The world’s 27 million nurses and midwives – who comprise 60% of the health workforce – are not only excluded from the health system’s corridors of power, but also have faced new levels of censure and reprisal during the COVID-19 pandemic when they protested dangerous or abusive working conditions, said expert panel members at the Geneva Health Forum on Monday.

Along with the widespread shortages of personal protective equipment (PPE) that put many nurses lives at risk and led to at least 20,000 deaths, the pandemic period has seen the suspension of labour laws in some countries, increased discrimination against healthcare workers, and employers’ restrictions or censorship of nurses who dared to speak about their working conditions. 

Speaking on the panel ‘The Year of the Nurse and Midwife 2020 – A Catalyst for Change’ on Monday, Soosmita Sinha, President of the Health Law Institute, said: “There were cases globally, and especially in the US, where … nurses could not talk to social media, nurses could not talk to government organizations. There were repercussions from employers.”

In an interview with Bloomberg News in March, Ruth Schubert, a spokesperson for the Washington State Nurses Association, observed that “hospitals are muzzling nurses and other health-care workers in an attempt to preserve their image”, threatening to fire employees if they talked to the media without authorization or publicized their working conditions.  

Two states in the US, Colorado and Virginia, expanded whistleblower protections to apply to these circumstances and allow nurses to report issues to their employers, social media, and other organizations. Other states enacted laws enabling healthcare workers to bring their own PPE if the hospital had a shortage.

“We’ve heard reports of nurses having to work long hours, not being able to take vacations, working when they’re sick … how is it compromising patient safety? If nurses are not safe, can patients really be safe in that environment? Aren’t we actually making them vectors of COVID to pass on to the next person?” posed Sinha. 

Healthcare workers form between 2% and 3% of the population in most countries, yet data has shown that the healthcare worker COVID-19 infection rate is 10-14%. Of the 54 million total COVID-19 infections globally, some 5 million could be healthcare workers. 

Nurses Needed in Leadership Positions and Decision Making Bodies

The panelists reviewed WHO’s first-ever State of the World’s Nursing Report released in April, which highlighted the unrecognized contributions of nurses to health systems and called for new policy measures and investments to strengthen the nursing workforce.

“We need to hear and see and be advised by nursing leadership voices at all levels through our health systems,” said Howard Catton, CEO of the International Council of Nurses. “It would bring this nursing perspective into the heart of decision making about how service is delivered and also into political decision making as well.” 

The ability of nurses to influence policies is essential because “they understand the reality on the ground,” Sinha said. Nurses account for 60% of the health workforce and provide 90% of primary health care.

“It is absolutely necessary to have nurses in all the decision making bodies, to have nurses in the COVID management taskforce, to have a government chief nurse, to have the voices and the views of nurses everywhere and to have influence … and not just to be used for managing crises,” said Roswitha Koch Heepen, senior member of the Swiss Nurses Association. 

Nurses have played a vital role on the frontlines of combating the pandemic and they will be essential in global vaccination efforts for COVID-19. Globally, nurses administer and lead the majority of vaccination programs, and they are crucial to a safe and efficient rollout of a COVID-19 vaccine – alongside pharmacists and refrigerated truck drivers. They have largely been left out of vaccination discussions, however. 

“Where is the nursing voice in terms of the big policy decisions? Where is the nursing voice in terms of managing the mass vaccination response?” said Catton. 

The State of the World’s Nursing Report highlighted the need to create at least 6 million nursing jobs by 2030, primarily in low- and middle-income countries. Elisabeth Iro, WHO Chief Nursing Officer, highlighted that without this increase “the ability to adequately respond to the COVID-19 pandemic or similar crises in the future is compromised and would jeopardize our collective ability to achieve Universal Health Coverage targets”.

“If you don’t have a nurse in place or a pharmacist to give that vaccination, it doesn’t matter how much of the vaccination we have or how we got to that point,” said Sinha.

The Geneva Health Forum runs from 16-18 November. Follow Health Policy Watch’s coverage here and on Twitter.

Image Credits: Alberto Giuliani, Geneva Health Forum.