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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)

  • I feel the 6C's express the obvious and imply that we don't adhere / aspire to them by their very need for definition.

    Their simplicity is insulting to both nurses and the public, although I understand the catchy and easily remembered concept (still insulting).

    Essentially, I find they express an infuriating and simplistic view of nursing. When Im feeling cynical, I feel they are being used to blame us again and of course the NMC has agreed were all at fault and need more paperwork, heaven forbid they defend us (see GMC). Overall it all serves to deflect from many of the real issues affecting patient care such as top heavy high level management (with associated remuneration) directing our 'customer care' and poor basic staffing levels, wages and skill mix. Overall reduced moral, patience and time to practice the 6C's....on a nice glossy poster near you!

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  • I don't think the 6 C's are designed to target good nurses who already understand and follow those without a second thought or blinking. Rather I think they are there for those few who simply see being a Nurse as a paycheck and let their patient care suffer, we all know a Nurse, HCA or other professional like that.

    Why take it so personally? Do you get offended when sent on a refresher course? "How dare they think I need to refresh my skills I'm perfectly competent"

    If a poster about the 6 c's offends you, you might be part of the reason it's there. It's a good training tool and should increase your confidence when dealing with other professionals you haven't worked with.

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  • I see the 6Cs as a mantra - a simple, effective mechanism to restore balance and focus when tired, stressed or under attack.

    To denounce them is, IMHO, indicative of either arrogant cynicism or compassion fatigue, or both.

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  • The most obvious concern for me has always been that the 6 C's (as first articulated by Roach over thirty years ago) were neither exclusive to nursing nor concerned with nurses, rather they referred to the practice of human caring. Clearly one can nurse without caring and care but not be a nurse - it is not qualified nursing's exclusive preserve nor should it be. Caring is the responsibility of every person and discipline involved. Something clearly explored and acknowledged by Roach in her seminal work.
    Of course, it may well be sheer coincidence that the 6 C's of nursing as a theoretical framework adopted by CNO use similar words, phraseology etc.. but in my opinion, they are a very poor second to those of Roach which seem (a) not to have been duly acknowledged at all as the originating theory and (b) changed to suit without too much thought for the implications, thereby considerably detracting from the intended meaning of a theory of human caring as a way of being.

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