WHO AM I?

I am Dr Marion Lynch BEM, RN, RMN FRSPH, FRSA. A registered nurse, general and mental, a public health specialist, global health consultant, creative health consultant, a Fellow of the Royal Society of Public Health and Fellow of the Royal Society of the Arts. This has taken 40 years of work and means that I have experience in nursing, education, research and national NHS leadership, global health roles with governments and charities. I still improve health and healthcare, and prove the impact, by putting the art and science of nursing at the heart of national policy, professional education and clinical practice.

My nursing legacy mission is to build an Art of Nursing social movement. This builds on my Doctorate and 15 years as Associate Dean in the NHS, studying and noticing what works to improve clinical practice and healthcare and experiencing what is missing in professional education and health service design and health policy.

My mission is to enable nurses and artists to work together and is happening through my webinars. I am currently (Sept 2024 - April 2026) running the Art of Nursing Webinars in partnership with Foundation of Nursing Studies (FoNS) and hosted by the Royal College of Nursing (RCN).

Why am I doing this?

I felt the need to start this art of nursing work when my life changed during COVID. I left my senior leadership post in NHS England and went back into scrubs! Working with the education team at the Nightingale Hospital London during the COVID pandemic changed my career priorities. Since 2021 I have led this personal Art of Nursing movement to enable nurses to be seen and nursing to be valued. And to use the arts to do this.

My personal creative health mission is to make 21st century health care person centred and in partnership with artificial intelligence (AI) but not replaced by it.

This personal mission to make nurses and nursing visible has resulted in me being nominated as a Gates Foundation Goalkeeper (globally only 200 people per year) and then invited to speak at the United Nations in 2023 and 2024. This expertise informs my forthcoming book, How are Nurses and Allies Harnessing the Arts to Deliver the Sustainable Development Goals.

I was thrilled to be awarded a medal by King Charles in 2024 recognition of my global work on health. I was awarded the British Empire Medal (BEM) for my work with women and children in Africa. This award came from the Foreign and Commonwealth Development Office and is an award for ‘getting things done’.

I have always worked across health and arts sectors. I bring the underlying knowledge forming, and overarching principles informing the art and science of nursing together in philosophically and practical ways. It is what my doctorate was in! By bringing my views and nursing experience to the design of global health programmes, and my voice and expertise to many organisation’s executive board, I challenge the status quo that prevents progress by building relationships, evidence and trust, and so improve health and builds sustainable change with others.

As Trustee of Foundation of Nursing Studies, I bring the Art of Nursing into action and host bimonthly webinars, fire side chats featuring nurses and artists sharing their work.

As a Trustee with Human Story Theatre Iam part of the board and also help inform the commissioning of and content of plays that address health issues that are too hot to handle in any other way. Practically I form part of the expert Q and A panel post performances and provide podcasts to add the health promotion messages needed to sustain the behaviour changes sought through the theatre performances.

As a global health consultant, I provide technical expert advice to universities, charities and global health programmes. In 2022 I worked with the University of Global Health Equity (UGHE) in Rwanda as a nurse education consultant designing the world’s first MSc in Global Nursing Leadership which launched in 2024.

In 2023 I designed and delivered two modules on the new MBA Global Health Leadership and Management with Coventry University: Transforming Global Health and Resource Management. I then taught and assessed the first international multi professional student cohort.

I have been a Visiting Professor with University of West London since 2018, teaching on international perspectives on dementia and health system design, and on research methods in the MSc programme.

I am an Honourary Adviser to Global Health Partnerships (Tropical Health Education Trust THET), supporting strategy, grant proposals and raising the nurse voice. I have evaluated global health and nursing programmes, and innovations in healthcare delivery across the world and I bring nursing values and skills into all my global roles.

My global mentoring and advocacy roles include; i) nurse leadership mentor for the SIGMA Global Leadership programme, ii) a mentor for the NHS Global Fellowship programme and iii) a gender equity mentor for UGHA. My research and nursing expertise roles include the evaluation of innovations in healthcare within the United Kingdom, and expert input to ITAD global programmes.

