What is a nurse? The Francis report and the historic voice of nursing

Following the Francis report into shockingly deficient standards of care at an English hospital, this paper examines UK nurse education and revisits the premises on which the professional narrative of nursing was built. The UK government's response to the report is to introduce the "associate nurse" role, to be nationally trained to do fundamental care in place of the registered nurse, and a nursing apprenticeship scheme-on-the-job training for a nursing degree. UK nursing bodies do not address the report's recommendations in regard to registered nurse education; rather, they advocate a further perpetuation of the current system. This shows deep uncertainty about what the "true" nurse is. To those familiar with the Nightingale model that characterised nursing in England and elsewhere for a century before the introduction of Project 2000 in 1986, there is an intriguing historical echo in the Francis report. One might wonder whether Francis is really recommending a return to a virtue-based, practice-driven, nationally standardised version of nursing education developed by Nightingale and evidenced in nursing syllabuses in England and Wales 1860-1977. This paper supports this position, and shows from a review of historical and contemporary evidence that this Nightingale model has current relevance.