Checklists vs. Critical Thinking

The question arises so often it's time to address it here: Nursing is more than a routine series of tasks; won't checklists supplant critical thinking?

This is the same question that Dr. Gawande often hears. And the answer is the same, too: a checklist does not replace critical thinking, it supports it.

Consider, for example, interruptions. I'm in the middle of some lengthy activity when something urgent pops up. So I go take care of that and in doing so am once again interrupted -- a new order arrives, or a call bell rings. Before long it's the end of my shift and that first thing still isn't finished.

Or how about ambulations? My patient needs them Q2H but if I'm a little late it doesn't matter. What does matter is if I miss a couple of them entirely.

I'm so busy! I'm juggling so many things! A mechanical tool like a checklist can help me be confident of the details, freeing my mind to focus on the bigger picture. In other words, critical thinking.