Understand Care, Compassion, Competence, Communication, Courage, and Commitment. Definitions, real-world examples, and interview guidance for every C.
The 6 C's of Nursing were introduced in December 2012 by England's Chief Nursing Officer, Jane Cummings, as part of the Compassion in Practice strategy. This national strategy was developed in response to the Francis Inquiry into failings at Mid Staffordshire NHS Foundation Trust, which revealed catastrophic lapses in the quality of nursing care.
The 6 C's were designed to provide a universal framework that all nursing staff could understand, remember, and apply in their daily practice. They represent the core values and behaviours that patients and the public have the right to expect from nursing professionals.
Since their introduction, the 6 C's have been adopted across the NHS and have influenced nursing education, recruitment, appraisal, and regulatory standards. They are now embedded in the NMC Code and form the basis of many nursing interviews and performance reviews.
Here is a quick-reference summary of all six values. Each is explored in depth in its dedicated section below.
Delivering care that is safe, effective, and puts patients at the centre of everything. Treating patients with dignity and respecting their individual needs.
Showing kindness, empathy, and understanding. Recognising patients as human beings with feelings, families, and lives beyond their illness.
Having the knowledge, skills, and expertise to deliver high-quality care. Understanding one's own limitations and seeking development.
Listening carefully, sharing information clearly, and building therapeutic relationships through effective verbal and non-verbal communication.
Doing the right thing even when it is difficult. Speaking up about poor practice and advocating for patients despite personal risk.
Dedication to patients, the profession, and continuous improvement. Going above and beyond to ensure the best possible outcomes.
Care is the first and most fundamental of the 6 C's. It means delivering care that is safe, effective, and of the highest possible quality. Care is about treating every patient with dignity, respecting their individuality, and putting them at the centre of all decision-making.
In practice, delivering care means ensuring that basic needs are met: patients are clean, comfortable, hydrated, nourished, and pain-free. It means following evidence-based practice, maintaining safety standards, and continuously evaluating the quality of care provided.
Compassion is about how care is delivered. It involves recognising patients as whole human beings with emotions, relationships, and lives beyond their illness. Compassionate care is intelligent kindness that is founded on empathy, respect, and dignity.
Research has shown that compassionate care improves patient outcomes, increases patient satisfaction, reduces anxiety, and even accelerates physical recovery. Conversely, the absence of compassion - as seen at Mid Staffs - causes profound harm.
Competence means having the knowledge, skills, judgement, and expertise to deliver high-quality care. It involves understanding one's own limitations, maintaining professional development, and applying evidence-based practice to clinical decisions.
Competence is not just about technical skills. It includes clinical reasoning, decision-making, leadership, and the ability to work effectively within multidisciplinary teams. A competent nurse knows when to seek help and how to escalate concerns appropriately.
Communication in nursing encompasses all interactions: with patients, families, colleagues, and other healthcare professionals. It involves listening actively, sharing information clearly and honestly, and building therapeutic relationships based on trust.
Poor communication is one of the most common causes of patient harm and complaints. Effective communication prevents errors, improves adherence to treatment, reduces anxiety, and ensures coordinated care across the multidisciplinary team.
Courage in nursing means doing the right thing even when it is difficult, uncomfortable, or carries personal risk. It involves speaking up about poor practice, advocating for patients who cannot advocate for themselves, and challenging decisions that may not be in patients' best interests.
The Francis Report highlighted that many staff at Mid Staffs knew care was inadequate but failed to speak up. Courage is the C that prevents such failures. It requires moral strength, professional confidence, and support from organisational cultures that welcome raising concerns.
Commitment is the dedication to patients, the nursing profession, and continuous improvement. It means going above and beyond basic requirements to ensure the best possible outcomes for those in your care. Committed nurses take ownership of their practice and drive positive change.
Commitment also involves contributing to the wider nursing community: mentoring students, participating in quality improvement projects, and helping to shape the future of the profession. It is the sustained dedication that turns values into consistent practice.
The following table shows how all 6 C's apply to a single clinical scenario:
Scenario: A nurse caring for a patient with advanced dementia who has refused to eat for two days.
| C | How It's Demonstrated |
|---|---|
| Care | Performs a full assessment, checks for swallowing difficulties, oral problems, and pain. Ensures basic needs are met. |
| Compassion | Sits with the patient, offers favourite foods gently, shows patience when food is refused, maintains dignity. |
| Competence | Recognises signs of aspiration risk, involves speech and language therapy, follows evidenced dysphagia management. |
| Communication | Speaks gently and slowly, uses non-verbal cues, involves family in understanding preferences, documents accurately. |
| Courage | Challenges the dietitian's generic plan when it's unsuitable, speaks up to the doctor about potential safeguarding concerns. |
| Commitment | Stays beyond shift to feed the patient, researches alternative strategies, shares learning with the team. |
NHS nursing interviews frequently ask about the 6 C's. Here are common questions and how to answer them using the STAR method (Situation, Task, Action, Result):
"In my previous role, I was caring for a patient who had received a terminal cancer diagnosis. She was withdrawn and refused to engage with the team. I made a point of sitting with her during every medication round, not rushing, and simply being present. Over several days, she began to open up about her fears for her children. I arranged for our Macmillan nurse to visit and facilitated a family meeting where she could express her wishes. By the end of the week, she had completed an advance care plan and appeared more at peace."
"I noticed that a senior colleague was consistently signing off medication rounds they hadn't actually witnessed. I was concerned about patient safety and the legal implications. I documented specific instances and raised my concerns with the ward manager through our local raising concerns policy. An investigation was conducted, additional training was provided, and the ward implemented a new double-checking system. It was uncomfortable, but patient safety had to come first."
"I take responsibility for my own professional development. I complete all mandatory training before deadlines, attend relevant study days, and read nursing journals regularly. I recently identified that my knowledge of diabetic ketoacidosis management needed refreshing, so I completed an online module and arranged a practical session with our diabetes specialist nurse. I also keep a reflective portfolio and use feedback from appraisals to set development goals."
Research and patient feedback consistently show that the 6 C's directly impact patient experience and outcomes:
Absolutely. They remain a core framework in the NHS Long Term Plan, NMC Code, and most NHS trust values. They are regularly cited in CQC inspection reports and nursing education.
Yes. Whether you work in hospitals, community settings, mental health, research, or management, all 6 C's are relevant. They are values, not clinical tasks.
Focus on the fundamentals: compassionate care (C), clear communication (C), commitment to learning (C), and courage to ask questions (C). Competence (C) builds over time through experience and supervision.
Some organisations have added additional values, but the original 6 C's remain the national framework. The NMC Code incorporates all six within its four themes.
Prepare 2-3 STAR examples for each C from your own experience. Be specific about what YOU did and what the outcome was. Avoid vague statements like "I always show compassion."
Care is WHAT you do (the clinical actions, meeting needs). Compassion is HOW you do it (the emotional quality, empathy, warmth). You can deliver care without compassion, but the best nursing combines both.
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