The International Council of Nurses (ICN) published a toolkit on Thursday in honour of International Nurses Day (IND) to help countries turn global goals and strategies established by the World Health Organisation (WHO) into action on the countr.

Each year, International Nurses Day is observed on 12 May, Florence Nightingale’s birthday.

“We have the WHO recommendations, which have been agreed by the member states. We know what to do. We need to move on from the talk and see action to support our nurses – and that is exactly what ICN’s IND toolkit provides,” said ICN president Dr Pamela Cipriano.

The toolkit is titled, “Nurses: A Voice to Lead.” It is meant to be a roadmap to help implement WHO-recommended policies and priorities including those contained in WHO’s: Global Strategic Directions for Nursing and Midwifery: 2021-2025; the WHO State of the World’s Nursing and the International Centre for Nurse Migration’s Sustain and Retain in 2022 and Beyond.

In addition, the report specifically looks at the role that nurses play in addressing global health challenges and securing global health.

“The value of nurses has never been clearer not only to our healthcare systems but also to our global peace and security,” said ICN Chief Executive Officer Howard Catton. “Nor could it be any clearer that not enough is being done to protect nurses and other health workers, tragically underscored by the more than 180,000 health worker deaths due to COVID-19. We should not shy away from calling out that this is a question of policy and politics because the policies to rectify this lamentable situation do exist, but they are not being implemented.”

He added that “the scale of the world-wide nursing shortage is one of the greatest threats to health globally, but governments are not giving it the attention it deserves. Access to healthcare is central to safe, secure, economically successful and equitable societies, but it cannot be achieved unless there are enough nurses to provide the care needed.”

Two strategic priorities: Health & wellbeing

The toolkit specifically focuses on two strategic priorities that have become even more pressing over the course of the COVID-19 pandemic: investing in and prioritising the safety of health care workers and caring for the health and wellbeing of nurses.

“Nurses have given their all in the fight against COVID-19, Ebola, in disaster areas and in war zones,” said Cipriano. “Yet, they continue to face under-staffing, lack of protection, heavy workloads and low wages. It is time now to take real action to address workplace safety, protect nurses and safeguard their physical and mental health.”

The report notes nurses’ heightened risk of exposure to COVID-19; it cites WHO data showing that while nurses account for less than 3% of the global population, they represented around 14% of COVID-19 cases and as many as 35% in some countries.

The situation was similar in the 2014-2016  Ebola outbreak in West Africa, when, according to WHO, the risk of infection among health workers was 21 to 32 times higher than in the general adult population.

ICN said nurses are 16 times more likely to experience violence in the workplace compared to other service workers.

Taking action by investing and prioritising the safety of nurses could not only improve retention of nurses, it would lead to improved patient safety and outcomes and make health systems stronger and more resilient, ICN notes.

The report also highlights how nurses feel “overwhelmed” and “stretched past their limits,” facing daily anxiety as a result of work-related stress. In the US alone, 64% of nurses felt overwhelmed and 67% reported difficulty in sleeping, the American Nurses Foundation reported in 2020.

“They have been asked to make complicated choices and decisions over a long period of time and are experiencing high levels of chronic exposure to acute psychologically traumatic events,
as well as high workloads, violence in the workplace and burnout,” the report said. “It is time to fully recognise and address the inherent occupational stresses and burdens that nurses bear on behalf of societies.”

The results of doing so, according to ICN, would be both improved health of nurses and improved health outcomes.

Four policy areas: Education, jobs, leadership and service delivery

The toolkit also specifically looks at the four policy areas of the SDNM: education, jobs, leadership and service delivery.

Education

“The pandemic has highlighted the complex work of nurses and their ability to meet the increasing health demands of patients, to work with new technology, and with a multidisciplinary team,” writes ICN, underlining the additional challenge of attracting people into the nursing profession and to retaining the current workforce.

Nearly all WHO member states reported pandemic-related disruption to health services and 66% of them said that health workforce-related factors are the most common causes of service disruptions, WHO said.

These challenges can be met by investing in nursing education: increased retention in the nursing workforce; increasing the domestic supply of nurses relieves over reliance on internationally educated nurses; and well-educated nurses progress into senior leadership positions, ICN stresses.

Nursing shortage of 13 million in coming decade

The world could experience a shortage of 13 million nurses within the next 10 years as older nurses retire, and as many as 10% leave the profession due to the “COVID effect.”

Ensuring nursing jobs are filled will not only allow countries to meet their citizens’ health needs, but would improve the job satisfaction and morale of other nurses.

Leadership, career progression and service delivery

“Nursing leadership is needed at all levels and across all settings to provide effective and relevant health services for patients and their families, individuals and communities,” notes ICN in the toolkit’s executive summary. “Nursing leadership is as important to the delivery of quality care as technical skills at the bedside. Now more than ever, we need nurses to lead the development and implementation of individual care plans, new and innovative models of care, integrated and team-based care, organizational policies and plans, research and innovation board decision-making and legislation.”

In addition, the report said, nurses need career advancement opportunities, which can be achieved through providing them with the knowledge, skills and capabilities of the profession and enabling career progression in clinical, leadership and academic roles.

What are the benefits? Improved quality, safety and person-centered care, according to ICN, as well as a better working environment and increased job satisfaction.

“Nurses are catalysts for positive transformation to repel the forces that threaten global health and to build strong healthcare systems,” concluded Cipriano. “We have seen the evidence and
understand the need for investment and protection. Now is the time for action.”

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Image Credits: Acumen Public Affairs, Public Services International/Madelline Romero.