I also run a small charity, Fiona Foundation for Kids which works in collaboration with other global health and social welfare charities to develop volunteer skills and empower mothers.

Never one to not practice what I teache; I am a respite and short-term emergency foster mother for vulnerable and unwell children in England. In the summer I go to sea as a volunteer medical cover with the Ellen MacArthur Cancer Trust. When volunteering as boat mate and nurse/ medic I combine my Yachtmaster level sailing skills and nursing skills to help build health, confidence, joy and new life skills. This happens by taking young people (aged 8-24) who are recovering from cancer to sea on life changing residential sailing adventures.

What others say about me.

Global Fellowships Mentee

“Thank you for your support over the last 8 months - professionally, personally, and as a woman. You truly created a safe platform for me to express myself, reflect and develop in my new leadership role in a foreign setting. This includes helping me challenge the imposed and internalized limitations/doubts for my career as a woman.

I truly admire your achievements and your leadership style - leading with humility and humanity, creating relatable dialogue despite our differences! In particular, I love that you celebrated me, and my development, over what I achieved on paper.” Mentee feedback. September 2025.

Volunteer of the Year Nominee. Ellen Macarthur Cancer Trust.

“Providing so much comic relief and making me feel so relaxed.”

Nurses as a 21st-Century Profession:

How to be Human

Dr Marion Lynch

Introduction

A nurse sits at the bedside of a patient living last days with myeloma. On one side of her chair, the monitor scrolls an endless stream of numbers, oxygen saturation, heart rate. Algorithms decide what to show and what the numbers say. On the other side, she notices the patient’s hand tremble slightly when he reaches for his water. She leans forward, catching his eyes, steadying the glass, and in that gesture communicates presence, reassurance, and artful nursing care.

This scene captures the paradox of nursing in the 21st century, and my memories of being a newly qualified general nurse on a haematology ward in Oxford the 1980s. Back then, the machines were background noise, sometimes soothing, sometimes shouting for attention, but the focus was on the person in front of me. Today in 2025 it is maybe different, maybe the same. This balance of human and non human interaction is however more than I initially trained for. This need led to my thinkinig on how to human in a non human system (Lynch 2025), and this Art of Nursing movement.

Nurses now work in health systems saturated with technology, globalised by policy, and shaped by relentless pressures toward efficiency. Yet the heart of our work remains profoundly human: being present, noticing absences, and responding with empathy. I am wondering what does it mean to be a nurse when there is demand for both patient data and patient dignity?

Charles Kenny (2021) reminds us that things are getting better, the arc of global progress is real: life expectancy has risen, child mortality has plummeted, literacy has expanded. The progress towards the Sustainable Development Goals, although not fast enough, is forward. None of this progress could have occurred without us nurses, who have historically been both implementers of public health advances and the people we see and speak up the uneven distribution of health, wealth and privilege. At the same time as this unequal rise in health and opportunity across the world, the fourth industrial revolution is bringing the world artificial intelligence. For nursing this has resulted in contemporary developments in artificial intelligence and digital health technologies that in turn demand new configurations of nursing practice (Ronquillo et al., 2021).

I suggest that nurses must claim their place as leaders in shaping the future of health care by harmonising what I have have named as artful intelligence™️. This includes the irreplaceable human capacities of empathy, presence, judgment, creativity, and hope (Loaiza & Rigobon, 2020), and the art of nursing so needed in times of crisis but so invisible in policy documents, and misunderstood in politician speeches about vocation, care and and other gendered tropes linked to less pay, less voice, and less power. The artful intelligence approach in nursing may be the balancing weight accompanying the computational power of artificial intelligence. If we hold both in equal measure, maybe nurses can ensure that technological progress amplifies rather than erases the relational and ethical dimensions of care.

