Intended for healthcare professionals


Does nursing have a future?

BMJ 1996; 313 doi: (Published 21 December 1996) Cite this as: BMJ 1996;313:1647
  1. Alison L Kitson, directora
  1. a RCN Institute, Royal College of Nursing, London W1M 0AB

    The history of nursing is rarely one of triumph in the face of adversity but of struggle and compromise and often defeat.

    A M RAFFERTY, 19951

    Starting a paper on the future of nursing with such a quote may be rather melancholic, but I am troubled for the profession of which I am a devoted and committed member. We, together with the rest of our health care colleagues—in every continent, it seems—are experiencing change unprecedented in its nature and scale. The turbulence is disorientating and almost prohibits us from seeing the things that matter. My purpose here, therefore, is to refocus on those essential elements that give nursing its structure, its character, its presence, and its strength in a turbulent environment. I want to explore the issues facing us, how we are tackling them, and to finish by considering what the future holds for us.

    Nurses as agents of control

    Some will recognise the description in the box (p 1648) as coming from one of Kurt Vonnegut's short stories, Welcome to the Monkey House.2 What interested me was the caricatures he used to portray the hostesses. These were manipulative, seductive, coercive individuals, trained in the techniques of caring but programmed to carry out definite tasks. They were plausible, socially skilled, and they upheld the values of the ruling party. There were no scientists or doctors in this story; the world government was in control, whose president, by the way, was an ex-suicide hostess. The great evils—illness, aging, suffering—seemed to have been overcome, but the world was without purpose or spirit.

    Perhaps this is one future scenario for nursing that we need to consider. If technology comes up with all its promises and delivers us from suffering and death what need will there be for nursing? Will we become agents of control, using our interpersonal and caring skills to …

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