Nurses around the world are in crisis, whether they are in the eye of the COVID-19 storm in India, the exhausted ranks of Britain’s workforce, organising against a 1 percent pay rise offer, or in Kenya where, in some areas, they have not been paid at all for months.
Underpaid, undervalued and under-supported: nurses are reporting unprecedented levels of stress and burnout. The International Council of Nurses says the “COVID-19 effect” means the global nurse shortage is now six million, the vast majority in low- and middle-income countries.
This has to change. If we are to beat this and future pandemics and address the spiralling burden of non-communicable diseases and mental illnesses, a strong, motivated nursing workforce will be the backbone of our efforts.
Now we have a once in a generation opportunity to turn things around. At the World Health Assembly this week, health ministers will be asked to endorse a new five-year strategy for transforming the nursing profession, via improved working conditions, regulation, education, training and leadership development.
As the largest group of health professionals, with the greatest reach into society and the highest level of population trust, nurses have a pivotal role to play in fighting disease – and achieving universal health coverage. Those governments that think they cannot afford it should think again: the evidence shows investing in nursing not only improves health, it also supports gender equality and economic growth.
The pandemic has shone a powerful spotlight on what nurses and other health workers actually do – the gruelling hours, the risks to their personal safety, etc. But there is still a tendency to think of them as “angels of mercy”, rather than as highly skilled professionals who combine emotional intelligence with complex problem-solving abilities, as they determine priorities for multiple patients around the clock.
Some of this has undoubtedly come from entrenched cultural attitudes, given the vast majority of nurses are women. Their low status within health systems means they have not traditionally been consulted about health policy or considered for higher-level leadership positions.
The World Health Organization has set an excellent example by appointing a chief nursing officer; all countries should follow its lead.
Nurses themselves are advocating for a new vision for their profession. The Nursing Now campaign has nurse groups in 126 countries, lobbying for greater recognition of what they can do and a greater voice in health policy decision-making.
In their daily work, nurses are showing they can be leaders and innovators – from Sana in Pakistan who is pioneering mental health treatment via telemedicine in the remote North West Frontier region, to Stephan in Ghana who is developing a new platform for remote neurorehabilitation of stroke victims via WhatsApp calls, and Harriet in Uganda, an entrepreneurial nurse-midwife whose organisation has worked tirelessly through the pandemic to support adolescent girls going through pregnancy and childbirth.
As we rebuild health systems after the pandemic, there is much to be done and none of it can be done without nurses. Nurses need to continue to embrace leadership and shatter negative and disempowering stereotypes and conditions that constrain their profession everywhere. But they cannot do it alone. Governments that want to see health improvements reaching every part of their populations – with all the benefits that will bring – need to invest in nursing and enable nurses to work to their full potential.
This means recognising the key role that nurses can play in both designing and delivering services for populations – and creating opportunities for nurse-led care, particularly for non-communicable diseases and in primary and community healthcare.
Nurse leaders must be part of all policy formulation, planning and management boards so they can bring their perspectives and experience to play in health decision-making. As the pandemic has highlighted so acutely, governments must ensure nurses have decent working conditions, appropriate education and regulation, and adequate funding for education and employment, if they are to continue to recruit and retain them.
Nurses are giving us so much: we must ensure they are supported, respected, protected, motivated and equipped to safely and optimally contribute to their full potential.