Over the years, the question of what nurses really do on a daily basis has confounded not only the general public, but also those who work in the healthcare field. However, one cannot attempt to explain what nurses do on a daily basis without first understanding what nursing is and why the healthcare field even exists. The field of nursing exists primarily to assist the physicians and to facilitate the recovery of ill, weak patients. Nurses exist to show each patient compassion, so the patient will feel welcome, and not like a burden onto others. It is the nurses’ obligation to possess the knowledge necessary to ensure and facilitate the patients’ health and healing process.
According to Suzanne Gordon (2006), “Nurses use their considerable knowledge to protect patients from the risks and consequences of illness, disability, and infirmity, as well as from the risks and consequences of the treatment of illness. They also protect patients from the risks that occur when illness and vulnerability make it difficult, impossible, or even lethal for patients to perform the activities of daily living” (p. 1). Gordon’s personal thoughts on what nurses do basically wraps the nurse’s duties into a nut-shell. Although her statement is quite vague, with no clear-cut answer to what nurses actually do daily, one gets an idea of the overall role of the nurse in the healthcare environment and, more importantly, to the patient.
Even some of the most obvious roles of the nurses, such as building a relationship with the family, has a positive impact on the patients’ health and the family’s coping with a loved ones’ illness. The main idea in Gordon’s belief of what nurses really do is protection. Everyday a nurse’s main goal is to protect the patient from existing and future complications of illness and disease. Patients realize this and tend to develop a close, trustworthy relationship with the nurse because the nurses is usually the first person to interact with the patient while he or she is going through a health crisis. For example, the nurse is the first one who come to the patient’s rescue when he or she slips and falls while trying to go to the restroom. “Nurses save lives, prevent complications, prevent suffering, and save money” (Gordon, 2006).
The Quality and Safety Education in Nursing (QSEN) is a project with intentions to meet the difficulties of preparing nurses who have the overall knowledge, skills, and attitudes (KAS) needed to continuously enhance the quality and safety of the healthcare systems in which they work. The Quality and Safety in Nursing establish six nursing competencies and the knowledge, skills, and attitudes necessary to successfully achieve each competency must be addressed in pre-licensure programs. These six competencies include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Each competency has distinct knowledge, skills, and attitudes that, when fulfilled, work together to ensure proper patient safety and health.
Patient-centered care is the act of acknowledging that the patient is the source of control and exists as a full partner in delivering organized and compassionate care centered on respect for the patient’s preferences, values, and needs. Patient- centered care lays down a foundation for the special relationship between the patient, the family, and the healthcare providers. “The care provider-patient relationship is one in which the care provider consistently maintains the patient and family as his or her central focus. The care provider knows that each person’s unique life story determines how he or she will experience an illness. The care provider conveys and unwavering respect and person concern for the patient, strives to understand what is most important to this particular patient and family, and safeguards their dignity and well-being, and actively engages them in all aspects of patient care” (Disch, n.d.).
The knowledge, skills, and attitudes needed to achieve patient-centered care primarily focuses on being there for the patient and working closely with the patient in order to achieve goals. One must have the knowledge to understand the varying aspects of patient-centered care, such as the patient and family’s preferences, coordination and integration of care, physical comfort and emotional support, and information, communication, and education. Furthermore, one must understand how different ethnic, cultural, and social backgrounds exist as sources of patient and family values. One must possess the skills to express patient values, preferences, and specific needs in the implementation of a care plan and evaluation of care.
Other skills include expressing the patient’s specific needs to other members of the healthcare team, and providing patient-centered care with understanding and respect for the diversity of the human experience. Attitudes needed to accomplish patient-centered care include viewing the health care circumstances “through the eyes of the patient”, valuing the patient’s knowledge with own health and symptoms, and seeking various learning opportunities with patients who signify all aspects on human diversity. These are only a few examples of the knowledge, skills, and attitudes needed for nurses to achieve patient-centered care; however, they serve as a framework for understanding the nurse’s and patient’s role in patient- centered care.
Teamwork and collaboration is used to function properly within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to accomplish quality patient care. The decision making between various members of the healthcare team helps ensure proper care and consensus on treatment. “The parties bring individual areas of expertise to a particular situation, as well as diverse perspectives which are influenced by professional orientation, experience, age, gender, education or socio-economic status. Conditions which enhance collaboration include shared goals, and understanding of the other’s roles and responsibilities, mutual respect, clear communication, and openness to learning, and an ability to change one’s viewpoint, given new information” (Disch, n.d.).
The knowledge, skills, and attitudes necessary for teamwork and collaboration mainly focus on working with the inter-professional team to achieve quality patient care. One must have the knowledge to describe own strengths, limitations, and values as a member of the team, describe the scope of practice and roles of health care team members, and analyze distinctions in communication style preferences among patients, families, fellow nurses, and other members of the healthcare team. The skills needed for effective collaboration include acting with integrity, consistency, and respect for opposing views, functioning efficiently within own scope of practice as a member of the health care team, and adapting personal style of communicating to the needs of the team and the situation. One must have the attitude to acknowledge own potential to influence the effectiveness of the team, value the perspectives and expertise of all health team members, and value teamwork and the relationships upon which it is based. These few examples of the knowledge, skills, and attitudes needed in collaboration and teamwork gives an idea of why communication and mutual agreement is important for quality patient care.
