Although mastering complex skills can appear daunting at first, think back to when you first started to learn to drive. At the start you were probably solely 'task focused' and unable to 'look, mirror, signal, manoeuvre and read the road' all at the same time as dealing with the mechanics of actually ‘driving’ the car. With practice and increasing confidence you started to master the integration of the tasks, skills and knowledge – then one day you found yourself doing it with increasing ease.  If you are not a driver you can probably think of other examples yourself where you had to master both cognitive and practical skills at the same time and suddenly found that they became second nature to you without you really noticing that you had mastered them.

• Reflect on recent experience in your practice where you have realised that you are completing care fairly effortlessly when previously you were worried about that same aspect of care. At what point did you realise you could complete this aspect of care without too much concern? How does this make you feel now about that aspect of care?

Possible answers:

• Monitoring vital signs whilst parents are watching and possibly asking questions
• Dealing with a fretful child whilst assisting with a procedure
• Giving handover to the whole team at the end of a shift
• Completing an aseptic dressing change whilst the child requires a lot of comfort and reassurance

Francis, R. (2013) The Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry.  Available at: http://webarchive.nationalarchives.gov.uk/20150407084003/http://www.mids....

Take time to read the Francis Report (2013) as this has particular resonance for all nursing practice. List six of the key recommendations from this Report.

Possible answers:

1. Accountability for implementation of the recommendations 
2. Ensuring implementation of the inquiry's recommendations
3. Creating the right culture and putting the patient first
4. Fundamental standards of behaviour
5. An integrated hierarchy of standards of service
6. Responsibility for, and effectiveness of, healthcare standards
7. Commissioning for standards
8. Performance management and strategic oversight
9. Patient, public and local scrutiny
10. Effective complaints handling
11. Openness, transparency and candour
12. Medical training and education and professional regulation of fitness to practice
13. Nursing: reversing the scandalous decline in standards
14. Leadership
15. Caring for older people (this report is children and young people relevant)
16. Information management
17. Enhancement of the role of supportive agencies
18. Coroners and inquests
19. Department of Health leadership
20. Outside the report: Inspections
21. Achievement of the recommendations outlined in the Francis Report