Eight in ten nurses face barriers to giving compassionate care, report says

Report: nurses face major barriers in delivering dedicated and compassionate care, with NHS pressures hindering ethical practice

Nurses face major barriers in delivering dedicated and compassionate care, according to research published today by the Jubilee Centre for Character and Virtues at the University of Birmingham.

Sir Robert Francis QC. Picture: John Houlihan

The study, Virtuous Practice in Nursing, aims to give a moral snapshot of the profession at a time of unrivalled pressure on the NHS.

It found factors including staff shortages, time pressures and pen-pushing are leading to moral disengagement among nurses – and could be compromising professional practice.

Values, compassion

The foreword of the report is written by Sir Robert Francis QC, who led the inquiry into failings of care at Mid Staffordshire NHS Foundation Trust. He calls for nurses to be supported without having 'values and compassion crushed out of them'.

The study is based on findings from surveys and interviews of 700 people across three key groups – first-year nursing students, final-year nursing students and registered nurses practising for five or more years.

Key findings include:

  • Eight out of ten experienced nurses face serious challenges staying true to their moral character and values due to the demands on their time.
  • Some 45% of respondents tend to follow the rule book, rather than their own moral compass, when faced with moral dilemmas.

'Many nurses felt their moral obligations to the patients had to be compromised due to the time constraints and staff shortage,' the report says.

Deserved care

'Many nurses said often there have been times when they come away from patients feeling they did not do as much for those patients as their hearts dictated and that the patients did not receive the care they deserved due to low numbers in staffing,' it says.

The report’s authors say its findings show a reliance on duty or rule-based moral reasoning.

The report recommends that moral role modelling be placed at the heart of nursing education.

'In the absence of adequate role modelling, the tendency will be to "go by the book", circumventing individual reflection and responsibility and doing uncritically whatever the rules or standards of practice say.’


In his foreword, Sir Robert says values-based ethics in nursing should not be dismissed as 'soft and lacking definition' when compared with rules and standards.

Nurses need the support of leaders to face the challenges of NHS staff shortages, increased demand and responsibilities.

Sir Robert says: ‘The more specialised nursing becomes, the greater the need to support nurses at all levels in serving their patients without having their values and compassion crushed out of them, a phenomenon which explains in part the tragedies of Mid Staffordshire and similar scandals.’


Professional regulators should support the practical application of virtues in everyday practice, says Sir Robert, adding: ‘A culture of empowerment is likely to be more beneficial for patients than the culture of fear where that currently exists.’

In the report, researchers call for a greater emphasis on ethical theory in the education of nursing students to help them relate values and virtues to practice.

They also recommend a 'robust approach' to character evaluation at the interview stage to assess the suitability of candidates for nursing, and to monitor the development of their character throughout the programme.

Positive findings

Researchers also identified several positive findings, including:

  • Nursing students in particular consistently identify moral motivators such as care and compassion as the principal reason for joining the profession.
  • Both nursing students and experienced registered nurses view the job as a vocation.
  • Despite significant institutional pressures, nurses feel they can work autonomously and feel supported by colleagues.
  • They also believe it is possible to maintain a level of emotional engagement with patients and their profession.

Further information

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