Are we forgetting how to care?

The profound act at the heart of nursing.

Helen Cowan

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A nurse bends beside a bed and talks to a patient

Marie Curie.

Recently, at a nursing leadership programme in Oxford, attendees focused on the fundamentals of care. Have we forgotten how to care? What can we re-learn from those who pioneered an ordinary yet profound act that affects millions?

Anam Cara is an old Gaelic term for ‘soul friend’, a person with whom you can share your innermost self, your mind and your heart. It is a term that Tom Hill, former chief executive at Helen House Hospice in Oxford, used to describe the relationship between his staff and the thousands of children and their families who passed through their ‘big red door’ in its first twenty-five years. The hospice (or ‘loving respice’ as it became known) had been founded by Sister Frances Dominica in 1982.

Other care in this country can also trace its religious roots. Between 1048 and 1070 in Jerusalem, the Order of St. John was founded for the purpose of helping pilgrims (“our Lords, The Sick”) who had become lost, weary, or beset by other difficulties while on their way to the Holy Land. Today, in the United Kingdom, the British Association of the Order has extended care to older people first in almshouses and later in care homes. A trustee for ten years was John Monckton, a man of ‘considerable talent, enormous integrity and deep religious conviction’; his tragic murder in 2004 led to the creation of the John Monckton Memorial Prize, which recognised and rightly celebrated commitment to care by care workers.

Today, across the world, seen and unseen, nurses, carers and families continue to provide compassionate care. “Assisting individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge” is the very essence of nursing, captured by ‘architect of nursing’, researcher and author Virginia Henderson in 1966. Meeting more than basic needs such as breathing, eating, drinking and eliminating bodily waste (which are of essential importance), Henderson recognised the role of the nurse in enabling humans to communicate with others, worship according to their faith, satisfy curiosity and sense accomplishment.

In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care?

An uncomfortable truth brought out in healthcare reports such as the Final Report of the Special Commission of Inquiry (The Garling Report) 2008, and the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (The Francis Report) 2013 is though that this type of nursing is too often done badly or even missed, leading to pressure injury, medication errors, hospital-acquired infection, falls, unplanned readmission, critical incidents and mortality. According to nurse scientist and scholar Professor Debra Jackson, “missed care occurs much more frequently than we might think”. She cites a systematic review in which ‘care left undone’ on the last shift ranged from 75 per cent in England, to 93 per cent in Germany, with an overall estimate of 88 per cent across 12 European countries’.

In one offensively-titled paper, “Shitty nursing - the new normal?” (in which the authors apologise for the title but not the questions raised), real-life pen portraits are drawn of patients lying for hours on hospital trolleys, immobile through infection or injury, ignored by staff. Whilst acknowledging contextual factors for poor care, such as a shortage of nurses and resources, the authors argue that circumstances cannot be the sole cause of missed nursing care.

A report published by the University of Adelaide, School of Nursing, has called for nurses to ‘reclaim and redefine’ the fundamentals of care. It asks whether the cause of the problem (of missed nursing care) lies “deep in the psyche of the nursing profession itself?” “Has something happened to the way modern nursing views and values caring?” it continues. “Indeed, is nursing in danger of losing its claim to care? In the desire for modernisation and professionalisation, have we lost sight of the core values and activities central to patient care? Or is this a broader social pattern where individuals are less inclined to show kindness, compassion, and care for others even if it is a necessary requirement of the job?”

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness.

Writing in the British Medical Journal, Professor of critical care medicine Peter Brindley and Consultant in intensive care Matt Morgan wonder whether doctors also “too often default to high-tech and low-touch” when patients are dying – a time “when community and connection matter most”. They powerfully begin with a mother’s comment: “Humans are gardens to tend – not machines to fix.”

Professor Sir Al Aynsley-Green, the first National Clinical Director for Children in Government and former Children’s Commissioner for England, and past president of the British Medical Association, suggests that we as a society need a “momentum for compassion”. Struck by the extremes of compassion witnessed during his wife’s treatment in the last years of her life, Sir Al wants to see a cultural transformation in healthcare: for compassion to be a key operating principle in NHS and care settings, led by the Chief Nurse’s Office; for every organisation to promote the importance of compassion at the professional level; for the views of patients and families to be sought regularly; for much earlier and better focus on compassion in undergraduate and postgraduate teaching programmes for all staff; for compassion to be inspected against by the Care Quality Commission; and for a willingness to encourage staff at all levels to expose poor practice as well as celebrating excellent care.

