Nursing professionals represent over 50% of the health services workforce in the Region of the Americas (1). They form a valuable professional group in order to overcome the existing health inequalities, which affect mainly those populations in vulnerability situation. However, there is a major gap in the availability, distribution and access to qualified, motivated and adequate professionals. The shortage of Nursing professionals jeopardizes the conditions and ability to expand the access to health and universal coverage with equality and quality.

The Nursing workforce distribution in the Region is heterogeneous. There are countries with over 80 nurses per 10,000 inhabitants and others with five professionals per 10,000 inhabitants. In 34.1% of countries, the professional ratio between Nursing-Medical Professional is below one (2). The difficulties to attract professionals to remote and rural areas, as well as the inequalities prevailing in working conditions, will have an impact in the training and access of qualified professionals.

An analysis of education in Nursing in Latin America and the Caribbean shows that there are over 2,500 Nursing Schools; Brazil stands out as the country with the highest number of schools. The study programs, overall, have incorporated the principles and values of Universal Health and Primary Care; however, post-graduate training should be encouraged: master and doctorate degrees, mainly among professors in the Nursing Schools (3).

There are 51 Nursing Doctorate Degree Programs in Latin America and the Caribbean, divided into countries as follows: Argentina (2), Brazil (37); Colombia (2); Chile (2); Cuba (1); Jamaica (1); Mexico (2); Panama (1); Peru (1); Puerto Rico (1) and Venezuela (1). The “Doctorate Training in Nursing” document by the PAHO/WHO shows that 29% of the doctorate programs in the region have been created from one to five years ago (4).

Other challenges to strengthen Nursing include: an improvement in working conditions, acknowledging and providing incentives to the professional, applying regulations, retaining specialist professionals, and increasing their leadership and influence upon national and international policies. In this setting, the Pan American Health Organization (PAHO) presented in 2019 “The strategic guidance for the advancement and strengthening of nursing in health systems and services”, with three lines of action: strengthening and consolidating leadership and strategic management of nursing in the context of health systems and in policy-making and monitoring; addressing the working conditions and capacities of nurses to expand access and coverage with equity and quality; and improving the quality of nursing education to respond to the needs of health systems (1).

In order to promote the profession at world level, the Nursing Now Campaign, initiated on February, 2018 by the English Parliament, in collaboration with the World Health Organization (WHO) and the International Council of Nurses (ICN), has become a great social movement, with the creation of an active network of national groups working, from their potential, in order to influence international and national policies.

The campaign is focused on ensuring that nurses and midwives will have a more leading voice regarding the creation of health policies; to encourage a higher investment in the work force; to advocate for more nurses in leadership positions; to encourage research and to share examples of better practices in Nursing.

Countries have been developing different activities. In Brazil, the campaign included the publication of reports on Nursing certification programs, work environment, and training for nurse managers in order to change the operational practice (5).

In the United States of America, the campaign includes local groups throughout the country, and it addresses key issues such as violence in the workplace, pay equity, staff shortage, and barriers to expand the setting of practice (6).

In Canada, the campaign management has granted the Ontario Award to a registered nurse, a registered practice nurse, and a nurse practitioner, for their contributions to the practice, health policy, and the health and wellbeing of inhabitants (7).
In Mexico, one of the campaign topics was to train nurses for advanced practice at Primary Care; and studies will be conducted for decision making regarding human resources programs (8).

In Peru, Nursing Now invited all nurses to participate in the “First Award for Innovation in Nursing”, with the aim to stimulate and promote innovative practices, encouraging development and technology for health (9).

Colombia has set up academic events and conferences, and Argentina has developed activities such as workshops, series of lectures, training in innovation, leadership, and scheduling monthly activities (10,11).

Uruguay has established multiple activities and actions for awareness and information about the profession, in different places. One of these actions was an invitation to present projects conducted by nurses and their teams in order to acknowledge leadership and innovation, from training and healthcare (12).
 
Trinidad and Tobago promoted awareness in nursing professionals regarding safety, both for the patient and the professional (13).

In the World Health Day, 2020, the WHO launched the report “State of the World’s Nursing”, which requests investment in education, occupation and leadership. However, the year 2020 will be already marked in history by the COVID-19 pandemics, which currently represents a challenge and requires an extra workforce in terms of human resources for health, at all levels of care.

The Nursing Now Campaign, with the collaboration efforts by the WHO and its regional offices and the ICN, has created awareness among the population, government authorities and professionals; and it is expected that the Health, Education and Labour Ministries, together with universities and professional guilds, can define jointly the future roads for Nursing now and forever. To invest in Nursing and Midwifery and strengthen them means providing the population with professionals who have updated technical and scientific skills, who are motivated, qualified, well distributed and acting within interprofessional teams. Without the investment required in education and labour market, it will be very difficult for countries to reach the Sustainable Development Goals and Universal Health.