Although I welcome the development of technology in health care, this does not diminish the need for clinical skills or the need for competence in those who undertake those clinical skills. As the profession advances, it has to rely on the combination of art and science—clinical skills and technology are inextricably linked.
Complex and cutting-edge investigative methods can and do improve clinical savvy and competence; however, nurses and other health professionals must know how to interpret the results generated by the tools they are using. Nurses must also be cognisant of the limitations and possibilities for error as the practice of nursing becomes more dependent on technology.
Over 150 years ago Anstie (1867) noted that the technology associated with the sphygmograph (a device used to record the fluctuations of the pulse) should be used with some governing principles. The then state-of-the-art technology, he said, should be used carefully, there should be no reliance on the sphygmograph unless there were strict and diligent observances. Anstie was engaging with technology but also calling for caution. This still rings true today. Tools such as the sphygmograph or indeed the pulse oximeter are only adjuncts to the human relationship between the nurse and patient; they cannot replace the art of nursing.
In September 2018, BJN introduced a new series focusing on clinical skills acquisition and development. A series of bite-sized, evidence-based ‘At-a-Glance’ articles have been developed by Barry Hill and a team of colleagues from the Department of Nursing, Midwifery and Health at Northumbria University. The intention was to help develop skills and also to assist the more experienced nurse in maintaining competence as part of their continuing personal and professional development. This has proved a very popular series and we are delighted to announce that it will be extended. The series in BJN will include technical skills such as clinical examination and invasive procedures as well as non-technical skills such as team working and communication, essential for providing effective end-of-life care. It will represent all fields of nursing.
The teaching and assessing of clinical skills continues to play a key role in the preparation of nurses and other healthcare staff. The use of clinical skills programmes to support role development and to improve practice standards among nurses and other healthcare staff has increased in recent years—in hospitals, other care settings and in universities.
There is never a formal end to the learning of any clinical skill, technical or otherwise. Development through various stages of competence is ongoing (Nursing and Midwifery Council (NMC), 2018), this is important as skill acquisition changes as healthcare needs change. The NMC (2018) requires all nurses, midwives and nursing associates (in England) to share their skills, knowledge and expertise with others. Nurses, midwives and nursing associates are expected to maintain the knowledge and skills needed in order for them to practise safely and effectively. There are many post-qualifying programmes of study at various academic levels that have skills competence testing as integral to their assessment and, as such, updating and developing clinical skills should never be seen as an add-on or an inconvenience, but an essential hallmark of the professional practitioner. BJN recognises the need to ensure that skills education and training remain high on everyone's agenda, supporting practice and practitioners. As Sir William Osler (1849-1919) said (Tayer, 1920):
‘Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell and know that by practice alone you can become expert.’