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Prepare for revalidation:

read this CPD article and
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Practice skills
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Read Adam Davies’s
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Guidelines on
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Professional practice skills for nurses

NS759 Groves W (2014) Professional practice skills for nurses.
Nursing Standard. 29, 1, 51-59. Date of submission: March 6 2014; date of acceptance: June 19 2014.

Aims and intended learning outcomes

This article examines ways in which
Nurses work in a healthcare system in which different partners in care developing professional practice skills can
have different expectations of them. Demands to provide compassionate help nurses to cope with conflicting demands
care that is patient-centred and responsive while adhering to budget and ‘compassion fatigue’ in their roles,
constraints are contributing to ‘compassion fatigue’ and adversely while remaining responsive and providing
affecting nurses’ mood and effectiveness. This article discusses how targeted measures and high standards
an understanding of professional practice skills, communication skills of patient care. After reading this article
and teamwork can help nurses to cope with these conflicting demands and completing the time out activities you
and compassion fatigue while performing their professional roles and should be able to:
responsibilities. This approach is discussed in the context of nursing Identify
 the main partners in care that
discourse and related professional and government recommendations. nurses work with and briefly describe their
expectations of nurses.
Author Outline
 the main challenges faced by nurses
Winnifred Groves as a result of the different expectations of
Public sector researcher, Surbiton, Surrey. them of different partners in care.
Correspondence to: Identify
 and describe essential
professional practice skills needed by
Keywords nurses to meet personal, professional and
legislative requirements.
Code of conduct, communication, compassionate care, compassion Explain
 how professional practice skills
fatigue, interpersonal skills, nursing care, nursing practice, professional can help support nurses faced with the dual
practice, revalidation, 6Cs of nursing demands of providing effective practice and
compassionate care.
All articles are subject to external double-blind peer review and checked
for plagiarism using automated software.
One of the main narratives in nursing today is
Online that patients are suffering from serious neglect in
the NHS; ‘compassion fatigue’ is also of growing
For related articles visit the archive and search using the keywords above. concern. Nursing has been in the spotlight
To write a CPD article: please email for providing poor care, partly highlighted by
Guidelines on writing for publication are available at: events at Mid Staffordshire and Winterbourne View (Department of Health (DH) and NHS
Commissioning Board (NHSCB) 2012).
The Report of the Mid Staffordshire NHS
Foundation Trust Public Inquiry (Francis 2013)
proposed a way for all those involved in care to
provide it in a way that meets expectations and
standards. It emphasised the importance
of adequate resources, as well as the right
CPD professional issues

