When you notice yourself sinking into "stinking thinking" and negative pathways, consider using the techniques outlined above to counterbalance the negativity. This takes practice, determination, and an actual willingness to change. If your thinking feels completely entrenched and beyond your ability to alter, consider psychotherapy or counseling, specifically Cognitive Behavioral Therapy or a similar cognitively-based modality.

My own therapist will sometimes pose these questions and comments when I'm stuck: "Are the thoughts you're having based in reality? Is there another way to think about this? Is your rumination about the future useful? Remember that worrying about the future is focusing on a negative fantasy that hasn't even happened yet." These are incredibly useful for breaking out of poor thinking.

No one is perfect in this world, even though so many nurses seem determined that they need to be. Nursing can be stressful, and a nursing career can have many ups and downs. That said, it's your choice how you think about your career so that you can make prudent choices, think constructively about your next move, and counter those habitual negative thoughts with new thoughts that are more likely to goad you into action.

Think critically about your thinking, make the best possible choices, and continue to examine your own habituated behavior and thoughts. In controlling and harnessing your thinking, you will move inexorably closer to a happier, healthier life and a more satisfying nursing career.

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Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AUSMed, American Sentinel University, Black Doctor, Diabetes Lifestyle, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.


Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and remarkably intelligent cat, George.

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