Basic skills of a nurse

These are skills every qualified RN should master, and they serve as the foundation on which the professional development of the nurse is built. This item consisted of five issues, which were named ‘Core nursing skills’, ‘Ability to master practical nursing ethics’, ‘Human relations skills’, ‘Ability to situational awareness’, and ‘Ability to tolerate change’ (Figure 8).

FIGURE 8. Basic skills of a nurse.

Core nursing skills

Manual psycho-motor skills, mastery of equipment and procedures, and skills required when assisting a MD were dealt with in this occasion. As the name of this issue refers, it deals with

the very core nature of what it is to be being a nurse and to implement nursing in day-to-day life. A wide variety of issues were specified, and the approach turned out to be predominantly technical. The very core of nursing was considered to be tightly connected with taking care of medication, mastery of procedures, since all intravenously administered drugs and fluids are a nurse’s domain, together with supporting the vital functions, when necessary: “You must master the pharmacotherapy and procedures.” “Setting i.v.-lines and implementing intravenous fluid therapy, and implementing pharmacotherapy.” “We must be able to treat severely injured patients fluently.” “Bag-valve-mask ventilation and intravenous medication are ED nurses’ duties.”

Skills, and especially manual, psycho-motor skills, were highly valued. They were connected to clinical nursing situations, and more emphasis was also wished to be placed put on the development of psycho-motor skills during the education of nurses, and during in-service training as well. It was considered as an obligation to acquire these necessary skills, as the lack or inadequacy of them was perceived to be harmful for patients, and could not be replaced by anyone else’s input to the work:“You must have extremely good manual skills.”

“They should be extensively skilled and competent.” “Certain kind of competence is required, as there are certain things the implementation of which should not be delayed in some situations more than a few tens of seconds. So, then these people, anyone of them, would be able to do what is needed.” “A remarkable amount of attention should be paid to clinical skills.”

A sovereign, or at least fluent mastery of the technical devices and equipment needed in care was regarded as a matter of patient safety and characteristic to ED nursing. In a clinical situation there does not exist time for trying to learn the appropriate and safe use of the necessary equipment and devices, and some of them were considered to be of vital importance in the care of critically ill and injured patients. An insufficient mastery of technical skills was pointed out by several respondents in terms of newly recruited nurses, and some teachers also expressed their concern. On the other hand, the younger nurses were claimed to be more active and competent in technical skills than the more experienced ones, unless some very infrequently needed devices were dealt with:“An absolute necessity is the mastery of technical devices and equipment.” “The use of medical equipment such as defibrillators, infusion pumps, they have to be mastered.”

In addition to the requirement of mastering the procedures performed by nurses, it was mentioned necessary to master the assisting of MDs in procedures performed by them. It seems appropriate to point out that assisting an MD was not considered to be a passive function of a nurse. On the contrary, it was rather considered a matter of honour, or at least part of a nurses’ professionalism, to be sufficiently skilled assistants that the circumstances for MDs to perform procedures are as favourable as possible. This, furthermore, was necessary in order to save the MDs valuable time, as well as to protect patients against unnecessary delays and even pain. This did not, however, turn out to be a major issue, but the data indicate that these skills should not be taken for granted, either. Some of the procedures were reported to be infrequently needed, and the more experienced nurses appeared to be more familiar with them:“You have to be able to assist an MD in performing procedures.”

The role of an observer did not arise very clearly from the data. Only a few mentions were noticed, and they were connected to monitoring the vital functions of critically ill and injured patients:“There are lots of observation of the vital functions belonging to us.”

Ability to master practical nursing ethics

Moral and value- related issues appeared here. Morality was described by expressions connected with willingness to help patients and their relatives. Acting professionally with patients, while simultaneously being in the situation as a human being was considered desirable. A clear concern of these issues was expressed, and a soft side of nursing was brought under discussion. Such a perception was formed that a deep respect towards the distress of patients and their relatives was built into the respondents. Abilities to relieve that distress were highly appreciated, which was expressed frequently; “…that you are able to face an acutely ill patient, and in addition to that, also the relatives.” “In order to be able to help patients and their relatives.” “Humanity and humane skills in general.”

Values and their realisation in real-life were raised to be a concern, not widely, but clearly.

Values were not mentioned as separate concepts, but closely connected with action: “It is required that there be a perception of values and their realisation in practice. Ethicality should show.”

Human relations skills

Skills to organise, to create a caring relationship without delay, and to act as a team-leader as well as to act as a member of a multi-professional team were emphasized. It was clearly demonstrated that an ED nurse needs such skills that enable a human approach to patient

situations. The contact and caring relationship should be established quickly due to the nature of ED work. Organising skills and preparedness to act as a member in a multi-professional team were highly valued.

Nursing was regarded as serving clients, and skills related to creating a caring relationship in the often hasty circumstances of an ED were emphasised. The caring relationship should often be established simultaneously with patient assessment and while care is continuing. This sets its own demands to the human relations skills when handling people, and in giving the impression of calmness and having things under control. Due to the multi-professional nature of the work, the role of an ED nurse is both the role of a team-leader and a role of one to be led. This, in turn, was believed to set special requirements for the knowledge of human behaviour:“How the caring relationship is created, while the action is going all the time.”

“You should possess good skills in handling with people.” “A real professionalism can be noticed also as client service skills.” “Communication skills are in continuous use.” “You must have knowledge of human reactions here.” “The importance of the social side of this work should not be underestimated.”

As patients are discharged from ED they should receive guidance, and that also seems to often take place in haste. Interest in patients’ holistic approach and their managing of their health problems should be expressed. As the population ages, the importance and quantity of these tasks seems to be growing and becoming more demanding. While an ED nurse should have the time, patience and skills to guide an elderly patient ready to be discharged, all the rush and congestion continues. Demanding prioritisation questions were revealed:“You should have a holistic view of your patients and their life span.” “There ought to be time for patient teaching and guidance.” “…and then we should see the big picture, in other words that we are, within nursing, interested in how those human beings are managing with their diseases.”

“This work is more than examining patients, too.” “Discharging older patients is demanding.”

Ability to situational awareness

Skills to master changing incidents and control the prevailing situation in the ED appeared.

Under this issue, an expression of ‘Situational mastery’ was detected. It turned out to be close to the very nature of something called ‘A good, skilled ED nurse’. Furthermore, it was expressed that some just seem to have this skill, and others do not. Mastery of suddenly changing situations is in close connection to ability to prioritise, but it also means ability to

face difficult situations with patients, relatives, own staff, and others:“Being able to face all the situations that come across.”

Ability to tolerate change

It was repeatedly mentioned that ‘nothing is as sustainable as the continuing change’, and the requirements caused by this fact emerged here. The changing age-class distribution is bringing along new and growing challenges, and the unavoidable ageing of the population will set more requirements for taking these predictions into account. A clear message was that all kinds of requirements have increased constantly. Nurses with a long working history were able to compare current and previous requirements, and expressed the change as follows:“In a way you have to master a lot more than in the old days.” “The age-distribution has brought along this change.” “The demands have grown all the time.”