Monday, 2 February 2015

Text of editorial on Lancet Commission in British Journal of Nurisng

The Lancet Commission on Nursing
Ian Peate

The terms of reference for the Lancet Commission on Nursing were published in May 2014 and stated that the purpose of the Commission was in the public’s interest and that the Commission was charged (by the Lancet presumably) to consider the nursing contribution to improve UK health care outcomes.  The Commission is driven by the poor perception of nursing in the UK (Dean, 2014) this is a pity. It is undeniable that nursing has and is receiving bad press (and I am as distressed as are most nurses about these atrocities) but nurses are still leading the way in many areas, they are stellar in their dedication to the people they serve but the Commission tells us it is driven by the poor perception of nursing. It could be suggested that had the Commission focused on the outstanding and competent work that nurses do then the often featured negative stories that appear in the media would be put into much needed context. 

There are sixteen Committee members made up predominantly of nurses, national and international. The membership has impressive CVs with nearly all of the nurses being affiliated to a university, what would appear to be missing are practicing nurses. The terms of reference allow for additional members to be invited as necessary to either attend meetings or to review the work of the committee and I suspect that the review of the work of the committee will be handed down to the practicing nurse.  The committee will hold hearings periodically with the intention of gathering further opinion about UK nursing, again the committee will no doubt draw heavily on the practicing nurse in this respect. The Chair of the Commission is keen to make it clear that they are not out to fix any immediate problems; this is about a vision and an agenda for nursing in 10-20 years time.  

Two full day meetings were destined to be held in 2014, with three planned for 2015 and communication was to be maintained online and via Google Drive. Yet,  (according to my knowledge) there has not been any communication regarding any progress.

The Commission will review and report on UK nursing education, review and report on the UK nursing workforce, review and report on UK nursing practice and review and report on the public image of UK nursing. On completion of all this a report will be produced in 2016 concerning the Commission’s deliberations and proposals, the most patronising thing about all of this is that the report is to be published, not in a nursing journal but, in the Lancet. The Lancet is a journal for doctors and medical scientists, regardless of the fact that the Lancet regularly holds commissions on health issues, how many commissions has it held on other health and care professions. Despite protestations by the Commission’s Chair that this is not going to be punitive, it smacks of retribution – ‘naughty nursing can’t be managed by the nurses’ so the doctors have to take it over. In 1932 The Lancet published its report on nursing, The Nursing Commission’s Report (Lancet, 1932), it was unacceptable then that a medical body professed over nursing matters and it is such the case today, regardless of the fact that the Commission is Chaired by a nurse under the auspices of the Lancet,, who is pulling the strings? In 2011 Delamothe in the British Medical Journal penned the editorial “We need to talk about nursing” – the audacity of a medical journal again attempting to patronize our profession, Delamothe (2011) is cited as saying “The problem is not just heartless nurses or “resources,” although they’re a part of it” – a clear case of tarring all nurses with the same brush, when the truth is that the majority of nurses do an outstanding job under terms and conditions that leave much to be desired. We do indeed need to be talking about nursing but it needs to be done in a constructive way.

I find it inconceivable that the Commission is making a comparison with the nurse in the UK to that of the nurse in the United States (Dean, 2014) this is akin to comparing apples with pears. There are so many independent and dependent variables at play here that it ridicules comparison.

In 2010, the Commission on the Future of Nursing and Midwifery in England published its findings decreeing that the public image of nursing was out of date. This was a Prime Minister’s Commission; the first overarching review of nursing and midwifery in England since the Committee on Nursing chaired by Asa Briggs in 1972, this was not a general medical and scientific journal commission.

The Royal College of Nursing (RCN), whose job it is to represent the interests of nurses and nursing locally, nationally and internationally, has encouraged the Commission to set forth and understand why the image of nursing in the UK is poor (Dean 2014). The RCN is in collusion here and this is tantamount to admitting that the image of nursing – lock stock and barrel – is poor. The RCN should and must take a look at those nurses who are making a difference, who are having a positive impact on the health and well being of the nation and then tell me that their image is ‘poor’.

Nurse bashing has to stop and the Commission would be wise to think about its role in perpetuating the negative image of nursing and nurses, of course there is always room for improvement but let us take time out to publicise the good things that nurses do. Imagine what else nurses could do if they were given the right support and encouragement and if their terms and conditions were commensurate with their outputs.

The Commission’s Terms of Reference make provision for these to be kept under review. It might be an idea to invoke this provision and invite shop floor nurses to sit as members of the Committee; these are the people who live the job day in and day out and can give first hand accounts of nursing as they see it.

Dean, E. (2014) “Lancet Commission to Tackle the Poor Perception of UK Nursing” Nursing Standard Vol 28 No 21 pp10

Delamothe, T. (2011) “We Need to Talk About Nursing” BMJ 2011;342:d3416 last accessed January 2015

Lancet (1932) “Nursing Commission’s Report” Lancet Vol 219 No 5660 pp 409

Prime Minister’s Commission on the Future of Nursing and Midwifery in England (2010) “Front Line Care: the Future of Nursing and Midwifery in England. Report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England 2010”.,_2010.pdf last accessed January 2015


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