approach and attitude of the carer, in meeting Professional practice skills are generic
these expectations. skills that enable nurses to understand the
Trust is the basis of the relationship between legislative framework, be aware of professional
nurses and their patients. As a result of requirements and standards of behaviour,
challenges to and developments in nursing, possess the knowledge base and skills for
the nursing profession, the DH and the NHSCB reflection, and communicate effectively
have made several recommendations, including (Oku and Reid 2009). Mindfulness of how
the 6Cs: care, compassion, competence, ethics, morals and values affect the care
communication, courage and commitment provided by nurses is also required (Fry and
(DH and NHSCB 2012, Watterson 2013). Johnstone 2008).
Nurses are expected to embrace new and These skills promote a careful assessment
smarter ways of working to enable the 6Cs to of the needs of individual nurses, those of their
become a reality. colleagues in clinical practice and those of
There is also debate about a new revalidation professional bodies and relevant legislation,
process for nurses and midwifes. The premise as well as the demands and expectations
of revalidation is that nurses need to of individual patients. Knowledge and
demonstrate their continued competence and application of these skills will help nurses to
fitness for practice consistently and regularly plan, implement and review care that more
(DH 2013, Keogh 2013). effectively meets the needs and expectations
Nurses are at the forefront of providing of all main partners in care.
1  Identify the health care. The commitment to provide Complete time out activity 1
different groups of excellent care that is safe, compassionate and
people and professional holistic is integral to nursing. It is vital for
bodies that have nurses to develop and maintain professional Expectations of nurses
expectations of the practice skills that are patient-centred and Nurses have a moral and professional
quality of patient care promote safe and effective care, while responsibility to patients, carers, relatives,
provided by nurses. being cost-efficient. Applying these skills colleagues, professional bodies and the state.
Briefly describe these will enable nurses to achieve the care and Together, these groups represent partners in
expectations. compassion that have been under recent care in nursing (Figure 1).
scrutiny in the NHS. Nursing involves working with different
professional groups and families to meet
FIGURE 1 the needs of individuals, promote and
maintain health, care for patients when
Main partners in nursing care
they are ill, assist patients’ recovery and
independence, maintain their wellbeing,
The state or healthcare system and improve their quality of life (Royal
Organisations College of Nursing (RCN) 2003). Public
Regulatory bodies expectations of nurses are at an all-time high
The general public and the government’s agenda of consulting
and involving service users (DH 2010, 2012)
has led to a rise in ‘patient power’ and resulted
in care environments where nurses must be
accountable for their actions (Ellis 2013).
bodies, for
example: Nurses to The public trusts nurses to meet patients’
provide good Patients health needs and ensure their safety, involve
Royal College
quality care which Carers them in their own care, treat them with
of Nursing
is cost-efficient Relatives respect and dignity, provide timely care,
Nursing and
Midwifery listen to and inform them, and demonstrate
Council empathy (Care Quality Commission (CQC)
2013). In addition, professional bodies
require nurses to have the knowledge, skills
(Kozier et al 2011) and attitudes necessary
Colleagues or nursing managers to provide and sustain evidence-based and
Medical staff cost-efficient care.
Other members of the multidisciplinary team Given these competing demands, nurses
have to demonstrate through their practice
the ability to identify and understand the
needs of different partners in care while an ongoing barrier to providing excellent care.
being realistic about available resources. The central question is that with management
The principal argument is that nurses should driven by targets and the 6Cs requiring
balance a commitment to the patient with compassion and sensitive care, what support
standards of care that meet the needs of is there for nurses to achieve this? It remains to
all partners in care. This involves making be seen whether the 6Cs recommendations will
decisions and prioritising care. be effective without the resources nurses need
Continuing professional development (CPD) to achieve them.
is a professional requirement for nurses that These problems call for a multiplicity
involves learning in practice. Training nurses to of solutions from the different partners in
deliver excellent care throughout their careers care. Effective use of nurses’ knowledge and
is one way of safeguarding the health and skills has numerous benefits. So, which core
wellbeing of the public, thereby achieving the professional practice skills do nurses need
state’s function and responsibility to its citizens. to cope with competing demands and avoid
The need to provide a high standard of care is the shortfall in standards of nursing care
stressed by the Nursing and Midwifery Council reported in the media?
(NMC), which requires nurses and midwives to Complete time out activity 3
keep their skills and knowledge up to date and
uphold the standards of their professional code
of conduct (NMC 2008, 2014). Essential practice skills for nurses and
Complete time out activity 2 their relevance to practice
Table 2 lists practice skills that are essential
Nurses provide care to patients from diverse to good nursing practice. Learning and
backgrounds. An ageing population will developing these skills will enable nurses to
have more complex and multiple medical provide individualised care and tailor measures
conditions. Furthermore, the public has to meet patients’ needs. Sometimes it can
high expectations of what constitutes health be difficult to effect professional demands,
care and support and how these should given the scarcity of resources (Table 1).
be provided (DH and NHSCB 2012). Nurses need to provide evidence-based care
However, there is a mismatch between these compassionately, sensitively, cost-effectively
requirements and the availability of nurses to and efficiently, thereby meeting the needs
meet them (Ross et al 2005), which reduces of different partners in care, combating
nurses’ capacity to provide individualised compassion fatigue and achieving the
care. There is evidence to suggest that staff revalidation requirements of the future.
shortages, poor working conditions and An ability to think critically fosters
low staff morale result in poor nursing care, reflection, self-confidence, inquisitiveness
and dissatisfaction among patients and and open-mindedness (Scheffer and Rubenfeld
other partners in care (Newman et al 2002, 2000). Critical thinking is a transferable skill
Groves 2012). Heavy workloads make nurses that enables nurses to analyse situations from 2 Describe the main
focus on technical tasks rather than caring, multiple viewpoints (Lloyd and Murphy 2008, challenges faced by
making patient-centred care an unrealistic du Boulay 2009) and can lead to changes nurses as a result of the
expectation. Without the necessary resources, in attitudes. Furthermore, critical thinking different expectations
care will become mechanistic, which will involves cognitive flexibility, which allows of them by different
become a barrier to compassion. the nurse to scrutinise the evidence and its partners in care.
Other barriers to good nursing care include: usefulness meticulously. By so doing, the nurse Compare your answers
poor workplace policies and practices, lack of is complying with the need to practise with the challenges
managerial and ward support, and the gap evidence-based learning as encouraged listed in Table 1.
between theory and practice. Lack of time by professional bodies (NMC 2008,
has also been noted as a major source of DH and NHSCB 2012). 3 Identify the core
stress for nurses (Demerouti et al 2000). Good research skills help nurses to access professional practice
Nurses feeling unappreciated and inadequate information on legislation and professional skills required by nurses
social support have been cited as barriers to requirements. Nurses require information to meet different
effective communication (Reynolds et al 2000, on sources of training and to acquire expectations. Describe
Chant et al 2002), while teamwork and CPD ‘professional know-how’ to understand how such skills can help
can support nurses (Melnyk et al 2004). what type of care will have an effect, what is in achieving the 6Cs in
From these challenges, it appears that the gap practicable, and what is ethical and sensitive. practice.
between clinical leadership and management is Gaining access to this information helps
CPD professional issues