My thinking unfolds in six parts: (1) nursing within the frame of global progress, (2) the dual identity of nursing as both science and art, (3) the interplay of artificial and artful intelligence™️, (4) ethics and equity in digital health, (5) professional identity and agency, and (6) future directions for a harmonised profession.

Nursing in a Century of Global Progress

When Charles Kenny (2021) opens Your World, Better with the tragic life and early deaths of Louis XIV’s children, and the paintings that show this family as a unit of care, he makes a startling point: even the wealthiest families of the 17th century endured losses that modern medicine has largely prevented. In other more positive royal accounts (to be continued in the Highness of Health Series I am writing), there are stories of Queens taking it upon themselves to innoculate their children against Smallpox in a time where mistrust of such actions prevented lives being saved. (A moment here perhaps for nursers to relfect on current vaccine hesitency. Today, in 2025, far fewer parents bury their children. Infant and maternal mortality have declined dramatically, life expectancy has nearly doubled in many world regions, and vaccines have turned once deadly illnesses into rare events. However, misinformation and removal of global health finding is putting this progress at risk, and so needing nurses to notice the impact of these individual and collective omissions in public health progress, and act as one.

The gains, Kenny argues, are not accidents of history but the product of collective action of people. evidence that progress is possible, uneven, but they are real and that uniting people for a common good brings good. A note of caution that such collective calls for public good are not universal drivers and the differing approaches to nursing evolution in neo liberal and collective societies means a global phosophical lenses is needed as well as a practical workforce one.

Nursing has been an agent in this public health transformation. The eradication of smallpox (with the Queen’s help), the control of measles ( which is currently not so good), and the dramatic reduction in deaths from pneumonia and diarrheoa depended not only on scientific discovery but also on nurses’ relentless efforts to deliver vaccines, teach sanitation practices, and sustain patients through recovery (World Health Organization [WHO], 2019). In hospitals and communities, we nurses have made this happen: the hands and voices through which public health becomes personal health and people trust their nurse to help them get well or be well in whatever context they are.

Kenny (2021) reminds us that all all is fair, and progress is never universal. Millions still live without reliable access to clean water, adequate food, or affordable health care. The WHO / Unicef report (2025) states that only 50% of healthcare facilities in the poorest countires have basic WASH, waste and reliable electricity services. My own global health work made this so clear to me when, on an evaluation visit to rural health posts in Zambia, the requested powerpoint presentation was impossible as there was no power.

Nurses stand at these dual front lines of progress and lack of progress, working in rural clinics without broadband access, improvising treatments when supplies run out, and advocating for patients left behind by uneven global systems. Nursing, in this sense, has always embodied the paradox of progress: it is both a marker of how far we have come and a reminder of how far we have yet to go.

The 21st century now adds new layers to our global story. Migration, climate change, and pandemics reveal how interconnected health truly is. The COVID-19 crisis demonstrated both the fragility of health systems and the indispensable role of nurses as the largest group of health professionals worldwide (International Council of Nurses [ICN], 2025). In Kenny’s terms, “billions of people have been part of solutions” (2021, p. 9), and we nurses are counted among those billions, not only as caregivers but also as the innovators, educators, and advocates for equity. As nurses we are the agitators at the edge of policy changes but rarely get the limelight for the work we do and the difference we make.

The story of global progress therefore shows nurses as successful in some ways, but so silenced in others, and so sets the stage for reimagining nursing as a 21st-century profession. If the last century was about scaling sanitation, vaccines, and maternal care, this century requires scaling the non human in health and nursing, artificial intelligence, digital health, digital competencies, ethical governance, and the human side. artful intelligence™️. Hanlon (2011) called the move from the fourth wave of public health, i.e. telling people what to do about their health (run more, eat less, do not smoke) to the fifth wave of public health as a shift to addressing the wider culture that enables health, this includes the arts and also how the world views what it is to be healthy. In this wave culture will take more of a role in helping us be healthy, and define what that is too.

