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Views And Reviews Provocations

Nursing—the wave of the future

BMJ 2018; 361 doi: (Published 31 May 2018) Cite this as: BMJ 2018;361:k2355
  1. Nigel Crisp
  1. member, House of Lords, and chair, All Party Parliamentary Group on Global Health
  1. crisp{at}

Medicine will be enhanced by nurses taking on greater responsibility, says Nigel Crisp

Nurses are already more trusted by the public than doctors. What does the future hold? A recent report by a parliamentary group described how developing nursing worldwide would not only improve health but also make progress towards two other UN sustainable development goals: improving gender equity and strengthening economies.12

This Triple Impact report argued that nursing philosophy and practice were particularly well suited to the changing global burden of disease, with an increasing prevalence of non-communicable disease and comorbidity in older people. Nurses are educated to take a person centred, holistic view of health that considers psychological, social, and environmental aspects as well as the purely biomedical. Other professions—including, of course, medicine—also take this wider view, but for nurses it is at the centre of their philosophy.

Nurses typically are responsible for continuity of care and are generally part of the community they serve, meaning they are well placed to work with patients and local communities on the promotion of health, prevention and early detection of disease, and development of health literacy. They understand the local culture and how to influence people in their area and are there when other professionals aren’t.

New roles

Nursing in the UK has developed enormously in recent years, with nurse practitioners, nurse prescribers, and nurse specialists of many different kinds. Nurses are increasingly taking on leading roles in managing patients with diabetes and other long term illnesses. Countries as different as Singapore, Uganda, Sudan, and Sri Lanka are all expanding and developing their nursing roles. In South Africa nurses and pharmacists can initiate antiretroviral treatment, which has proved to be a turning point in the battle against HIV. In the words of two leading UK nurses, a new story of nursing is being created.3

A new story of nursing is being created

The Triple Impact report found that nurses were too often undervalued and underused, in the sense of not being able to work to the limit of their competence or “the top of their licence.” This is truer in countries such as India, where nurses are often still doctors’ handmaidens, or Portugal, where a powerful medical establishment inhibits change, but nurses in the UK too will say they are “invisible” and could take on wider roles if permitted.4 This is an astonishing waste of all that talent and commitment, and of resources. It is simplistic to say that if the world’s 20 million nurses were enabled to work 1% more effectively this would be the equivalent of 200 000 more nurses, but it nevertheless makes an important point.

The time is right

All this might have been said five years ago, but in health policy as in politics timing is crucial. The new priority given to universal health coverage, the evidence of what nurses are achieving, the growing politics around gender, and the new emphasis on social determinants of health and on promotion and prevention are combining to create a climate where the approach and skills of nursing are becoming more important. It is for these reasons that I and colleagues have launched Nursing Now (, a global campaign to improve health by raising the profile and status of nursing. The fact that within only two months we now have Nursing Now groups active in 40 countries suggests that we have caught a tide and have got our timing right.

What does this mean for the UK? We are one of the world leaders in the development of nursing, but I don’t believe that this government has yet understood its importance. In my view the government has been clumsy and inept in its dealings with the health professions, appearing to think that somehow their morale doesn’t matter. Nursing will develop more slowly without the government’s help, but it will develop anyway.

And what does it mean for medicine? I can imagine some of the senior consultants I knew 30 or more years ago being horrified at what has happened to nursing since. Looking forward, I believe the changes will be as dramatic in the next 30 years, and I would expect to see major developments in nursing in areas such as non-communicable disease, primary care, public health, and mental health. Medicine will be enhanced, not diminished, by these developments, and doctors can concentrate on what only they can do, confident in the knowledge that their nursing colleagues are competent and well educated professionals.


  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Competing interests: None declared.