the nurse not only to provide care that The importance of concise, timely and
meets patients’ needs and uses resources accurate documentation has been noted as
efficiently but also complies with statutory a prerequisite for safe and effective nursing
expectations and The Code (NMC 2008). practice (Casey and Wallis 2011). Decision
Clauses 40 and 41 of the code require making is the basis of professional practice,
nurses to update their knowledge and skills particularly given the competing demands
throughout their working life by participating on nurses and the scarcity of resources,
and engaging in learning activities which necessitates the rationing of care.
that promote competence and improve Decision making underpins ethics (doing
performance (NMC 2008). what is right) and morals (pursuing behaviour

Barriers and aids to care
Challenges and barriers Assisting factors
Increasing legislative and professional Continuing professional development.
expectations. Research skills.
Increasing paperwork. Reading.
Decision-making skills.
Information and communications technology.
Critical thinking.
Sharing of information.
Report writing.
Workplace policies and practices. Assistance with interpreting workplace policies.
Engaging nurses in all aspects of care initiatives.
Seeking nurses’ views and acting on them accordingly.
An open culture that is not intimidating.
A culture that helps with effective communication.
Lack of managerial support. Management support.
Unhelpful organisational culture. A transparent and fair work environment.
An environment that promotes learning and encourages nurses to speak out.
Counselling and emotional support.
Lack of resources: Availability of adequate resources.
Severe staff and/or skill shortages. More nurses with appropriate skills.
Heavy workloads. Opportunities to assist with integrating research evidence into practice.
Poor working conditions. Willingness to share knowledge and skills that only come with experience.
Promoting a positive work environment.
Lack of time. Effective time management.
Decision-making and negotiation skills.
Theory-practice gap. Research skills.
Ability to select knowledge and reflect on practice.
Critical thinking ability.
Learning from each other.
Poor pay and increasing cost of living. Pay rises for nurses.
Other incentives.
Lack of appreciation and recognition Feeling valued, appreciated and supported by:
for nurses. - The ward sister and other leaders.
- Management.
- The state.
Diversity of nursing, professional Teamwork.
relationships with colleagues. Effective communication skills.
Good interpersonal skills.
Motivation and respect for each other.
Low staff morale (Royal College of Increase in wages.
Nursing 2014), low job satisfaction, Teamwork.
compassion fatigue. Nurses sharing a common vision.
Support from colleagues and mentors.
that society finds acceptable) (Fry and the 6Cs. ‘People have a right to expect safe,
Johnstone 2008). effective, compassionate, high-quality care’
Ethics, morals and values – as well as (CQC 2013) – the right knowledge, skills and
professional knowledge – are essential attitudes are vital to the provision of such care.
components of decision making in practice.
Nurses’ duties are set and regulated by Communication skills in compassionate care
legislation and professional bodies; however, and effective nursing practice
when equipped with the right knowledge, skills, For the purpose of this article, communication
resources and attitudes, rather than operating is defined as social interaction through
simply as passive observers of the rules, nurses messages (Fiske 2011). Communication is
should be able to make decisions that meet the multidimensional. It involves the transmission
needs of all partners in care by identifying and of information from one person to another.
analysing problems, and performing searches It has a clear purpose.
for evidence-based information. Learning in For example, during a consultation between
practice fosters competence, which is one of a nurse and a patient, the model developed

