Fundamental Care: The Foundation for the Profession of Nursing

These days, in the United States, you might expect the emphasis of this editorial to be on all the ways in which nursing is a profession. Although it is stunning that in 2025 the Department of Education of the United States has declassified nursing as a professional degree (Nurseonestop.org/staff 2025) that qualifies for higher loans (unlike medicine, law, or dentistry), this appears to be an attack on predominately female professions (as social work, education, physical therapy and audiology were also excluded and all of these are predominately female in composition in the United States), rather than an evidence based decision on equitable loan distribution. I don't think anyone who has recently been hospitalized or who has had a family member hospitalized would dispute that nursing is a profession. The amount of knowledge nurses must have, the digital literacy, the understanding of pathophysiology, pharmacology, and psychology (to name just a few areas of knowledge) are all unquestionable. Nursing possesses all the attributes one would find listed when searching for “respected profession” (Key traits of respected professions 2025) including having ethical standards, integrity, lifelong learning, accountability and responsibility, and effective interpersonal skills. However, while I think patients and their families would all agree that nursing is indeed, despite the Department of Education's misguided decisions, a profession, I wonder if all patients and families would agree that nursing as a profession adequately responds to the fundamental care needs of patients and families? Alison Kitson (Kitson 2026) in Volume 58 Issue 1 has written a very thoughtful commentary entitled “The transformational power of person-centered fundamental care delivered by nurses.” In this commentary, Dr. Kitson questions whether problems with missed nursing care and patient safety breeches aren't inherently linked to the way we are currently providing or failing to provide fundamental care. Dr. Kitson examines how changes in health care systems such as electronic medical records have not built upon our fundamental interventions and, as a result, so much of nursing work does not become evident to patients, families, and other health care providers. Dr. Kitson provides three examples of areas where patient safety is a common concern: falls, infections, and hospital acquired delirium. She links the fundamental care that must happen to avoid these problems including adequate nutrition and hydration and active mobilization. When nurses attend to these fundamental care interventions, do we see changes in outcomes? Have we adequately researched key components of the fundamental care we provide? I urge you to read this commentary and to think about what drove you to go into nursing? What do you value most about the nursing care you deliver? What are you proudest of in your nursing practice? For me, and for many of the nurses I respect, it is the moments that I am truly “with” a patient and responding to their needs in a way that only a professional nurse responding to fundamental care needs can experience. Rather than debating whether nursing is a profession, let us debate how we go back to providing the patient centered fundamental care that treats each patient with dignity, respect, and helps them to maximize their independence and health. This isn't to say that those of us in America shouldn't contact our legislatures, raise questions of misogyny and advocate for nurses being able to get higher graduate loans. But clearly, as Dr. Kitson so eloquently discusses, we also need to advocate for changes in the health care system that let us do what we do best: provide patient centered fundamental care. I look forward to hearing your thoughts on where we are getting this right and how we could potentiate the excellence in nursing care that we all wish to see. Please do share your thoughts at [email protected].