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.
Time for action on nursing
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
We have the evidence, we have the experience. Let’s speak truth to power.
Join a global network of nurses and allies in connecting directly with decision makers in the weeks running up to World Health Day on 7th April. This toolkit provides information, resources and ideas to help you plan your lobby activity.
- 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.
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.
- 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.
- 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.
- 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.
Plan your lobby
Step 1: Define the problem and build your case for 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.
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.
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?
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.
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.
Step 2 - Choose the target
Step 2: Choose the target
Who has the power to change? Target analysis is a useful tool to help decide which targets to focus on by identifying the individuals and institutions with the power to achieve change. You can download the Nursing Now Power Analysis template here or identify one of the many tools available online (search power mapping examples).
- Parliamentarians: Elected representatives are there to represent us, regardless of political party, so we need to tell them what we want. Not many people contact their representative - only a handful write letters or arrange to meet them. They can advocate on behalf of your cause by raising your concerns with government ministers or by asking questions in your national assembly or parliament.
- Head of state/government: Making contact with a Prime Minister or President may feel unattainable but be bold and write to them. Your issue may fit with their political agenda or resonate with them personally.
- Ministers of health: The Minister of Health is instrumental in setting the direction of national health care priorities. She or he will have special advisers and officials who can be an essential link who can draw issues to the minister’s attention.
- Directors of national and local health services: They are ultimately responsible for the delivery of health services and workforce.
- Local government and councillors: For local issues seeking the support from within your local system of government might be your best option.
Step 3: Find your allies
- 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
Step 4: Call for change
- 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.
Step 4 contd
Media campaigning: Write to the national or local press, TV and radio and explain your campaign and suggest potential spokespeople. See our toolkit for more tips on working with the media and a template press release.
Social media campaigns: If the person or institution has social media accounts, you and your allies can write them messages and ask questions, which members of the public will be able to see. See our toolkit for sample posts, tiles and hashtags.
Engage champions: Ask your celebrities, experts and elected representatives to champion your cause. Celebrities do not have to be movie stars or singers (though if you know any, that helps!). Traditional, community, faith and business leaders can all help promote your campaign. Ask them to:
- Get the message out via social media.
- Record a short video message or give you a quote that you can use in your campaign materials.
- Write a letter or opinion piece in support of your campaign for publication in newspapers or on news websites
Step 5: Tell us about your Nurses Together campaign
Remember that not all campaigns are successful immediately but you have to start somewhere and you may have to try lots of different approaches before you achieve change.
Think about what worked well, what challenges you faced and what approach you might take next time.
Join Nursing Now for a workshop in April when we would like to hear from you.
State of the World’s Nursing report
National Health Workforce Accounts - SOWN data set
Investing in the Power of Nurse Leadership: What Will it Take?
Labour Market Analysis
Meeting and influencing your MP: a toolkit from the Royal College of Nursing
Click here to download the toolkit.