Essential practice skills for nurses and their relevance to practice
Essential practice skills Relevance to practice
Critical thinking and decision making. Critical thinking enables nurses to be open-minded, see the bigger picture and reflect,
so they can make more effective judgements and clinical decisions.
Decision making is a significant aspect of clinical practice.
Critical thinking and decision making promote ethical practice, since nurses can
argue why their organisations’ actions or inaction deprive patients of their rights and
wellbeing. By acting as the patient’s advocate and using the right knowledge in the right
situations, nurses work towards achieving components of the 6Cs, including competence,
commitment, care and courage.
Critical thinking and decision making promote a less stressful environment, since nurses
are able to critically analyse situations to arrive at a clinical decision that helps achieve
desired health outcomes. This promotes effectiveness and ultimately efficiency by
maximising the use of limited resources.
Information and communications Knowledge of ICT is relevant to clinical practice because of its increasing use in care.
technology (ICT), writing, reading, Good knowledge of ICT assists competence and care, by allowing the nurse to access
note-taking, proofreading. recent research to provide evidence-based care.
Legible and concise writing of care plans achieves effective communication and continuity
of care.
Smart reading and note-taking saves time in busy clinical environments.
Proofreading minimises mistakes, improves understanding and promotes competence in
Interpersonal skills, teamwork. As noted in the 6Cs, communication is central to providing care.
Nurses need to communicate with patients, carers, relatives, colleagues and other
partners in care, and to work in teams.
Good communication and interpersonal skills enable nurses to demonstrate empathy and
an ability to listen and provide care, underpinned by respect and dignity.
Presentation skills. Nurses need good communication skills to conduct presentations.
Presenting information in a manner that is convincing and easy to understand is vital.
Consultation and negotiation skills. Nurses work in consultation with patients to help them feel they are partners in their
own care. This results in greater co-operation since nurses and patients agree on care
that is acceptable and right for them.
Nurses constantly negotiate with patients, colleagues and other healthcare professionals.
Time management and cost Time is a finite resource. There is a need to deal with matters quickly and prioritise them
management. according to their importance.
A nurse needs the time and knowledge to assess a patient, process different types of
data, and define the problem, its components and its origins.
Carefully analysing costs enables the nurse to devise a plan of action and set realistic
goals, resulting in resources being used more strategically.
Careful use of equipment and disposable items should also be considered.
CPD professional issues