As health systems in some of the world start to move away from telling people how to behave to be healthy and instead start shaping society so people can be healthy (perhaps the neighbourhood approaches bering advocated in the UK as part of the NHS Fit for the Future Plan (NHS, 2025), there is a accompanyinh shift away from bio medical approaches. This may shift thinking on personal responsibility and blame to social determinants of health, neighbourhood approaches and collective cultural community approaches to health making. Or it may be about getting people healthly enough to get into work and earn money rather than cost money. Nurses are never passive bystanders, we are part of this future and we are therefore at the balancing point between building on our agency or being pushed into ambivalance because of how we are seen, not heard and unvalued. I choose action over ambivalace which is why I act and develop this work. We as a collective of wise innovative nueses are ensuring that the benefits of progress are distributed fairly and that its human meaning is never lost. This is possible as long as we are here to do this, there in places of power (or here on the website) to share this, and that what we do is seen as effective. Wer need to show, tell and provwhy the art of nursing matters.

The Dual Identity of Nursing; Science and Art

Consider the image of a nurse adjusting an infusion pump while simultaneously noting the hesitation in a patient’s voice. One action is technical, measurable, and easily documented in an electronic health record; the other is relational, subtle, and invisible to most systems. This juxtaposition illustrates what Barbara Carper (1978) named the patterns of knowing in nursing: empirical, ethical, personal, and aesthetic. Together, these ways of knowing remind us that nursing has always been more than technical proficiency, a task, or a semi professional which is how it was still being framed in 1995.

The scientific dimension of nursing is undeniable. Evidence based protocols, pharmacological knowledge, and infection-control practices sustain safe and effective care, degree educated nurses save more lives. All the evidence is there to support the economic agruement for desgree qualified nurses and high quality nursing. We as nurses are trained in systematic assessment, diagnosis, and intervention, a knowledge base that is testable, replicable, and essential for accountability, and we measure what can be counted, and potentially miss what matters but cannt be counted. I recall always being told, if it is not written down it did not happen. I do not think I have ever written down the sympathetic presence shown when the person in front of me is broken with grief, or the matching of my calm 4x4 breathing for a person too scared to take another breath on their own. Our ways of counting only count some of what we do. what can currently be counted is the part of nursing that aligns most easily with the technological age, where algorithms and predictive analytics can support clinical reasoning (Ronquillo et al., 2021).

But there is also the art. Jean Watson (2008) describes nursing as the philosophy and science of caring, where presence, empathy, and compassion are as vital as medications or procedures. The artistry of nursing lies in sensing what is unspoken: the pause before a patient answers, the absence of laughter in a child’s play, that 1000 yard state that any nurse who has worked in a trauma informed way can see in a child’s eyes, the grief folded into silence hidden behind a forced smile. These are acts of noticing that cannot be reduced to metrics, yet they often make the difference between good nursing care and poor nursing care, they make the difference to the tone we take, the words we use, the time between the silences that say so much. People do not feel cared for if they do not feel connected to. Nurses know that healing is the recovery of the body, the restoration of dignity and the return to one’s life. Tghis aspect of human may be possible through an AI bot, as it has been possible through a screen, I am both glass of water on my desk half full and half empty on this.

As nurses we inhabit the dual roles of scientist and artist, technician and companion, evidence gatherer and storyteller. The Art of Nursing webinar content and stories, and the poems in the resource section of this website are testiment to that, Our authority rests precisely in our ability to hold both and to translate the rigor of data (and sometimes the metaphorical rigormortis of more paperwork into compassionate action.

The challenge of the 21st century is that technology risks amplifying one side at the expense of the other. Artificial intelligence can process data faster and more accurately than any human, but it cannot offer that sympathetic presence, remember when someone said that they did not know what the nurse did, ‘she was just there’. Digital health tools can chart symptoms, but they cannot sit quietly holding that suffering. Without attention to the aesthetic and ethical dimensions, nursing risks being reduced to “what can be measured” (Krick et al., 2020), and what can be recorded as ‘there’. The relational aspect between two people, maybe described as not here or there, and so not so easily measured using the metrics that currently matter. Does it matter?

