Nurses Together

Join us in a global public lobby throughout March aimed at making an evidence-based call for investment in nursing to ministries of health and finance, elected representatives, decision-makers and budget holders.

Nurses have a unique role in keeping the world healthy and we have reached a critical moment when it is vital that we address the global shortfall of 5.9 million nurses by investing in the recruitment, education, decent work and leadership.

Evidence from the State of the World’s Nursing report and from lived experiences tell us what is needed - let’s use this to shape consensus around priorities and for informed discussion with decision-makers. Together we have a once in a generation opportunity to shape the health of the public for decades to come.

"It is time for nurses and our allies to unite in a call for governments everywhere to invest in nursing. Action is needed now to rebuild and strengthen health systems, and deliver health for everyone, everywhere.

The world’s indebtedness to these workers should now be turned into national, regional and global actions: countries, professional associations and all relevant stakeholders working together in 2021 to protect and invest in the health and care workforce."

Jim Campbell & Fahrettin Koca, WHO Bulletin of the World Health Organization 2021;99:2

Click to read the bulletin 

Nurses are powerful and credible advocates because they are:

• Critical to the achievement of universal health care targets
• On the frontline of healthcare
• Look at health holistically, and
• Treat patients at every stage of life.

Nurses, as essential members of multidisciplinary teams, provide high quality, patient-centred health care. An investment in and support for nursing leads to a system-wide transformation in the delivery of health care and is the most cost effective way for countries to improve health, promote gender equality and support economic growth.

As a result of our united advocacy efforts, our objective is for governments and health leaders to prioritise nursing through policy change and commitments to strengthen working conditions, education, practice and leadership of nursing. And at the very heart of everything we do is our focus on improving health for everyone, everywhere.

Here are three reasons why now is a unique opportunity to get nursing onto the agenda of decision makers:

1. The period running up to the World Health Day on 7th April is an opportunity to influence decision makers, ahead of the World Health Assembly when countries will be focused on the future of health systems.
   
   
2. The evidence and recommendations from the State of the World’s Nursing report combined with the development by the WHO of the Strategic Directions for Nursing and Midwifery will help us to shape an advocacy agenda that you can use to influence decision makers.
   
   
3. The COVID-19 pandemic has shown us how essential is nursing care; providing complex clinical skills delivered with empathy and comfort during these terrible times. It is critical that we share our story and the lessons learnt from the pandemic.

What is the challenge or issue that you want to address and what needs to change?

A good place to start is with the draft WHO Strategic Directions on Nursing and Midwifery (SDNM) which shares policy options that reflect the most effective evidence based health workforce strengthening approaches. These policy approaches should enable midwives and nurses to contribute fully to implementing national health goals, such as primary health care for Universal Health Coverage (UHC), battling the COVID-19 pandemic and rebuilding a strong health system afterwards. Other issues addressed in SDNM include mitigating the health effects of climate change, managing international migration, and ensuring access to health care in rural and remote areas or small island developing states. Nurses and midwives remain central to delivering health care services to everyone, everywhere.

The State of the World’s Nursing report (SOWN) developed by the WHO in partnership with the International Council of Nurses (ICN) and Nursing Now provides much-needed data and evidence behind calls to strengthen nursing leadership, advance nursing practice and educate the nursing workforce for the future.

The SOWN and the SDNM both use a theory of change which progresses along an arc of gathering and analysing data, then getting stakeholders together to look at results, and that discussion informing decision making. This is where nurses and midwives have to be - in these discussions - even to convene the meetings through the Chief Nursing Officer (CNO) or Professional Association (PA), or both. The more you know about what data is available in your country, where it is held and how often it is collected, the better your advocacy arguments will be.

The SOWN report published in 2020 shows that there is a shortage of at least 5.9 million nurses - prior to the global Covid 19 pandemic. ICN has projected that this shortage could just about double if the nursing workforce shrinks as predicted, with disillusioned nurses leaving for other careers. The shortage is overwhelmingly (89%) in low and lower-middle income countries.

Nurses migrate frequently to seek work and are most likely to go from low to higher income countries. While retention of nurses and midwives is a problem everywhere, it is especially difficult in rural and remote areas and other low income settings.

What is the situation in your country? How can you present this information to policy makers and politicians so that they take notice?

The SDNM suggests a nursing and midwifery workforce analysis that takes a labour market approach see here. 

Do you know how to get this information for your country or even your locality? Look in the State of the World’s Nursing data set at WHO to see data from your country - see here.

Jobs have to be funded so recruiting and retaining nurses has to be high on the management agenda. You can help to get it there by making data based arguments for posts and ensuring that every post is funded. In some settings unemployment and vacancies exist side by side because not all posts are funded.

The curriculum that prepares nurses and midwives has to keep pace with health developments, demography, technology and epidemiology. Nursing and midwifery curricula must be quality controlled for content and level. The SOWN and SOWN found wide variation in the quality and levels of education with some being competency based and some not.

Ensuring quality in nurse education remains a challenge.

