Rapid Response: Re: How the nursing profession should adapt for a digital future

Letter to the BMJ: https://www.bmj.com/content/373/bmj.n1190/rr-0

June 18th 2021

Dear Editor,

Digital transformations are not inevitable, and they do not lead inevitably to social progress.

Richard Booth and colleagues have provided a timely analysis of a range of emerging technologies that may impact nursing and healthcare. They draw attention to important issues of ethics and suggest useful remedial strategies such as greater involvement by nurses in technology design processes.

But missing from their account is broader discussion of who exactly gets to decide what progress is, and how digital transformations shape such progress.

The authors would have us believe that technological change is inevitable, and that job now for nurses is to adapt to these external forces of change. But automation, AI and robotics is not inevitable. Their journeys to hospital wards are shaped by countless choices, ideas, interests, and institutions along the way.

Good governance of progress in nursing is a question of engaging in these choices and deciding the direction in which progress is seen—and incentivized— to unfold.

Decision makers need to ask who benefits from certain directions in digital transformation, who pays, and who decides? The dimensions and uncertainties raised in this challenge are a matter of social values and political judgements as well as technical capabilities.

These issues take on new importance as we build back from covid-19. When digital transformations are driven and steered only by narrow academic, commercial, or governmental interests, the results will tend to sideline less-privileged perspectives.

The urgency now is not simply to develop technical capabilities to allow nurses adapt to transformation. But to develop collective and collaborative capabilities that will allow nurses influence the direction of transformations, or where interests between say firms, healthcare professionals and patients cannot be aligned, to resist entirely.

In this task, the cultures and histories of nursing should not be seen as an impediment as the authors suggest. But rather as a rich repository that can guide innovation away from imposing technologies of control, and towards building democratic infrastructures of care.