Headlines: December 9th, 2005

A medical expert argues today that nurses are the key to restoring public confidence in hospital care. Writing in the British Medical Journal, Professor Nick Black of the London School of Hygiene and Tropical Medicine says nurses had led the transformation of hospitals in the 19th century and he asks why, after a century of outstanding success, the future of the large general hospital is in question.Professor Black argues that hospitals are partly victims of their own success because developments in pharmaceuticals, information and communication technology now offered alternative ways of delivering care. That meant that when patients did need to attend hospital, they were less likely to stay overnight.

Those changes, he says have been largely welcomed by patients and health professionals but there are other negative reasons threatening the future of large hospitals. These had arisen from changes in management, nursing, and building strategy over the last 20 years.

He argues that if public confidence in the hospitals is to be maintained, nurses have to play a central role and he says they, rather than doctors, have always really run hospitals at the clinical level with doctors providing specialist help. Nursing, he believes, also has the potential to moderate people’s need for hospital care through innovations such as nurse-led telephone help lines and more care being delivered in the community.

Doctors, managers and politicians had to recognise and respect the contribution nurses could and must make, Professor Black says and he suggests that the response to the current MRSA crisis indicates that that this may be happening.

“The 19th century teaches us that nurses must be central to the running of all aspects of hospitals, not just those areas deemed appropriate by the medical profession,” he writes. Bringing this about will require improved leadership and enhanced opportunities for nurses. This would ensure hospitals remained viable, doctors would be able to pursue the activities in which they excelled and public concerns would be allayed.