The healthcare system in Turkey offers Universal Health Insurance, and this system ensures equal, accessible and effective health services for all individuals regardless of their economic status. Having an adequate number of competent health professionals is necessary for a society that wants to enjoy safe and quality healthcare services. Filling most of the ranks in the healthcare army, nurses are the backbone of service delivery in the healthcare sector.

In this context and within the Nursing Now Campaign, the World Health Organization (WHO) and the International Council of Nurses (ICN) have published this year the State of the World’s Nursing 2020 report in 191 countries, including Turkey. Coinciding with the WHO’s International Year of the Nurse and Midwife, the report highlights the need to empower nurses in order to make them more efficient in achieving the health goals for the 21st century. To this end, the report calls all governments and stakeholders to create new nursing jobs to offset projected shortages; to strengthen nurse leadership in order to ensure that nurses have an influential role in decision-making, and to improve nursing education by investing in graduate-level nursing education (1,2).

While the report stresses the importance of graduate-level nursing education, nursing education has been offered at various levels through health vocational schools, two-year associate degrees and 4-year graduate degrees in Turkey until 1996. Nursing education was strictly graduate-level between 1996 and 2007, when Turkey re-introduced high school-level nursing education in order to meet the demand for nurses in the country. In 2014, high school-level nursing departments were adapted in order to assist nursing programmes, after which nursing education started to be offered once again only at bachelor’s level (3).

Moreover, while it is reported that a larger nursing workforce should be created to meet the demand for 5.9 million nurses on a global scale, Turkey is falling behind many countries with 2 nurses per 1000 individuals. Although the need for nurses in Turkey has become more drastic during the COVID-19 pandemic, we still have thousands of nurses waiting for their placements and job assignments. In this pandemic crisis, and coinciding with the International Year of the Nurse, the entire world has seen clearly the indispensability of the nursing profession and the need for well-educated, qualified and experienced nurses; that countries cannot possibly win the war against epidemics without nurses and cannot reach Sustainable Development Goals; the importance of having dynamic, adaptable and flexible national health systems; and the indispensability of nurses as key health professionals in keeping the world healthy (1,2).

In Turkey, nurses have been at the forefront of the war against COVID-19 and have become the building blocks keeping the health system functional. Despite the inadequate number of nurses, all our colleagues continue to do their jobs under difficult and stressful conditions in order to maintain the highest level of safe and quality nursing care. However, experiences all around the world, including Turkey, have shown that there are problems in finding nurses in the number and quality required to meet the surging demand.

In keeping with the Nursing Now campaign and the International Year of the Nurse, the Turkish Nursing Association (TNA) has accelerated its activities and initiatives oriented to solve the existing problems related to nursing education, execution, management and personnel rights in the sector, make improvements in these areas, have more nurses among policy-makers, decision-makers and in leadership positions, and increase the visibility of the profession. In addition, the TNA has been actively involved in the management of the current pandemic, working at national and international level to overcome the crisis with minimum loss since the announcement of the first COVID-19 case. The TNA has endeavoured to ensure access to scientific and factual information by both the public and health professionals. It has reached out to nurses working throughout the country, with the aim of guiding them about how to perform their jobs while ensuring safe and quality healthcare services for all patients. Moreover, the TNA has kept close track of the COVID-19 pandemic at both national and international level, demonstrating a dynamic approach in its management.

This year, the TNA has focused its efforts on the community, in line with the ICN theme. In the first days of the COVID-19 pandemic, seeing the intense fear and anxiety felt by the public, the TNA reached out to the people, promising “good nursing care” and showing solidarity with slogans like “we will keep on touching you” and “we are with you”; the Association has offered its knowledge, expertise, experience and care to serve the public. The TNA has addressed the public with messages designed to help them manage this crisis with minimum loss; it has aimed to prevent information pollution so that people could access reliable information, and has fought to have a say on various platforms, making its voice heard and promoting the nursing profession. Our association has also met with decision-makers to discuss how we can heal the world and make the voices of nurses and other health professionals heard; it has given interviews to printed and audiovisual media, provided press releases and shared informative letters and statements. Yet, the TNA’s biggest challenge during this crisis has been “increasing the media visibility of nurses”. In line with its active engagement in the Nursing Now campaign and the WHO’s call urging governments “to ensure that nurses have an influential role in health policy formulation and decision-making”, the TNA, for a better management of the pandemic, called for having nurses on decision-making organizations such as regional pandemic boards, and met with decision-makers and policy-makers to this end. Due to the pandemic, many activities of nursing schools, health institutions and professional nursing organizations including the TNA within the scope of the International Year of the Nurse and the Nursing Now campaign, had to be postponed, cancelled, or held as on-line initiatives focusing on COVID-19.

The reports prepared by the TNA in pandemic COVID-19 highlighted the problems regarding public health and safety of patients and health professionals in delivery of health care services. The TNA raised its demands and suggestions, and shared in these reports its vision and solutions with the Ministry of Health and other relevant agencies and organizations, decision and policy makers, and executives. The problems and risks highlighted in these reports included the fear and anxiety taking hold of the entire public, including health professionals; problems in accessing personal protective equipment in adequate numbers, quality and conformity; the intense, challenging working conditions of nurses who have to work long hours; non-standard nurse/patient ratios; lack of appropriate and adequate resting spaces and opportunities; accommodation and travel problems; ambiguities in duties, powers and responsibilities; fear of transmitting COVID-19 to loved ones and members of the public; violence against health professionals; other psychosocial problems such as burnout and child care issues; and problems regarding personnel rights and compensation. Some of these problems have been resolved while some became more severe; some of them became less important in time while some new issues appeared (3).

COVID-19 pandemic has evidenced the critical importance of nurses. At the same time, our experiences have once again demonstrated the necessity of never giving up the fight, of systematically continuing our efforts and initiatives -despite the resistance and challenges we face- so as to have more nurses in leadership positions and ensure that nurses play influential roles in policy and decision making so that they can better demonstrate their critical role in healthcare. The key to success in this struggle is to achieve a common language among all nurses working in the academic, hospital and other sectors, and to act united as one single voice.

As a conclusion, nurses have been fighting in the forefront of this disaster that has visited us in the International Year of the Nurse; and they have successfully managed this pandemic and will continue to do so. However, a big responsibility falls on the shoulders of executives and decision-makers: that nurses fighting against COVID-19, with recognition of how sacred and valuable life is, should not be left alone, damaged, tired, burnt out and lost their hope.