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'The profession is right to debate the 6Cs'


The 6Cs – the words selected by Jane Cummings, the chief nursing officer for England, to articulate nurses’ values in response to a spate of care scandals – seem to divide the profession as much as unified it.

Jenni Middleton

While some have defended them, built initiatives and even written songs about them, others feel they oversimplify the skillset required by nursing.

That division was the motivation behind a debate at London Southbank University last week. This first debate, which organisers hope will become a series on issues affecting the profession, argued whether the 6Cs could improve care. The audience agreed that the words were right. All patients and service users should be treated with care and compassion, and nurses should exhibit courage, communication skills, competence and commitment.

“But the simplicity of the 6Cs is the thing that raises antibodies in some of their opponents”

I don’t think any of us would argue with that. But the simplicity of the 6Cs is the thing that raises antibodies in some of their opponents. Stella Backhouse, a blogger and prolific tweeter under the handle @grumblingA, thought that distilling nursing down to something as simple as six words misrepresents the com- plexity and skill involved in nursing.

The debate saw people support the 6Cs as advocated by both Juliet Beal, NHS England’s director of nursing for quality, improvement and care, and Sue Hartley, director of nursing at Birmingham and Solihull Mental Health Trust. Meanwhile, many agreed with Tony Butterworth CBE, who spoke against the principle of 6Cs because he felt that, while they were “nice words”, they did little to support those working in overstretched and challenged organisations.

“Nursing is, like real life, not black and white”

Blindly following the 6Cs, or blanket refusal to recognise their existence are both questionable approaches. Instead, nurses should think critically about whether they can add value to practice, or if they need to be moved on.

What isn’t helpful, as Professor Butterworth expressed, is being treated like “a devil man” because you are a non-believer. Nor is it right to claim that if nurses have been inspired by the 6Cs and introduced initiatives to improve care as a result that it is a bad thing.

Nursing is, like real life, not black and white. It needs to debate, question, reflect and challenge. The 6Cs were not and should never be regarded as a one size fits all. If the profession is going to deliver person-centred care, then nurses too must be treated as individuals and be free to explore that.

Jenni Middleton, editor

Follow me on Twitter @nursingtimesed


Readers' comments (14)

  • michael stone

    I could be wrong, but I suspect that the 6 Cs arose partly out of a 'high-level plan' to 'distract' the public from the service-provision aspects of Francis, etc.

    It was clear from reading the Francis report, that there were some concerns that nursing was perhaps 'losing some of the 'caring' as nurse training becomes more 'academic'', but a HUGE part of Francis was '... but even if nurses want to 'care', they can't 'reveal caring' if they are hugely over-stretched'.

    And stories in the media, about 'uncaring nurses', made 'the 6 Cs' an appealing idea - while also, to the majority of nurses who 'already grasp the 6 Cs instinctively, and were already doing that stuff', 'insulting'. And, some nurses see the very idea that things like the 6 Cs might be needed, as 'yet more nurse bashing'.

    The King's Fund has just pointed out, that one reason the NHS is about to go into significant financial deficit, is that Francis, etc, has made Trusts employ more nurses, without proper long-term funding for these 'extra' nurses - so, again, the 6 Cs needs to be accompanied by a proper analysis of the 'resources side' of the equation.

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  • Well said Michael Stone

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  • michael stone

    Thanks Emma - I'm taking your comment at face value (having just been told I understand nothing, somewhere else on NT).

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  • Michael stone makes some important and valid points.

    the Media view of Nursing and then by extension the view that most of the public have is unrealistic but thereseems to have been little effort to educate the public on this.

    One could argue that part of the reason for this is that one of the major Staff Side organisations positive revels in the confusion between RNs and the assistant grades because it boosts the ego of the assistant grades (we'[ve all met HCAs who hang on to the title of {mumbled} auxillary {strongly spoken} NURSE and we've even seen badges promoting the confusion from both trusts and representative organisations ... and then there's the trusts that have very similar looking HCA and RN uniforms ( either identical or just differing piping) - rather than a clear distinction between HCAs and RNs

    none of this demeans the role or contribution of the well trained HCA , just points to a wider issue that needs to be addressed

    the other part of the reason is that it suits employers to muddy the waters in the eyes of patients and the community at large between Assistant grades, associate practitioners and registered practitioners in all the professions ...

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  • I understand why people can be initially very sceptical about them but let me tell you why they matter to me.
    3 years ago I nearly left Nursing. I was going home at the end of every shift demoralized, deflated and sad. I started to drift in my nursing career and ended up working on the nurse bank, where I became even more detached and unappreciated. I was feeling undervalued and unable to make the difference. Because of that, I felt emotionally drained and I started to develop negative attitudes and feelings towards patients, and a growing devaluation of my own competence. I could say that my care was compromised.
    It was like a marriage going sour. Nursing was not for me anymore but I gave one last change before filing for divorce and I ended up being a Community Nurse. I took one last breath and like a boy with new shoes I went to my first day at work and on the induction package there were the Compassion in Practice document.
    I felt in love with the vision and the idea of person centered care. The 6cs for me remained me of my marriage vows that I discovered for change a few years ago and from that day I try to live and breathe the 6Cs.
    It´s a privilege and an honor being a nurse but with that privilege comes professional responsibility. The 6Cs can renew our professionalism and public confidence in our professions.
    The 6cs are not the panacea and they are not compulsery, they are a reminded, to nurses like me, that got lost in the system why we became Nurses in the first place.
    The 6cs come part of a Compassion in practice vision that takles 6 areas to focus and tackle all the issues highlight into the Francis report like staff numbers, patient satisfaction, leadership, inproving staff and patient experience.. Compassion in practice and the 6cs go hand to hand and the 6Cs.

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  • michael stone

    Hi Joan,

    I'm pleased the 6 Cs worked for you.

    But I'm interested in something - you said:

    'but I gave one last change before filing for divorce and I ended up being a Community Nurse.'

    I'm wondering if the 6 Cs are easier to 'apply' in community nursing, than in hospital nursing ?

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  • The 6 C's were the best thing since sliced bread according to the NT when they first came out, some of us could see them for the gimmick they were.

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  • compassion/empathy is bandied around without people understanding its true meaning. It is not something that can be turned on or off or picked up and learned at the drop of hat. I often come across serious studies on the subject and although I haven't time to dig up any links at the moment it can easily be researched from reliable sources in order for people to draw their own conclusions.

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  • michael stone
    michael stone | 31-Mar-2015 2:10 pm

    don't be so silly. Go away and troll somewhere else!

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  • The 6 c's form a useful 'core' from which spiderwebs out to what nursing actually curtails. It's 'friendly' and 'nice' and mentions none of the bad points... it's a good recruitment tool like the Kitchener Wants You posters from WW1 sending countless people into a meat grinder by oblivious leaders flying desks. Good to see things haven't changed.

    It's idealistic and a good goal to set and works perfectly in theoretical practice. In reality it dips or totally breaks down when you have someone suffering withdrawal, whose hit several other nurses and is currently evacuating their bowels in the middle of a bay.

    It would be nice in an NHS where we were fully staffed, funded and didn't feel like Atlas with the world on our shoulders. But right now those at the front of the coalface need more than 6 C's to restore to them the ideals they had when they started. Real action is needed rather than glossy middle management ideals.

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