• Do you know when the curricula in your country was last reviewed and amended?
• Do you understand how quality is maintained?
• Do you teach students and if so, what is your liaison like with the academic teaching staff? 
• There is now good evidence that nurses educated to degree level deliver care that is more effective: what level is education in your country?
• Do you have advanced education tracks for midwives and nurses?
  
  With an advanced education midwives and nurses can take on wider roles and greater responsibilities in health systems. Advanced education should ideally be part of a career track so that nurses can progress not only to senior management roles, but also senior clinical, research, and teaching roles in clinical and academic settings. 
• What do you know about advanced nursing and midwifery roles in your country? 
• Where are there gaps that well educated advanced nurse practitioners could fill?

Finally, take a look at how the number of places in education is calculated every year for your country. Is it based on a labour market approach so that enough nurses and midwives are produced to compensate for attrition (those leaving the workforce for whatever reason) every year?

While women comprise 70% of the global health workforce, 89% of the nursing workforce, and the majority of the midwifery workforce, they hold only 25% senior management roles in health organizations. Nursing and midwifery leadership is critical in health care, because without it nurses and midwives will find it difficult to influence policy, especially policy that supports their professions.

The SOWN found that around 70% of countries reported a national-level senior government position for nursing, and where there was a senior nurse regulation of nursing practice and working conditions were improved. But the senior positions have to be accompanied by staff and budgetary discretion otherwise the senior nurse is not able to carry out a programme of work. An ICN survey found that few senior nurses had authority to influence or advise at a strategic level.  
Advocating to increase the senior leadership positions for midwives and nurses is important. Including leadership training in pre-service and continuing education means that nurses learn how to be influencers in health care both within and outside nursing and midwifery.

Opportunities should be inclusive of gender identity, race, age and ethnicity. These opportunities need funds to be made available for both pre-service and in-service education, as well as a variety of innovative approaches such as coaching, mentoring and distance learning.

Evidence shared in SOWN and SDNM shows that nurses and midwives can safely provide a range of care with appropriate education. But that education has to be available, of a high quality and practice has to be regulated so that all nurses and midwives can practice to the limit of their skills and knowledge. This isn’t always the case, with nurses and midwives often asked to take on tasks and roles that are not within their scope of practice. While ad hoc training may be provided, the role expansion and change needs also to be regulated so that patients are protected.

Know who your regulators are and what they do and seek to influence them so that regulation systems are modernized. All nurses and midwives should have to periodically re-register with a portfolio of continuing education to support their reregistration. Is this happening in your country?

When you are looking for advocacy opportunities, don’t forget to look inside nursing too.

Adapt and amend these messages to suit your local, country or regional context by adding specific examples, data or stories and local facts and figures that bring the issues to life in ways that are relevant to you.

Consider other stakeholders that can influence your target decision maker:

• National Nursing Associations, nursing alliances and networks
  
  
• Other professionals

• Health centre and hospital management

• Patients and patient advocacy groups

• Local government officials

• Civil society eg. national and local NGOs, alliances and community groups

• Experts and influencers eg respected academics and leaders

• Traditional and community leaders

The more allies you have the more likely you are to gain the attention of the person or institution you are trying to influence.

Meet face-to-face: Ask for a virtual or in person meeting. If you have key allies on board, e.g. Chief Nursing Officer, ask them to request the meeting on your behalf.

Meeting checklist:

• Start with what you do, not what you want. Explaining what you do, your expertise and experience, and the impact you make will build your credibility.

• Be clear and concise about what you want to achieve. It’s great to be passionate about an issue but come prepared with recommendations and explain what you would like them to do.

• Think about how what you are asking them to do will ultimately contribute to improving health for all or how it can fit with their priorities or agenda.

• Prepare an elevator pitch - use a combination of data and stories to set out your case.

• Keep calm and carry on - you may disagree with a politician’s approach or response but remain calm so you can explain your concerns and keep the conversation going.

• Follow up with a thank you note that includes a concise summary of your key advocacy messages and remind them why they can make all the difference to tackling the issue.

• If they are happy to take a picture with you, post it on social media. If you have a personal Twitter or Facebook account you can promote the meeting and share your picture. Remember to tag @NursingNow and use #NursesTogether so that others can see.

The State of the World’s Nursing 2020, developed by the World Health Organization in partnership with the International Council of Nurses and Nursing Now, provides an in-depth look at the largest component of the health workforce. Findings identify important gaps in the nursing workforce and priority areas for investment in nursing education, jobs, and leadership to strengthen nursing around the world and improve health for all.

Click here.

Country level information is available online in the SOWN data set which is published on the WHO National Health Workforce Accounts Data Portal. View SOWN country profiles and register to explore health workforce statistics.

Click here.

Women make up 70% of the total health and social care workforce and an even larger share of the nursing and midwifery profession, yet women only comprise 25% of health system leadership roles. This report from Intrahealth, Nursing Now and J&J explores gender-related barriers to nurse leadership.

Click here.

A health labour market analysis provides a useful approach to generating the information needed to help forecast and plan for the health workforce of the future and to guide short term strategies.

Click here.

The Royal College of Nursing represents nurses in the UK. This toolkit is a practical guide to help you advocate for change with your MPs with tips that can be adapted to suit every country context.

Click here to download the toolkit.