I beliece so an that the dual identity of nursing must be protected and amplified if the human in the non human healthcare is to survive. As we turn toward artificial intelligence, the question becomes: how do we preserve and elevate artful intelligence™️ alongside the scientific?

Artificial + Artful Intelligence™️ in Nursing

Artificial intelligence (AI) has entered nursing in the same way as it has entered other areas of life. Like the new electricity. Policy frameworks such as the NHS Fit for the Future Plan (NHS, 2025) predict automated documentation, predictive risk scores, and therapeutic chatbots as solutions to workforce shortages and efficiency pressures (Buchanan et al., 2021). In theory, these tools we liberate us nurses from routine tasks and allow more time for human connection and the automation or augmentation of work may free up nurses to do the human elements so needed. Maybe that ‘being there’ aspect of relational presence. However, the introduction of AI does not simply add new capacity to care; it reconfigures what counts as knowledge, what is valued as labour, and who gets to decide what is right or true.

The promise of such time saving processes is seductive in an economic way, and as we know money talks and this is where the power is. The issue of the power in the future of nursing thinking is scary. As AI can detect sepsis hours earlier than clinicians, predict patient deterioration from subtle biometric shifts, and generate care recommendations based on population-level data (Koo et al., 2024) will it replace some of what we do, and be welcomed as the time saving solution it is, and at what cost?

Most AI systems have been designed without nurse input, leading to tools misaligned with practice realities and inattentive to relational care (Zhou et al., 2021). When algorithms structure decision-making, the invisible work of presence, empathy, and advocacy risks being removed, irrelivant to the role of a nurse. If care becomes what machines can contribute and calculate, then what remains of the art of nursing, the hearing a silence, sensing a shift, making moments safe by what Bell Madden’s poem in the resources section shows as ‘sorted’. It’s okay Jennie is here may bring the same trust and relief if Jennie is not Jennie and human in all senses of the word.

Here, the concept of artful intelligence™️ becomes critical. This builds on what Loaiza and Rigobon (2020) identify as the five domains that cannot be replicated by machines: empathy, presence, judgment, creativity, and hope. These are core to nursing’s professional identity. AI may simulate empathy, offering warm phrases in response to patient queries, but it cannot feel with patients. It cannot sense the tremor in a hand, the fatigue in a parent’s eyes, or the moral weight of a decision that the end of life symptom management medication package now needs to be opended. Or can this be via an algorithm and resolved by a bot? And if so, how would this be decided and discussed?

Zohny et al. (2025) have demonstrated how large language models can mimic four physician–patient communication styles: paternalistic, informative, interpretive, and deliberative. For nursing, the lesson is double edged. On one hand, AI can help patients articulate preferences and practice dialogues, potentially empowering them before clinical encounters. On the other hand, the persuasive power of AI risks manipulation, reinforcing biases rather than fostering autonomy. Nurses, long attuned to relational ethics, are uniquely positioned to mediate these tensions, to ensure that communication remains value sensitive and person centred. If the AI bot is programmed for paternalistic there will be one way of speking about dealth, if it is programmed for interpretative there will be another. I wonder whether last words and last rites are so reduced.

A vignette makes this tangible. A nurse in an oncology ward uses an AI tool to flag elevated infection risk in a patient receiving chemotherapy. The algorithm predicts with striking accuracy, but it is the nurse who contextualises the alert, explaining gently to the family why neutropenia matters and offering reassurance that vigilance does not mean there should be fear, we as nurses are aware of everything that is going on around the person. As Gaye Poole in the webinar on Novel Nurses so wonderfully said, we as nurses are nosy. Maybe AI can be viewed as nosy too, over and above the noisy monitors defining what is happening. The machine informs; the nurse interprets, translates, and sustains that relationship.