Evidence-based practice involves incorporating best current evidence with clinical expertise and patient and family preferences and values for delivery of optimal health care. Evidence-based practice provides insight into thinking about clinical practice and leading practice change. “Evidence-based practice incorporates the development of skills in how to frame a question, locating knowledge, critical thinking, and clinical discernment. An evidence-based approach to clinical decision making is embedded with tan appreciation for the continuous generation of knowledge and a philosophy of life-long learning” (Barnsteiner, 2010). The knowledge, skills, and attitudes needed in evidence-based practice focus on understanding what can be achieved in healthcare in an ever-changing world. One must possess the knowledge to demonstrate understanding of basic scientific methods and processes, separate clinical opinion from research and evidence summaries, and describe how the strength and relevance of available evidence impacts the choice of interventions in providing patient-centered care.
Skills include participating properly in appropriate data collection and other research activities, reading original research and evidence reports related to area of practice, and contributing to structuring the work environment to facilitate integration of new evidence into standards on practice. One must have to attitude to appreciate the strengths and weaknesses of scientific bases for practice, value the necessity for continuous enhancement in clinical practice based on new knowledge, and acknowledge own limitations in knowledge and clinical expertise. These brief examples of the knowledge, skills, and attitudes necessary for evidence-based practice provide some insight into why this competency has the potential to positively impact patient care.
Quality improvement involves using data to monitor the outcomes of care processes. Quality improvement uses enhancement methods to design and test changes to constantly improve the quality and safety of health care systems. “It is important for nurses to understand that we are part of a system of care and that quality improvement is a process that involves nurses, physicians, and everyone involved in patient care. In order to improve care, the entire team has to be committed to that goal. If just one person or just one discipline works to improve care, the overarching systems of care will never get better” (Johnson, n.d.). The knowledge, skills, and attitudes needed for quality improvement focus on developing strategies to advance patient care.
One must have the knowledge to describe strategies for learning about the results of care in one’s clinical setting, recognize that nursing and other health care professions’ students are a part of the care systems that affects outcomes for patients and families, and explain the importance of differentiation and measurement in assessing quality of care. Skills include seeking information about results of care for population served, using tools to make processes of care explicit, and identifying breaks between local and best practice. One must have an attitude to appreciate that constant quality improvement is a crucial part of the daily work of all health care professionals and value own and others’ contributions to outcomes of care. These few examples of the knowledge, skills, and attitudes necessary for quality improvement give an idea of how quality improvement enhances patient care.
Safety involves minimizing the risk of harm to patients and providers through both system effectiveness and personal performance. “Safe, effective delivery of patient care requires understanding of the complexity of care delivery, the limits of human factors, safety design principles, characteristics of high reliability organizations, and patient safety resources” (Barnsteiner, 2010). The knowledge, skills, and attitudes necessary of safety focus on understanding and eliminating threats to patient safety. One must have the knowledge to examine human factors as well as frequently used unsafe practices and outline general categories of errors and hazards in patient care. Skills include demonstrating proper use of techniques to reduce risk of harm to self or others and using strategies to lessen reliance on memory. Attitudes needed include valuing the contributions of standardization to safety. These a just brief examples of the knowledge, skills, and attitudes needed for patient safety, but they give insight into how safety is achieved in the healthcare setting.
Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. “Technology is changing how patients manage their own health care needs and how nurses manage patient care. Nurses need new skills to use and contribute to the development of electronic health records, to find and evaluate the relevance of evidence to support clinical decisions, and to use data to solve patient and system problems” (Johnson, n.d.). The knowledge, skills, and attitudes needed for informatics focus on using technology to improve patient care. One must have the knowledge to explain why information and technology skills are essential for safe patient care and identify crucial information that must be available in a common database to support patient care. Skills include applying technology and information management tools to support safe processes of care and navigating the electronic health record. One must possess the attitude to appreciate the need for all health professionals to seek lifelong, constant learning of information technology skills. These examples of the knowledge, skills, and attitudes needed in informatics helps one understand why technology is essential for better patient care and outcomes.
Through discussing all of the six competencies for Quality and Safety Education in Nursing, one may still not have a clear answer to what nurses really do. Personally, I believe that a good nurse embodies all of the competencies, with care at the center. Nurses complete a variety of tasks and duties each day, which makes the nursing field complex and difficult to understand. However, as long as patients know that nurses are there to help and protect them, there should not be an issue on the exact role of the nurses. “The public knows that nurses are kind, caring, and compassionate and that they provide patients with more information than doctors do” (Gordon, 2006).
Barnsteiner, J. (2010). Evidence Based Practice Competency Resource Paper. AACN, QSEN Evidence Based Practice, 1-14. Barnsteiner, J. (2010). Safety competency resource paper. AACN, QSEN Safety, 1-25. Disch, J. (n.d.). Patient-centered care competency resource paper. AACN, QSEN Patient-centered Care, 1-21. Disch, J. (n.d.). Teamwork and collaboration competency resource paper. AACN, QSEN Teamwork and Collaboration, 1-42. Gordon, S. (2006). What Do Nurses Really Do? Topics in Advanced Pratice Nursing EJournal, 6(1), 1-5. Retrieved December 5, 2014. Johnson, J. (n.d.). Health informatics competency resource paper. AACN, QSEN Informatics, 1-24. Johnson, J. (n.d.). Quality improvement competency resource paper. AACN, QSEN Quality Improvement, 1-35. Pre-Licensure KSAs | QSEN. (n.d.). Retrieved December 5, 2014, from http://qsen.org/competencies/pre-licensure-ksas/