by Silverman et al (2004) suggests that Good communication skills affect the working
effective communication involves moving environment, colleagues, the quality of care,
from developing a rapport to developing and how patients feel and respond to treatment.
a relationship that puts the patient at ease, Francis (2013) noted a public concern that
with the nurse asking questions, using patients are treated in a dehumanising and
active listening, reflecting on what is heard, impersonal way. In the light of current
rephrasing responses to ensure that the patient public complaints about poor nursing care,
and the nurse have the same understanding of effective communication is vital. Effective
events, and agree on a care plan. communication requires the nurse to know
The importance of effective how best to gather information from a patient
communication is stressed by NMC (2008), and how to explore sensitive issues. To help
which emphasises that the information achieve this, the nurse can offer genuine
that people need or want to know about acceptance, ensure confidentiality and
their health should be shared with them in listen with interest.
a way that they can understand. Nursing Communication serves different functions.
demands effective verbal and non-verbal It expresses our state of mind and emotional
communication skills (Debnath 2010), state. This involves seeing and hearing
including active and purposeful listening. and, to some extent, feeling (intuition).
Listening skills are vital in improving the Nurses therefore need to observe patients’
quality of communication. They show the body language (non-verbal clues), gestures and
person with whom you are talking that you facial expressions. Nurses should also listen for
respect and value him or her. words that suggest doubt, anxiety, discomfort,
‘Good communication is central to working anger, denial, acceptance and gratitude,
with people. It’s important to be able to among other emotions.
4 Are your
communicate both on a one-to-one basis One focused method of communication is
communication skills
and in a group context. Communication is to make links between what patients say and
serving you well?
not just about the words you use but also their intention to act on it. Does what the nurse
Think of an example in
your manner of speaking, body language sees and hears suggest that the patient could
clinical practice where
and, above all, the effectiveness with which be at risk of self-harm? Does it suggest that the
you had a consultation
you listen. To communicate effectively it patient has given up hope? If so, how will that
with a patient, carer
is important to take account of culture affect the patient’s adherence to treatment and
or relative. Reflect on
and context, for example where English is the treatment outcome? With this knowledge,
your performance using
an additional language’ (Department for the nurse can plan and implement targeted
the statements shown
Education and Skills 2005). intervention strategies.
in Box 1.
Complete time out activity 4 Empathy entails considering the
situation from the patient’s point of view.
BOX 1 After listening to patients, nurses should
show their understanding of what they have
Assessing your communication skills
heard by paraphrasing and repeating it back
I am a good listener. to the patients. Treatment plans should
I maintain good eye contact when I’m speaking to someone. be negotiated in a confident, reassuring
I don’t know how to maintain eye contact because of my cultural manner that suggests that the proposed
treatments are patient-centred. This can be
I am aware of my body language, posture, tone of voice, pitch and
done by sitting on a chair next to the patient,
I do not think it is wrong to chew gum when I’m speaking to patients, perhaps holding the patient’s hand, making
relatives or colleagues. eye contact and using an appropriate tone
I give patients my full attention when they speak to me. of voice that clearly conveys the message
My voice is naturally loud. that you care. Nurses should always
My tone of voice is patronising. communicate with patients in a manner that
I come across as aggressive but I am not. is sensitive and respectful.
My body language is open and receptive. Trust in nurses is especially important,
I keep an open mind when communicating with someone. given the public’s belief that some nurses
I try not to interrupt when someone is speaking to me.
are uncaring (Francis 2013). Developing
I listen to the unspoken words.
I ask for clarification by paraphrasing what the other person says to me.
trusting relationships with patients and
I am emotionally available when someone is speaking to me. colleagues can enable all parties to feel
I act on feedback to improve my communication skills. valued and respected. Listening to and
respecting patients fosters and restores
trust. This assists nurses to provide care culture. Different skills and knowledge offer
that is culturally sensitive, complying with greater opportunities for informal learning.
The Code (NMC 2008). As a patient’s However, different views and perspectives
advocate, nurses need to learn the skill of require effective management to ensure the
negotiation. Enhanced interpersonal and organisation maximises opportunities for
negotiation skills enable nurses to influence learning in its teams. According to Lloyd and
decisions that affect patients’ health Murphy (2008), learning to work with others
(Christiansen et al 2014). is a vital skill. Peer support for and trust in
For example, given the scarcity of resources, one another are prerequisites for an effective
nurses have to negotiate with patients team. These can be achieved through a shared
about what care can be provided. Having goal of continuous learning and a culture
professional practice skills assists nurses in that encourages nurses to participate actively
reviewing, co-ordinating and justifying care. and maximise their roles and responsibilities
Sometimes this will mean advocating patients’ in the team. Acceptance and integration
needs and having the courage to speak up of human resources policies and practices
about cuts in funding, the government’s (Gratton and Truss 2003) can be achieved
drive for targets and the challenges and through teamwork, through the search
negative effects these initiatives can have on for new knowledge and skills, and sharing
the provision of compassionate and sensitive professional knowledge in achieving
care to patients. organisational goals.
Good communication skills enable team
members to negotiate tasks, resolve conflicts
Importance of teamwork maturely, promote loyalty and influence,
Teamwork involves individuals working and motivate others. Having the right attitude
co-operatively to achieve the objectives and willingness to work with others is a
and goals of the organisation (West 2012). starting point. One method of achieving this
Teamwork is assisted by having clear goals is to provide a welcoming environment that
5 Reflect on the
and a shared understanding of how these values and promotes the sharing of ideas and
statements in Box 2.
goals will be achieved, thereby instilling learning among nurses. An appreciation and
Outline what nurses
shared responsibility (Thompson 2011). acceptance of our cultural and individual
can do to promote
Nursing involves teamwork, interaction and differences shows respect for and an ability to
teamwork. Describe the
the sharing of information with other team collaborate and seek advice from each other
benefits of teamwork
members to ensure the continuity of patient (NMC 2008). Colleagues serve as a valuable
to providing effective
care (CQC 2013). source of ‘social capital’ (Lee et al 2011)
nursing care.
Complete time out activity 5 for learning, using networks and co-ordinating

