Communication is the foundation of working with people; nurses learn verbal communication skills such as reflective listening, repeating, summarizing and clarifying. Good communication facilitates relationship-building with patients, families and other members of the health care team, such as physicians and other therapists. Much communication is written out to document the care given. Nurses must be able to write clearly and concisely to describe the assessment, diagnosis and plan for each patient. Nurse researchers have identified the "Nursing Minimum Data Set" with information to record on every patient encounter.
Nurses must take the information communicated by the patient and family (also known as the "history"), and information gathered by physical examination or laboratory tests and determine a diagnosis. The mental activity of making a diagnosis is to match the assessed patient problem(s), resources and goals with available treatments that are based on scientific evidence. For example, evidence-based guidelines outline routine care for diabetics that will keep their blood sugar under control and thereby decrease complications and hospitalizations. In this case, the medical diagnosis is "Diabetes Mellitus, type 2", and there may be several nursing diagnoses--a common one is knowledge deficit related to the disease process. The recommended interventions, based on research, include medications, laboratory testing and referrals, as well as teaching about the disease process, teaching foot care, teaching activity care and teaching nutrition care. Often, nursing interventions are individualized based on cultural and economic influences. The nursing process involves effective problem-solving that leads to a defined plan of action with interventions based on solid research evidence.
Nurses must be skilled at educating patients and families. Research shows that the most frequent nursing intervention in most settings is teaching and counseling. The first step in teaching is assessment of the patient's baseline knowledge, so that time is not spent going over information that is already known. Assessment also allows for clarification and correction of any prior inaccurate information. Subsequently, education will fill in gaps in knowledge pertaining to the diagnoses, goals, or plan of care. Often, nurses will teach about the normal functions of the body and how disease disrupts them. Recommended treatments can be explained in turn. In addition, after a risk assessment, nurses will teach how to prevent common problems that could complicate recovery and limit years of healthy life. One recommended principle of education is to transmit the teaching in several ways, using pictures and written materials, as well as discussion. For example, to teach a new diabetic, pictures of the pancreas and digestive organs and photos or videos of insulin injection technique will be used along with discussion and written instruction. Nowadays, multimedia and internet-based presentations are often available for common problems. One evolving aspect of patient education, considered to be an aspect of informatics used by all nurses, is for the nurse to evaluate educational materials and direct patients and families to the most up-to-date and accurate sources.
Those skills usually identified with nursing tend to be those referred to as procedural or technical. This includes insertion of intravenous (IV) catheters, placement and reading of electrocardiograms (ECG), injecting vaccines and medications, and wound care. Most technical skills are done by several different types of professionals and the specific skills needed are matched to a specific work environment. For example, NPs in outpatient practice do not routinely insert IVs, but RNs in hospitals do. ECGs are often read by physicians, but RNs in critical care are very skilled in their reading. Medications may be injected by patients themselves and by all types of health care providers. The general preparation that an RN receives in a bachelor's program will give an introduction to many commonly used procedures such as those just mentioned, but further on-the-job training is needed to build proficiency for most of these. That is one reason behind the requirement of a year or so of work experience before entrance to most advanced practice master's programs in critical care or neonatal care.
Care coordination, or case management, is one of the most important nursing skills for today's complex environment in health care. Many different health care professionals may be involved in this function, but because of their close and frequent patient contact in all health care settings, nurses often take the lead role. Depending on the problems the patient faces, there may be a need for a myriad of health care services, such as social work, medical equipment, medications, transportation, legal advice, housing, nutrition support, housekeeping support, safety and communications support, etc. Nurses are often in a position to serve as "command central" to coordinate these services to preserve and restore health. Indeed, a required part of planning a hospital discharge is to assess the resources and environment where the patient is going next.
Advocacy is a nursing skill useful on both micro and macro levels. An individual patient may benefit from nursing advocacy when, for example, he has no health insurance and little cash to purchase a medication prescribed by a physician. The nurse, knowing the relative costs of equally effective medications, could approach the physician and advocate for a less expensive prescription. On the macro level, nurses belong to professional organizations, such as the American Nurses Association (ANA), which maintain lobbyists to speak up for legislation to benefit the health of all Americans. ANA lobbyists also speak in favor of specific measures to benefit the profession of nursing, such as funding for collegiate nursing education, and state and federal laws pertaining to the licensure of foreign-trained nurses. Over the years, nursing advocacy has been key in making birth control legal and available and improving the health of low-income and vulnerable families.