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When it comes to nursing skillsets, one size does not fit all


A group of chief nurses I met with last week were discussing the challenges they face in the recruitment and retention of nursing staff, and the new roles entering the nursing family.

The conversation turned to whether competence or compassion was more important in nurses. And the verdict was that both were vital, but that you might just have to compromise or combine the skills of staff members to achieve the right balance in your rosters.

The truth is that with almost 700,000 on the NMC register it is unrealistic to expect them all to possess the optimum combination of compassion and competence – or for the balance to remain static within individuals throughout their careers.

However, nursing roles vary widely. And that means the optimum balance of compassion and competence differs between roles. Of course, there is a minimum level of each required by all nurses, but beyond this the balance often depends on the context in which they work. For example, for nurses working in management, academia or policy setting, competence in analytical skills, research or strategic vision may be far more useful than their ability to be friendly and warm. A newly qualified nurse, on the other hand, may have much to learn in clinical skills, but bring value in the form of empathy or the ability to look at their service with fresh eyes.

“I believe there has been too much emphasis on compassion as defining nursing of late”

Interpersonal skills are essential for nurses if they are interacting with patients, service users and their loved ones. They enable you to find out how a patient really is, so you can aim to give them choices about the things that really matter to them, rather than assuming all patients in a particular situation want the same thing. However, I believe there has been too much emphasis on compassion as defining nursing of late.

Actually the strength of nursing is its breadth and depth – you don’t just need to be good with people to be a nurse. You can be great with figures, awesome at interpreting policy, phenomenal at analysing data and brilliant at teaching students.

“The strength of nursing is its breadth and depth”

Some people try to distil nursing into a few elements that they believe make a good nurse. But this over-simplifies the profession. Nursing is highly complex and cannot be reduced to a catchphrase, a mantra or a few key words; it is more than the sum of its parts.

Those who imply that all nurses must possess equal amounts of the same set of values undersell the profession and those within it – because nurses can generally offer so much more.

One chief nurse told me recently that when she was a ward sister a patient had once remarked: “You’re not very caring for a nurse are you?” But that patient also observed that he felt safer whenever she was on duty.

The moral of the story is that individual nurses make different contributions, and we should respect their individuality instead of trying to make them all fit into the same mold.


Readers' comments (6)

  • Jenni, an interesting read. I thought more about your comment about some people distilling nursing into a few key elements. It'd be good if you could highlight some examples of this. When I read it I wondered if a target of the criticism was the 6Cs as I know speaking to front line nurses this is something that does get criticised. We do of course now have the 'Leading change, adding value' strategy launched May 2016. This added the 10 'we's' and if you think of my own profession, health visiting it means that we have:
    The triple aim
    The four principles of health visiting
    The four Ps in the NMC Code
    The four levels of health visiting service
    The five mandated contacts (at least for now)
    The six high-impact ares
    The six Cs
    The 10 we’s

    Therefore for me there's a bigger issue, not that nursing is distilled to too few key elements but no one has the time to read the complexity about what is expected apart from those nurses who don't have to work on the front line. I asked some nurses a few days after the launch of the strategy who had read it (all 133 pages) and who knew of its existence and no one had/did. I wonder how much that has changed in 9 months?

    Interested in more? I wrote this blog at the time:

    Another point I'd empahsise, nursing managers need to show compassion to their staff. It's really difficult to show compassion in your job if you don't feel or see compassion yourself from your boss. It goes both ways!

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  • A thought provoking article which echoed thoughts of mine. Caring and compassion are in my view given too much emphasis often linked with the view that nurses should not be educataed at university because somehow they are less likely to be caring. So when in 2015 I had to give a short talk at a graduation ceremony I took this as my topic and suggested that rather than staying with the ‘6 Cs’ we should move on, skipping ‘D – dull dismal… to E. Why E ? Because it is strong and forward facing, active rather than passive. So here in summary are my 6 E's:

    "E is for Education where you are starting from and which will, I hope, be a continuing and continual process for you as you progress in your careers.

    E is for Enquiring, ensuring you ask questions and enabling you to look for and then apply Evidence to inform your clinical care.

    E is for Expert– the essence of what defines a professional and professional practice

    E is for Enthusiastic– getting things done, willing to be involved, to take nursing forward.

    E is for Empathic, knowing what your patients need not just what they want, anticipating not just responding. Empathic also towards colleagues to ensure work is a friendly supportive place for all.

    And finally E is for Ethical not just for the big decisions we rarely face but for all those everyday decisions about things which may seem trivial but on which we should not compromise."

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  • Interesting and thought provoking Jenni! Complex and challenging but through consensus in the profession we need to illustrate/define that complexity and offer a model to structure its presentation.

    We did some work on the skills that new grads need and produced a 'skills areas' framework and assessment tool kit - initial paper published in BMC Nursing.....Brown and Crookes BMC Nursing (2016) 15:23
    DOI 10.1186/s12912-016-0144-8

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  • I agree completely with Jenni Middleton. It appears that nurses are expected to be all things to all men. It's great to hear of superhuman nurses but most are like me; not good at everything but can still fill an important niche.

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  • David Munday ... Excellent post and 100% correct.

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  • Jenni, I enjoy reading your articles as I believe it captures a lot of what nurses think. You do not shy away from addressing the issues nursing is facing.Nursing needs to get away from being identified ONLY as the caring profession. It does seem we have been reduced to catchphrases even among nurses ourselves, and the unions seem to perpetuate this opinion. Why is it that they are not more obvious in the public domain standing up for what nursing is nowadays?

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