In this sense, the future of nursing is not about nurses resisting AI but about embedding artful intelligence™️ into its deployment and keeping the human elements of nursing where non human cannot help . Nurses must therefore be the co-designers of any AI care, ensuring that technology augments rather than undermines the relational, ethical, and imaginative heart of practice. This is a challenge as nurses and AI engineers speak different languages. Clare Su-Yeon Park’s poem In the Twilight zone; between AI and nursing ( in the resources section) highlights the issues we face. The task ahead for us nurses is not therefore to choose between artful and artificial intelligence, but to harmonise them into a profession that remains both scientifically rigorous and profoundly human, and ethical.

Ethics, Equity, and the Unfinished Conversation

The integration of AI into nursing is not occurring in a vacuum. Algorithms are built on data sets that carry the biases of the societies that produced them. As Peirce, Smith, and Kolotylo (2020) caution, electronic health records and machine learning outputs are not morally neutral; they embed histories of injustice, including racial disparities in diagnosis and treatment. I attempted to create some images of nurse leaders using AI for a presentation. I gave up as with each specific request I got a more and more unrepresentive image that become less and less like the leaders I know looking image. If we as nurses uncritically adopt such tools, we risk amplifying inequities rather than reducing them. Social justice is part of being a nurse, it is not as evident as direct nursing care, but it is there, here and there.

Kenny (2021) reminds us that progress is real but is uneven. While child mortality has fallen globally, five million children under five still die each year from preventable causes. Universal health coverage remains elusive for millions. The efforts to address this have been hampered by global politics and cuts to health care where the funds are needed most. The digital divide adds a new layer: hospitals in urban centres may boast AI-driven decision support, the huge AI investment promised by Trump and Starmer in September 2025 is useless while rural clinics lack broadband to upload vital signs. In this landscape, technology may widen rather than bridge gaps but the relational aspect of nursing, the trust built wihtin that community will prevail.

Nurses, grounded in the ethics of care, are well positioned to surface these inequities. If we are heard and if what we say matters. Consider my experience in Zambia. The clinic lacks reliable internet, rendering AI decision-support tools unusable. Instead, the nurse needs to draw on experiential judgment, community knowledge, and trust built with families to guide care.

The ethical challenge, then, is not only whether AI works but also for whom, under what conditions, and at what cost. Transparency, accountability, and distributive justice must be part of nursing’s engagement with digital health. If AI systems cannot explain their reasoning, or if they are deployed only in wealthy settings, they risk betraying the very ethos of nursing: to advocate for those most vulnerable.

In this unfinished nursing of the future conversation, artful intelligence™️ is not something aligned to old tropes of caring and nice quiet kind nurses, it is the human compass to where we need to be. Empathy, judgment, and presence guide nurses in asking hard questions about fairness and access. As Kenny (2021) insists, progress requires intentional effort and nurses need to now be intentionally artfully intelligent as well as harness artifical intelligence. For nursing, this effort means ensuring that such technological innovation does not take away our focus on equity, and that the humanity of care remains visible even in an algorithm led non human system.

Professional Identity and Agency

For much of our history, nursing has been cast in the shadow of medicine, essential but subordinate, technical but undervalued. Particularly worrying is the gender inequity in leadership posts in nursing, and the continued gendered concept to nursing. Whilst these words of Davies are from 1995, they resonate with much of the current power battles influecning the future of nursing.

“..there is a sense in which nursing is not a an adjunct to a gendered concept of profession, Nursing is an activity, in other words, that enables medicine to present itself as masculine/rational and to gain power and privilege of doing so. It has clearly had the first bite of the cherry in defining its work and… We get closer to the matter of recognizing that (nursing) is trying to put a conceptual framework around just those aspects of the work of health and healing that are ‘left over’ after medicine has imposed as essentially masculine vision.” (Davies 1995; p61).