Compassion, he emphasises, is more than empathy - and way "less fluffy" but much more measurable than kindness. “It’s putting yourself into somebody else’s shoes – and doing something about it.” Recently appointed the UK’s first Visiting Professor in Compassionate Care at Northampton University, at the age of 80, Sir Al certainly is doing something about it. He has made it his new purpose in life to “embed compassion into every aspect of care”.

Like Sir Al, Queen Elizabeth II, the UK’s longest serving monarch, espoused compassion, in word and deed. Living a life of compassionate service, the Queen made clear that her Christian faith was her guiding principle. She speaks of Jesus Christ as ‘an inspiration,’ a ‘role model’ and ‘an anchor’. “Many will have been inspired by Jesus’ simple but powerful teaching,” she said in her Christmas Broadcast, 2000. “Love God and love thy neighbour as thyself – in other words, treat others as you would like them to treat you. His great emphasis was to give spirituality a practical purpose.”

When nurses do unto others as they would have done unto themselves, and act as role model to colleagues, not only do patient experiences of care and their outcomes improve – but so does job satisfaction for nurses: a critical factor in nurse recruitment and retention – the biggest workforce challenge faced by healthcare organisations. Across the UK, there are currently more than 40,000 nursing vacancies, and thousands of burnt-out nurses are leaving the profession early. Whether nurses decide to stay or go is driven in part by their daily experience at work. The late Kate Granger, Consultant in medicine for older people, inspired Compassionate Care Awards in her name, envisioning that such a legacy would drive up standards in care - and surely also help retain nurses, through restoring a sense of pride, achievement and fulfilment to the nursing workforce.

Review

Culture

Music

Politics

25 July 2025

6 min read

As the congregation gathers Bruce Springsteen leans hard into hope

Chords of confrontation and communion

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

Bruce Springsteen crouches down and holds a hand out to a sea of outstretched hands

Springsteen plays Manchester.

Brucespringsteen.net.

I finally got to experience a Bruce Springsteen concert recently. Which is to say, for three hours, I touched a land of hope and dreams.

We walked along a canal to get to the arena – my husband, my father-in-law, and me –Manchester shimmered with the arrival of summer, and light bounced off red brick and still water. We neared the arena and the air felt dense with anticipation. T Between us we carried heartbreaks, elections, hopes, failures, and a collective return to music that had accompanied and clarified it all. We were drawn by loyalty and nostalgia and joy, but also I sensed by a hope that Bruce would meet the moment — the frayed, furious, anxious now — with something that mattered.

We found our seats and gripped our drinks as the lights dimmed. Thousands of people stopped individual conversations, and hushed, and then joined voices into a deep and reverent chant. “Bruuuuuuuce”. To my right, the glow of a screen, the woman holding it sending a text – “yes babe, 1pm, lovely” – and it seemed incongruent and true. In the tension before the release, in the dark before the light, we hold our breath even as the ordinary carries on. The ordinary carries on even as the world fractures and glows. The ordinary is what Bruce often sings of, it is one reason why fans feel heard and seen by him. That night though, all the ordinaries he sang of formed something extraordinary.

Then there was light, and Bruce walked slowly from the side to the front of the stage, his guitar suspended across his body, his face a relaxed, broad smile, his bandmates and companions beside and behind him. Then there was music. No videos, no pyrotechnics; just old songs that felt as if they existed for the now. My City of Ruins, Death to My Hometown, Land of Hope and Dreams, The Promised Land. The song Long Walk Home was introduced as a “prayer to my country”. It is a country that he embodies, despairs of, and loves. He sings of his home with fury, sorrow, tenderness, and love.

Riffs and rhythms that were decades old were being made urgent again. Springsteen’s music holds both grit and glory, and hard-won joys leave space for sorrow. I write this and lines by Mary Oliver come to mind: “We shake with joy, we shake with grief / what a time they have these two / housed as they are in the same body.” What a time they had, joy and grief, that night with Bruce.

The evening unfolded not as spectacle but as liturgy; all of us involved in something like devotion – in part to Bruce, but also to moral clarity, to the power of poetry, to the promise of who we could be. At times the crowd seemed silent, ushered into something deeper – not entertainment or escapism, but something like confrontation and communion. We were being offered the joy of music and memory, but also an opportunity to reckon with who we are.

