Thank you for the editorial regarding whether dogs are cute.1 First, I agree dogs are cute, and I commend you for encouraging nursing to use critical thinking when determining why. We all have different opinions, reasons, and biases that are pulled into every decision subconsciously, making us human. In the last 10 years, I have witnessed a shift in healthcare from critical thinking to protocols and algorithms. Every process must be standard to ensure the same thinking and quality for every patient interaction or scenario. Although this serves to improve quality, we have also managed to remove nursing critical thinking and human component.

So using your example, "Dogs are Cute," starts the process map with decision points along the way telling the nurse how to proceed related to the dog's color, age, and health; how quickly they wag their tail; and so on. In the end, you have decided which dog is cute and why. The protocol may make it easy to determine why dogs are cute; however, we have removed the critical thinking of the neuroscience nurse. We have ensured the patient receives the same care regardless of the care provider, but we have removed the diversity present in humans.

I have a small black dog, so thinking all small black dogs are cuter than all gray dogs regardless of the variables listed previously shows my bias and does not follow the protocol for determining whether a dog is cute. Is this bad? What if I have a grandmother who died of Parkinson disease and I am caring for a patient with Parkinson disease? Should I follow a protocol if the protocol does not help the patient or follow my personal experience? Should I give the Parkinson disease medications on the hospital schedule or the patient's schedule?

Nursing care is essential; neuroscience nursing care focuses on the ability of the nurse to differentiate subtle changes and rely on education rather than technology. In neuroscience nursing, protocols and algorithms may remove the critical thinking needed at the bedside. Neuroscience nurses are with the patient every minute of the day; now more than ever, maintaining the ability and confidence to think critically is essential!

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