written by: Isabel Cunningham•edited by: Wendy Finn•updated: 9/9/2014
There is a huge amount of scientific and technical knowledge needed to practice the nursing profession. But it is also a calling, and what makes a really competent nurse is not just paper qualifications: there are other attributes which are just as vital.
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A Graduate Profession
Nursing is nowadays by and large a graduate profession, but there are other attributes of a competent nurse which are as important as academic qualifications.
The most common routes into practicing as a nurse are either to gain a Bachelor of Science Degree in Nursing, or an Associate Degree. A Bachelor's degree usually takes four years to complete, includes clinical practice, and requires both academic and vocational aptitude. There are a large number of specialisms which call for a Master's degree, requiring even higher level academic ability. So it is abundantly clear that a nurse must be an intelligent person with a good level of academic potential.
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Care is Key
There have recently been criticisms of an overly specialized nursing workforce, At one time, the hospital nurse would have had quite a holistic role in patient care, ranging from bed-changing and temperature taking, to administering medicines and taking samples. There was always a hierarchy within the ward, but there would be a sense that a nurse was basically there to provide comfort and physical care to the patients. For example, the cleanliness of the ward was the business of the nursing supervisors, sisters or matrons, who would have ultimate responsibility for the nursing care within the ward.
The increasing technical demands of the job, together with the long academic training, may have removed the nurse from the direct and responsible caring role which he or she once had, and this is a development which deserves examination. There have been instances recently in the UK, of very basic caring functions being overlooked in the nursing care of the elderly. If even the fundamentals like making sure the patients are able to eat are not there, then the healing psychological effect of feeling well-cared for, which can hasten a return to health, will certainly also be absent.
There is no reason why a patient cannot have that feeling when being looked after by a team of highly skilled specialists. An advanced level of nurse training is an excellent thing for patients. Indeed there is a positive relationship between good clinical outcomes and a high proportion of fully qualified nursing staff. However, when a team is specialized, there can be a feeling that care is fragmented, so that the patient is not sure who to go to for help in any particular situation, and may feel rather lost. To counter that, it is important that all the nurses involved in a patient's care introduce themselves in a friendly and professional way, and basically make the patient feel welcome on the ward, which will actually be their home for however long it takes for them to be fit for discharge.
I would argue that the personal qualities of the nurse (which of course can and must be enhanced by support, training and proper systems of working), are as important as technical competence.
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What it Takes
These attributes are, in my opinion, what makes a great nurse.
High on the list of qualities is a liking for people, and enjoyment and ability to communicate with people of all sorts, together with the ability to listen. A patient can feel overwhelmed by the experience of hospital admission, and a friendly person who can tell them what will happen next, explain the routine, and answer any questions is absolutely vital.
A compassionate and empathetic nature is an obvious necessity. You need to understand the patients' feelings and have insight into what would improve their comfort and well-being.
Physical strength and emotional strength are needed, to help patients who lack mobility, or who need psychological support.
Confidence must be combined with tact, to deal with the inevitable few patients who indulge in patterns of anti-social behavior.
Conscientious attention to detail is of course absolutely vital. The nurse is the one who monitors hospital patients' progress, checks them regularly, and who measures out their dosages, among many other essential, routine tasks.
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A Tale of Two Hospitals
I recently broke my leg, and was admitted to hospital as an emergency. Whilst recovering, I had another fall, and was admitted to a different hospital.
The contrast between the two was extremely striking. In the first hospital, the noise at night was such that it was impossible to sleep. The nurses while not unfriendly, seemed indifferent. One of them was clearly in a very low mood herself and could barely manage to respond to requests, even placing refreshments entirely out of my reach when my movements were restricted.
In the second hospital, I felt welcomed into the ward and was given the feeling that the staff actually cared about the patients' well-being. I was impressed by the lack of a jaded, battle-scarred attitude, and their fresh approach to each patient. They were really excellent. Routine monitoring tasks were also carried out more regularly, and cheerfully.
It is likely that most of the staff in both hospitals had the potential to be good nurses: people do not start out in nursing with the intention of upsetting their patients; but the atmosphere and culture of the first hospital as a workplace, somehow failed to foster the best qualities of the nurses who worked there. Possibly also the first hospital was not managing to recruit people with the right attributes.
And for critically ill patients that makes a real difference to their clinical outcomes, because:
'The same factors that lead hospitals to be identified as effective from the standpoint of the organization of nursing care are associated with lower mortality among Medicare patients.' US National Library of Medicine National Institutes of Health.
Finding and supporting people who have the attributes to be a competent nurse (if not a great nurse), undoubtedly preserves lives.