Between songs, Bruce spoke. He apparently rarely does so in his gigs. His voice slowed and deepened – not chit chat, not to entertain, but to bear witness and stand defiant and call us to the best versions of ourselves. “I’ve spent my life singing about where we’ve succeeded and come up short in pursuit of our civic values,” he said. “I just felt that was my job.” He proceeded to describe how those values are being torn apart, and why they matter. The crowd roared. He was making civic values shine, speaking about them with urgency. He acknowledged both the dream and the failure, but still he believes in the promised land and he asks us to as well. Before he belted out Rainmaker, he said, “when conditions in a country are right for a demagogue, you can bet one will show up.” He spoke of America, and really of the world – what it is, what it is becoming. His honesty and poetic rage situated us, then became a map for how to keep going.

We can be glad to be alive even while we are honest about sorrow, injustice, broken politics, fractured families, and tired hearts.

I found myself wondering: why is it that Bruce can sing and speak about justice, warped politics, and who we are becoming, and be met with cheers, while so many churches avoid doing so, preferring instead to whisper in neutral tones while the world burns? That night, I stood in a crowd of thousands and I heard a kind of moral clarity that orientates the soul and made me cry. It wasn’t partisan, it was human. Why can it feel riskier to speak specifically and prophetically in a sermon than in a stadium? I wonder if it’s because Springsteen has always rooted his politics in people’s real lives – in work, family, grief, memory. He doesn’t gesture toward abstract ideologies for fear of alienating people, or in the hope of retaining fans: he tells stories and gives names to problems and injustices, singing about crooked institutions, boarded-up factories, buses that never come, lovers who don’t come back.

The evening felt, for me, like the kind of church I long for and sometimes touch: no tidy answers, no insincere lyrics, no vague calls for justice, but rather honesty and specificity and the chance to stand alongside strangers and feel something challenging, beautiful, true.

I scribbled a question as the music soared: can a chord be mystical? Because that’s how it felt. As if there are progressions – minor then major, dissonance into harmony – that can reach past language and speak directly to the part of us that longs for love more than cynicism, to the part of us that still dares to hope even when there is very little obvious reason to do so, to the part of us wondering how to be truly alive.

Near the end, Bruce quoted the American writer James Baldwin:

“In this world, there isn’t enough humanity as one would hope. But there’s enough.”

There’s enough. It was a small phrase but it hung in the air like incense. For Bruce, there is enough humanity to keep singing for, and about. Now, he seemed to ask the crowd, what will you do with that enoughness, with that humanity?

In the final stretch, Bruce leaned hard into hope with songs like The Rising and Born to Run. The energy in the room felt like resistance – not against something, but for something. He didn’t pretend everything’s fine, but he sang anyway. “It ain’t no sin to be glad you’re alive.”

We can be glad to be alive even while we are honest about sorrow, injustice, broken politics, fractured families, and tired hearts. Gladness is being asked to stand its ground now, and to do something with our improbable aliveness. For the final song, Bruce played Bob Dylan’s Chimes of Freedom. It is a song about lightning and exiles and freedom, about the trembling of the soul and about a sky that “cracked its poems in naked wonder.” He sang it slowly, tenderly, like a prayer – which can also be a trembling of the soul, a song of naked wonder. Perhaps he prayed to God, perhaps to some other sacred thing: our better angels, or the fragile hope of who we might yet become.

In a BBC documentary about Bruce Springsteen’s history with the UK, someone says “there’s something in Bruce fans, you know you can implicitly trust them.” As we filed out of the arena, it felt like 25,000 of us briefly knew each other, trusted each other, could take on the world together. Perhaps we just had.

Soon it was just me, my husband, my father-in-law, and the silent dark canal as we walked back into the night. We were tired, we were awake. I thought of Bruce’s belief in the promised land, and of Baldwin’s line: there’s not enough humanity, but there’s enough. These are beliefs that can feel risky. So can belief in God. But enough is plenty. Enough can turn up the volume and let the spirit be our guide. With 25,000 other people, I’d turned that volume up and I could hear the spirit defiant, unifying, guiding. It is – has always been – time to go and sing of it, despite everything.