I find that there are still many who see nursing as such, mostrly those who have not needed nursing and not been in nursing. In the 21st century, this framing is dangerous to patients and unhelpful to our profession. Nurses are still the largest group of health professionals worldwide, often the first and last point of contact for patients, and increasingly recognised as leaders in interprofessional teams (ICN, 2025). Yet as digital health expands, there is a risk that professional identity could be pushed backwards and narrowed to what algorithms can measure and delegate, and what other health professions deem that they need from nurses. If that happenes nurses will be deskilled in their cognitive processes, mis skilled due to biased algorithms, and unskilled because we will never feel have learnt what we need to do if it is something AI can do.

To mitigate this risk we need to expand our professional agency and resist such narrowing. We and other health professionals need to tell the “hidden stories” of our work, more than the stories of work left undone. We need to tell of the improvisations, negotiations, and moral labour that do not fit easily into metrics set for measuring quality and the tasks set out for nursing in NHS Fit for the Future (NHS, 2025). For nurses, these stories are the quiet advocacy for a patient waiting too long for care, the careful calibration of a gentle smile and humour to ease a child’s fear, the courage to challenge a physician’s decision when it conflicts with observed patient values, and loud activism for gender equity, patient safety and professional respect. These acts are invisible to AI and constitute our profession’s ethical backbone. They are not invisible if we look at nursing in other ways than ‘adjunct to medicine’, there are other wider way of viewing nurses’ ways of knowing.

Carper (1978) reminds us that professional identity is not only about competence but also about self-awareness. Nurses continually navigate tensions between autonomy and hierarchy, between algorithmic recommendations and lived patient realities and consider weighing up both sides all of the time. To claim agency in this forthcoming context where AI is everywhere means weighing up both sides again, and refusing to be reduced to data entry clerks for machines or passive recipients of an algorithmic authority. It means positioning nursing knowledge, empirical, ethical, aesthetic, and personal, within all developments of care. Whilst I imagine an image of an ethical bathbone, I am also now seeing large nursing elbows coming into view.

Kenny’s (2021) broader argument about progress resonates here: societies evolve when professions step into leadership, aligning their expertise with the arc of human betterment and explore boundaries and scope of their practice. Nurses can do the same for the evolution of nursing. This evolutionary stage is that of boundary maintainence and inter-professional negotiation and will require ongoing negotiation within the healthcare system and against emerging roles such as digital health and AI. Key traits in this phase of any professional evolution are the expansion of scope of practice and resistance to role dilution or deskilling. So we as the nursing profession are not alone here, it is how all professions evolve.

One tangible aspect of this evolution is the need to be active in engineering AI. As Clare Su-Yeon Park has shown in her poem, the mismatch of language is shown by the responses; thw work on nursing and AI is “too philosophical” from the AI engineers, and seen as “too technical” from the nurses. As nursing has reached this professional evolution stage we need to now embed ourselves in AI design, governance, and evaluation so that we can ensure that nursing knowledge shapes rather than merely adapts to digital futures. By advocating for patient-centred outcomes and the need for artful intelligence™️ as much as efficiency metrics, we can hold systems accountable to values as well as numbers and build a shared language.

In this light, no professional identity is or has ever been static, and nursing identity needs to now evolve. Nurses in the 21st century must claim our dual role as designers of health systems that include AI, and the providers of and guardians of relational care. Our agency lies in harmonising technological innovation with artful intelligence™️, ensuring that progress serves not only efficiency and the utalitarian view of what we do, but also equity and human dignity and emancipatory view too.

Future Directions: Harmonising Artful and Artificial

What, then, does the future of nursing look like in a century shaped by both exponential technology growth and widening inequities? It looks bright and bleak to me. I always see both sides. I am a mental health nurse after all!. To make the bright outshine the bleak I believe we need three things.

First, education must prepare nurses as digitally literate, ethically reflective and able to embody the human aspects of nursing that humans need. However, not on its own. Scoping reviews warn that AI in nursing education often emphasises technical skill at the expense of relational practice (Buchanan et al., 2021). Nursing curricula should therefore integrate training in digital tools with sustained engagement in humanities and arts-based methods, preserving empathy and creativity alongside computation. This is called diological literacy and needs to be named and supported alongside digital literacy. This is where the art of nursing movement and the concept of artful intelligence TM can help.

