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One aspect of this project considers the cadets’ acquisition of skills which is a critical issue which lies at tlie heart of the cadet experience. By researching the importance

placed on the sldlls, a greater understanding of the students’ perception of their confidence and competence in the workplace becomes apparent.

An argument persists as to whether nursing is an art, as perceived by Florence Nightingale, or a science, and there is a suggestion it is a ‘coalition’ between the two thus forming its own identity and profession (Rafferty 1996). With scientific advancement, nurses have had to review their role and educational requirements required to enable them to function in a more teclinological environment (Brown & Gobbi 2006). In specialist clinical areas, such as intensive care or dialysis units, they have to combine technical skills alongside a caring role (Holland 1999). Jackson and Borbasi believe it is a combination of “laiowledge, skills and expertise” (2002:67) developed over a period of time which leads to the ability to become a professional carer. Indeed, a Government evaluation of nurse educational partnerships stated “....whilst the students [student nurses] were in practice, die art of nursing was explicitly role modelled, and the science of nursing was taught” (Scholes et al. 2004:19) suggesting very clearly that there remains a blend of both art and science. The Fitness for Practice document published in 1999 highli^ted the importance of linking skills and knowledge to enable nurses to become competent practitioners (UKCC 1999.) The use of Clinical Skills Laboratories as a teaching tool has been in use for many years and is welcomed by student nurses as it enables them to practice and perfect skills outside of the clinical environment. They have also provided the opportunity for student nurses to practice essential skills in a safe and supported environment (Hilton 1996; Godson & Wilson 2007).

Over the past 10 years, the use of OSCE or Observed Structured Clinical Examination, as a means of examining practical skills has become a way of assessing

clinical skills competencies at different stages of pre-registration programmes. They are used for “formative and summative assessment, as a learning resource, and to identify gaps and weaknesses in clinical skills” (Khattab & Rawlings 2008).

Witlhn nursing practice, it is ‘the essence of caring’ which “distinguishes nursing and sets it apart from other heath related activities” (Jackson & Borbasi 2002:59), but that quality is equally hard to define. Caring is at the heart of nursing and care is provided through the skills gained during pre-and post registration. Hudacek succinctly defines caring as:

“ the core of nursing. It is the unifying focus of nursing practice; the reason nurses garner the public's trust and support; and an instinctual, natural part of the work. To enter a caring partneiship, one has to be attentive, concerned, and knowledgeable.”

Hudacek 2008:124

Hudacek aclcnowledges both the need for knowledge and skills but also recognises “nursing goes far beyond technical skills” and includes “compassion, spirituality, community outreach, providing comfort, crisis intervention, and going the extra distance” (2008:124). Kirby and Slevin liken caring to the wind saying “Care like the wind is invisible. What one sees is its action. What one feels is its presence” (1992:66). An essential skill, beyond the technical, is communication. Learning how to talk to, and listen to patients is essential to be able to provide the compassion and comfort alluded to by Hudacek (2008), and it is these caring elements which are not measurable, or visible. However, clinical skills competencies are measurable, and this is achieved thiough the work experience as cadets, and reinforced or increased at HEI tlirough placements and in the clinical skills laboratories discussed earlier.

It is important tliat the acquisition of skills is recognised as essential to the clinical environment and a valuable asset for any aspiring student nurse. Draper and Watson identified that the “possession of skills meant they [cadets] themselves felt useful and part of the clinical team” (2002:465) which reflects the notion of ‘beyond technical skills’. Equally, they recognized that many cadets aclaiowledged that the acquisition of practical skills gave them more confidence as student nurses, and were subsequently treated like third yeai' students during their first placements on the wards as they possessed so many basic skills (Draper & Watson 2002). Die data gathered for this research reflects the evidence presented by Draper and Watson (2002) and similarities between both groups of cadets are evident. Evidence will be presented in a later chapter on data analysis where the concept of the acquisition of basic clinical skills, confidence and competencies the Valley College cadets gained, and the value of the work placement experiences will be analysed.

There is no doubt that when the cadets enter the ward placement for the first time, they are novices in the field. Through the acquisition of the skills and laiowledge required for the clinical setting, cadets learn how to perfonn basic day to day tasks and are able to make valuable contributions to the care provided. Pat Benner (1984) succinctly presented a model of skills acquisition for nurses, adapted from the model by Dreyfus and Dreyfus (1980). The model is a series of six stages firom novice, (stage one) advanced beginner (stage two) tlirougli to the expert (stage six) (see Appendix Seven for a fuller description of the stages). The model is helpful in identifying the acknowledgement of sldlls acquisition and an understanding that it not only applies to cadets at the beginning of their nursing career, but also to those

experts who continue to learn new skills and knowledge as technology continues to advance and impact on the nursing profession.

The novice is one who has “no experience of tlie situations in which they are expected to perform” (Benner 1984:20) which reflects the position of the cadet in their first ward placement. The experience and skills the cadets acquire throughout the clinical placements places them at stage two of Benner’s model as an advanced beginner, described as “one who has had sufficient prior experience of a situation to deliver marginally acceptable performance” (Benner 1984:22). The cadets gain experience and a level of competency, in a variety of situations, and are able to perform basic tasks in the workplace such as personal care, bed making and recording clinical observations which are performed with competence and confidence (Draper & Watson 2002). Evidence from the data supporting view this will be presented in chapter five.

The expert is the practitioner who has “an enormous background of experience... [with]...an intuitive grasp of each situation” (Bernier 1984:32) and it is these professionals the cadets leam from. The expert operates at an instinctive level of skill and ability, achieved not only by experience but through education which is not only the pre-registration programmes but also through continuing education and training. While the level of education provided within the FE settmg for the vocational qualification differs from that of the HEI, and the experience gained is not the same as the student nurse, it should not be dismissed. Knowledge is quantifiable through educational programmes, and expertise is not, but the observation and experience gained at all levels provides the foundation for nurse’s tacit knowledge.

This section has demonstrated the importance and value attributed to the acquisition of clinical sldlls. Chapters five and six will analyse the data wliich reveals the value held by the cadets of the experience and skills acquisition not only during tlieir FE course, but also in preparation for their HE programme. Hudacek concluded “you cannot teach caring” (2008:129) but the acquisition of the skills which enables caring to take place can be taught, observed and shared. As Draper and Watson observed “the clinical skills learned as cadets were highly valued by the cadets and clinical staff and provided cadets with immediate currency in clinical areas” (2002:456). This demonstrates recognition of the cadets’ abilities and reflects similarities to the model of Pat Benner and the stages of skills acquisition. However, it is pertinent to acknowledge that Eraut criticizes tlie model for its lack of “references to theoretical learning,” (1994:125) however it is the focus on skills acquisition which has been useful in illustrating the abilities of cadets.

Evidence has been presented to establish that cadets have not only the competencies to carry out basic clinical skills, but also the confidence to be able to communicate with patients and staff. The acquisition of these skills and competencies is the essence of the Valley College programme which enables cadets to reach this state of proficiency and subsequently apply to step-on to the nursing diploma programme at HE.