Caring after Francis: moral failure in nursing reconsidered

This discussion paper considers recent nursing failures. Drawing on a selection of key literature and ongoing research, it argues that nursing failures are a possibly inevitable consequence of work in healthcare systems with their combination of cognitive, bureaucratic, professional and work-related pressures. It also argues that nursing has a residual tendency to be viewed as primarily character-based moral work and that this can encourage understandings of causes of failures and their solutions in similar terms, i.e. as moral failures of caring requiring recruitment of those with the appropriate characters. Drawing on ongoing research with those training for the profession at an English university, it suggests that while the profession focuses on the recruitment of those with a ‘caring ’ orientation it has not developed an adequate explanation to support new recruits in understanding the causes of inadequate practice. This leaves those entering the profession without a strong model with which to understand their own work or its failures-what I refer to as ‘critical resilience’. Keywords compassionate care, ethical issues, focus groups, health and social care policy, nurses, workforce and employment Caring after Francis: Moral failure in nursing reconsidered All occupations – most of all those considered professions and perhaps those of the underworld – include as part of their very being a licence to deviate in some measure from common modes of behaviour. (Everett Hughes, cited by Chambliss (1996: 19)). This article discusses the challenging circumstances in which many commentators see contemporary nursing. The focus is on nursing in England, but the theoretical and professional issues cut across national boundaries and often across time. These circumstances take the form of a number of exposures of nursing failures leading, it is said, Corresponding author