Second, governance structures need to include nurses at every stage of AI design and deployment. Excluding them, as the current trends suggest, results in tools misaligned with practice realities and inattentive to patient-centred outcomes (Zhou et al., 2021). Nurses’ proximity to patients makes us indispensable in evaluating whether technologies enhance or erode care. We need to avoid wasting time and money and expertise, and the waste in the system will be seen when work arounds appear to allow patients and nurses to get around the AI. We have all seen these work arounds with technology when it has not been tested with the nurses who are supposed to use it, and benefit from it first.

Third, metrics of progress must shift. Efficiency cannot be the only outcome. As Kenny (2021) reminds us, global improvement is measured not only in wealth or survival but in dignity, opportunity, and shared wellbeing. For nursing, this means developing indicators that capture relational outcomes, trust, comfort, presence, alongside clinical effectiveness, efficiency and all the economic models of quality that can be counted. This is the challenge for the social return on investment meaasures and accounting for nurses’ worth. Whether this is more than ‘staff wellbeing’ and more than ‘more nurses’ remains to be seen

Return to the opening vignette but 40 years ago. This was me as a nurse at a bedside, one hand steadying a glass of water, the other monitoring a monitor, not an AI-generated one, just one with numbers I needed to read out of the corner of my eye. This was a side room when the machine was there as a prop and prompt as this was the final part of this man’s life. Let’s call him Mr Smith. Becasue that was his name. I still remember him because he was the first person to die with me when I was also in charge of the ward and had other pressing priorities too. This memory of being torn between being there and being somewhere else distills for me the essence of 21st-century nursing. We need to have the capacity to hold responsibility, technology and humanity in unison whatever century we are in, whatever monitor is there. I know, because later his wife told me, that it made a difference to both of them that I was there. Not the monitor, the human.

I am suggesting that nursing’s future depends on harmonising artificial and artful intelligence™️. Global progress, as Kenny (2021) reminds us, has transformed health outcomes, but inequities across the world remain, and may well be getting worse. Nurses, as agents of this progress, must ensure that digital tools do not deepen the current structural violence and social divides. Carper’s (1978) patterns of knowing and Watson’s (2008) philosophy of caring remind us that nursing is irreducibly both science and art. AI promises efficiency, but it cannot replace empathy, presence, or hope. I hope. Our professional identity, long marked by invisibility, must now be reasserted in design rooms, policy debates, and ethical governance. Those elbows I mentioned. Education, leadership, and advocacy will be key to embedding relational outcomes alongside clinical ones.

If the 20th century belonged to antibiotics, vaccines, and sanitation, (Hanlon 2011), the 21st will belong to data, algorithms, and digital platforms, and culture, and maybe the new profession of nursing. I hope so, but as I was always reminded in senior health management meetings, hope os not a plan.

We as nurses will not be replaced, completely, but we do need to be redefined. Nurses will be and do what we have always been and done: bridge art and science, human and non human care, and maybe have the artful intelligence counted and be counted as more than just being there. How will this happen?

Artful intelligence™️ now it is named, (and trade marked as I have often found my thinking and work when given freely has been taken and made not free) needs to be considered as a professional resource. In an era when machines can calculate risks and suggest treatments, it is the uniquely human capacities of empathy, judgment, and hope (not as a plan but as a position in life) that distinguish nursing and will enable nurses to flourish. These are essential for navigating ethical ambiguity, service complexity and sustaining patient trust so needed and wanted.

Kenny’s optimism offers a closing reminder that progress is not inevitable but possible if enough people contribute. “Billions of people have been part of solutions” (2021, p. 9). This speaks to me of collective action and positive assett based approaches to being healthy. Among those billions, nurses have always been and must continue to be central in communities. We are millions. At the last count I think it was 10 million. The 21st-century nurse needs to perhaps advocate for both artificial and artful intelligence™️. This Art of Nursing movement works is one way of helping us to do so.

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