To promote effective teamwork, nurses BOX 2

should appreciate individual differences,
Assessing your teamworking abilities
respect each other, and appreciate and value
the different skills, knowledge and expertise I am more respectful and courteous when I speak to doctors than to
of each team member. Nurses should trust patients and colleagues.
one another and collaborate to achieve good I am good at managing conflict with colleagues.
I acknowledge individual differences in the team and treat others with
patient care. Teamwork is challenging.
The growing diversity of nurses’ ages and I am dismissive of colleagues who can’t speak proper English or who have
cultural and educational backgrounds could strong accents.
lead to conflict. Team members’ different I keep my ideas to myself.
personalities can give rise to conflict (West I fear that if I share my ideas with others, they will know more and seem
2012). Nurses should be aware of this and cleverer than I do.
use different ways of resolving conflict. I am afraid of asking questions in case people think I am stupid.
In some cases, this may require recognising I don’t like to be criticised.
and managing self-esteem and insecurities, I struggle to express myself because English is not my first language.
being humble in acknowledging limitations I am not confident about giving presentations because I fear I will make
a fool of myself.
and mistakes, and compromising to
I worry that people will laugh at my accent.
promote collaboration. I am a good team player.
Nurses have a responsibility to treat I can’t stand colleagues who are lazy and don’t do their fair share of
others with respect and dignity (DH and the work.
NHSCB 2012). Diversity enriches workplace
CPD professional issues

to improve efficiency. Acceptance of others ideas to individuals in small and large groups.
and feeling a sense of belonging offers a In contrast, the inability to communicate
comfortable, less threatening working properly can be misconstrued and can
environment and improves job satisfaction undermine a nurse’s authority and right to
(Rafferty et al 2001), particularly at a time be taken seriously.
when morale is low. Nurses are encouraged Nurses use different ways of communicating
to learn from positive role models and from in a team. The Code (NMC 2008) requires
each other’s strengths and shortcomings, nurses to keep clear and accurate records
irrespective of ethnicity, gender, age, grade, of assessments, discussions, the treatments
and professional discipline or status. Sharing offered, and the treatments’ effectiveness,
information with colleagues helps with recall, and to keep these records securely. In the
improving understanding. course of nurses’ professional lives, nurses will
Effective communication can enable regularly communicate by writing care plans
nurses to articulate their roles and and reports. An ability to take notes and to
contributions within the team. Learning write in a structured and concise manner will
to communicate increases confidence. promote ease of reading, prevent ambiguity
It enables nurses to answer patients’ and promote a logical understanding of this
and relatives’ queries and to allay their information. This way, continuity of care can
anxieties sensitively, inspiring confidence and be ensured (Kripalani et al 2007). Technical
trust. Good communication skills can help and presentational aspects of writing can
to give nurses confidence to speak in public be improved by proofreading (Fairbairn
(McMillan and Weyers 2012) and present and Winch 2011).

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Conclusion demands. Effective application of these
Nurses face many challenges as a result of skills will fulfil the expectations and
often conflicting demands from different needs of different partners in care, enable
partners in care. Changes in how health nurses to provide compassionate care,
care is delivered have resulted in greater equip them with the knowledge to liberate
powers for patients and, consequently, themselves from accusations of poor care,
increased expectations of standards of and enable them to manage personal and
care. Recommendations by regulatory work-related stress NS
and professional bodies have resulted in Complete time out activity 6
increasing workloads for nurses without a
corresponding increase in staff and capital. USEFUL RESOURCES
This can lead to compassion fatigue and NHS England: Compassion in practice:
stress among nurses. These challenges
require a greater commitment from NHS England Chief Nursing Officer:
nurses to develop essential professional
practice skills, such as effective officer/
Nursing and Midwifery Council: Revalidation: 6 Now that you have
communication and teamwork. completed the article,
Developing professional practice skills
Revalidation/ you may like to write
assists nurses by providing a clear strategy
Royal College of Nursing: Defining nursing: a reflective account.
to equip nurses with the right knowledge, Guidelines to help you
skills and attitudes, and is one way of
(All websites last accessed: August 19 2014.) are on page 62.
enabling nurses to cope with professional

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