What skills are required for a nurse to work efficiently in a clinical setting with adult patients?

Essential Skills for Nurses Working Efficiently in Clinical Settings with Adult Patients

Nurses require a comprehensive skill set encompassing advanced physical assessment, critical clinical decision-making, effective communication, and specialized procedural competencies to work efficiently in adult clinical settings. 1

Core Clinical Assessment Skills

Physical Assessment and Vital Signs Monitoring

• Skill to perform comprehensive cardiovascular and respiratory assessments, including recognition of normal and abnormal findings 1
• Proficiency in obtaining accurate vital signs measurements, particularly blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation 1
• Ability to recognize abnormal 12-lead ECGs and rhythm strips 1
• Skills to assess breathing effort, skin condition, wound status, and mental status during every shift 2

Critical caveat: Research shows approximately 20% of nurses do not routinely check respiration rate, despite it being a core vital sign 3. This represents a significant gap that must be addressed through standardized assessment protocols.

Advanced Clinical Recognition Skills

• Skills to identify and respond to clinical deterioration through recognition of subtle changes in patient status 4, 5
• Ability to evaluate and manage patients with chest pain, palpitations, syncope, dyspnea, and peripheral edema 1
• Skills to recognize and manage hemodynamically unstable patients 1
• Competency in identifying physical findings of various cardiac conditions including heart failure, pericardial effusion, and tamponade 1

Patient Care and Procedural Competencies

Emergency and Critical Care Skills

• Skill to perform basic and advanced cardiac life support, including emergent defibrillation, transcutaneous pacing, and cardioversion 1
• Skills to manage vascular access sites and complications 1
• Ability to assist with or remove vascular access sheaths post-intervention 1
• Skills to manage patients with acute myocardial infarction and associated complications 1

Medication Management

• Knowledge of pharmacology of commonly used cardiovascular medications in diverse patient populations 1
• Understanding of indications, contraindications, and side effects of antiarrhythmic medications 1
• Skills to initiate and titrate medical therapy for patients with heart failure, hypertension, and lipid disorders 1
• Knowledge of vasoactive and inotropic medications used to treat patients with heart failure, hypotension, or shock 1

Communication and Interpersonal Skills

Patient-Centered Communication

• Ability to communicate with patients, families, and healthcare professionals in an effective, timely, and culturally-competent manner 1
• Skills to engage patients in shared decision-making based upon balanced presentations of risks, benefits, and alternatives 1
• Competency in utilizing motivational interviewing concepts when counseling patients 1
• Ability to discuss sensitive topics, including end-of-life care and palliative care within the confines of the patient's belief system 1

Evidence indicates that good communication is not only based on physical abilities but also on education and experience 6. Nurses must demonstrate courtesy, kindness, sincerity, and devote adequate time to communicate with necessary confidentiality.

Documentation and Coordination

• Skills to review medical records, complete documentation, and communicate diagnostic findings and management strategies in a timely manner 1
• Ability to respectfully participate in interdisciplinary care teams and consider opposing viewpoints for management 1
• Skills to coordinate care for postoperative patients admitted to critical care units following surgery or catheter-based interventions 1

Disease-Specific Management Skills

Cardiovascular Conditions

• Skills to evaluate and manage patients with new-onset, chronic, and acutely decompensated heart failure 1
• Ability to evaluate and manage atrial arrhythmias, including rate control, rhythm control, and anticoagulation 1
• Skills to evaluate and manage patients with ventricular arrhythmias and bradyarrhythmias 1
• Competency in risk stratifying patients with atrial fibrillation for embolic stroke and bleeding risk on anticoagulation 1

Preventive Care and Risk Modification

• Skills to perform cardiovascular risk assessment and develop evidence-based treatment plans 1
• Ability to develop, implement, and evaluate lifestyle interventions for prevention and treatment of patients with cardiovascular risk 1
• Skills to calculate global atherosclerotic cardiovascular disease risk for primary prevention 1
• Competency in educating patients on heart-healthy diet regimens and prescribing exercise recommendations 1

Professional Development and Systems-Based Practice

Continuous Learning

• Commitment to lifelong learning, including regular review of journals, practice guidelines, and participation in continuing professional education 1
• Ability to practice within the scope of personal expertise, training, and technical skills 1
• Skills to appropriately seek and integrate advice from consultants in a timely manner 1

Quality and Safety

• Demonstration of critical reasoning skills to promote optimal outcomes for patients with cardiovascular disease 1
• Ability to identify potential for impaired professional performance in oneself and colleagues and take action to ensure a culture of safety 1
• Skills to recognize noncardiac medical conditions that may affect patients in the cardiovascular setting 1

Key Factors Influencing Skill Utilization

Research identifies several barriers that impact nurses' use of physical assessment skills: reliance on others and technology, lack of confidence, work area differences, and clinical role variations 2. Nurses who had served over 10 years used more physical assessment skills than others 3, suggesting experience significantly impacts competency.

To enhance skill application, nurses identified the need for: continuing nursing education, participation in relevant courses, and implementation of standardized forms to record physical assessments 3. Medical and surgical intensive care unit nurses demonstrated greater use of physical assessment skills compared to other settings 3.

Critical Practice Gaps

Current evidence reveals a disproportionate focus on vital signs assessment at the expense of comprehensive nursing assessment 2. While early warning systems emphasize endpoints of deterioration, this may divert attention from comprehensive assessment that could detect subtle changes in health status earlier 2. There is a paucity of validated, holistic, structured nursing assessment frameworks for use in general ward inpatient settings 5, representing a significant gap in nursing practice that requires urgent attention.