How to quote
Stilwell B. Nursing Rising. Metas Enferm dic 2020/ene 2021; 23(10):3-6. Doi: https://doi.org/10.35667/MetasEnf.2020.23.1003081681
PhD, MSc, BSocSc, RN, FRCN. Directora Ejecutiva de la Campaña Mundial Nursing Now (Enfermería Ahora).
Contact email: email@example.com
Versión en Español
Let me start by saying thank you. Thank you to all the nurses who are turning up every day, continuing to work with not enough equipment, and taking the time to show you care. In Spain you continue to have an especially tough time in this pandemic and nurses - and all health workers - have responded. The world will never see nurses in the same way again. This terrible pandemic has shown all of us how essential is nursing care, offering as it does sophisticated clinical skills, delivered with empathy, and perhaps most important of all at this time – comfort, in times of physical and mental pain.
In many countries, the public have shown their appreciation for all that nurses have done by applauding them. In England, nurses have been recognised as ‘superheroes’ along with other health workers. For the first three months of the pandemic applause and adulation were an encouraging recognition of what health workers were doing to deal with the COVID-19 pandemic. But we are now into month 9 of this crisis. The health workforce is exhausted. Where do we go from here? What have we learned that will help us to build back a resilient, cost-effective workforce?
We have been listening at the Nursing Now campaign to what nurses around the world are telling us. We have grown in the almost three years since we began to have a presence in 127 countries (and still growing). We have over 700 groups around the world, each of them with activities in their own context that will raise the status and profile of nurses. We launched the Nightingale Challenge in 2019 and now have over 30000 young nurses signed up by 700 employers to develop their leadership skills. We have tens of thousands of nurses following us on social media platforms. This is truly a social movement: there is a vibrancy in nursing around the world that is rising and preparing to tell a new story of nursing.
But nurses tell us that it is hard for them to be heard when it comes to making health policy. They are often excluded at the highest levels. Women in nursing are still promoted less frequently than men and women tend not to make it to the highest management levels (1). Does this matter? It matters because women’s voices are often not heard and because most nurses are women, the nursing voice is not heard.
If nursing is to raise its profile and status globally, nurses have to become more strategic and astute at speaking to power at the highest levels. We will never have a better moment than now, so what should we be saying?
The State of the World’s Nursing
For the first time ever, in 2020, the World Health Organization, with the International Council for Nurses and Nursing Now, published a report on the state of the world’s nursing. This is an important milestone for nurses everywhere. It gives us data about how many nurses there are in the world, their education and leadership, and their work. Nurses everywhere should be reading this report because it will direct us to what we should be asking our Ministries of Health to invest in for nursing. This important report should be read and digested by nurses everywhere because its recommendations give us a structure for our new narratives on nursing. Below are three key areas for focus.
Firstly - and of huge importance – there are not enough nurses and that shortage will get far worse in the next decades. Nurses constitute 59% of the health professions in the global workforce and by 2030 there will be a shortage of 6 million nurses in that workforce. Without nurses, the world will simply not be able to achieve its health goals, including universal health coverage and the sustainable development goals.
A recent Financial Times article reported on the chronic shortage of nurses in Spain. This report estimated that there are 5.9 nurses per 1000 people in Spain compared with the EU average of 9.30. The article blamed Spain’s lack of nurses on chronic underinvestment in the profession which and resulted in temporary contracts, low pay and a heavier reliance on medical doctors (2). In Spain, as in many other countries, these conditions lead nurses to migrate and while the recipient countries benefit, the donor countries are left with a serious workforce issue.
In its recommendations the State of the World’s Nursing calls for increased investment in the education and employment of nurses and clearly this is required. But as we see from Spain, we also need better conditions of work, with good pay and security and a career ladder that keeps nurses both in their profession and in their country. Migration out of nursing must not be ignored; it must be managed, which means looking at why the health system does not retain nurses. Retention is about making nurses feel noticed and valued for the work that they do beyond the applause.
Secondly, countries have to invest in nurse leadership and governance. There must be a senior nurse at government level – preferably a chief nurse with a budget and staff. The State of the World’s Nursing report showed that in countries where there is a functional chief nurse there are more leadership opportunities for nurses in the health system. Nurses should be considered with other health professions for appointment to leadership positions. Young nurses should be mentored, coached and trained to become leaders at an early stage of their career so that they learn to be confident speaking out and advocating for their profession as well as their patients.
Thirdly, nurses everywhere have to find ways to articulating their value to policy makers and politicians. We are all expert at talking to each other but we need to be much better at explaining what we do to both the public and to those with power. There is a rich seam of research that underpins nursing practice – perhaps more than any other profession. And yet nursing as a science is in many places still seen as an adjunct to medicine (3) rather than a distinct professional body of knowledge.
It is time to perfect our elevator speech so that we can explain why nursing is a best buy in health care in a compelling way that influences those who have the budgets and power. Let’s use the data available and link outcomes of care to our education and profession.
Nursing Now’s goal has been to improve health care by raising the status and profile of nurses around the world. We are at a critical point in our journey. There cannot be a more important moment for nurses to raise their status and profile – and to claim the ‘superhero’ image as their own. Without nurses it will simply be impossible to build the health workforce that the world needs, and it will not be possible to recover from the effects of this pandemic.
Next year Nursing Now will be ending, but not before we have one final huge push to get our nursing manifestos to ministries of health everywhere. We need to have evidence based requests for investment and action. The data is readily available in the State of the World’s Nursing report, but we need to use it and apply it to our own situation.
In Spain you have seen the value of your nurses and you can see, too, that you need more of them. They must be included in all health policy making and be able to have a career that acknowledges their skills. We hope that you will join us for a parliamentary lobby in 2021, data at the ready, so that you can begin to tell a new story of nursing in Spain – one in which nurses are the star players and not only the supporting cast.
1. World Health Organization (WHO). Delivered by women, led by men: A gender and equity analysis of the global health and social workforce. Human Resources for Health Observer Series No. 24. Geneva: WHO; 2019.
2. Financial Times. Spain seeks to tempt back lost nurses as it wrestles with virus [internet]. [cited 8 nov 2020]. Available at: https://www.ft.com/content/b8ad72b7-ad7f-4846-9795-89cd7437852a
3. Salvage J, Stilwell B. Breaking the silence: a new story of nursing. J. Clin. Nurs. 2018; 27(7-8):1301-03.