Barbara Stilwell, Executive Director, Nursing Now
The publication of the first-ever State of the World’s Nursing Report (SOWN) comes at the worst and the best of times. The worst because everyone’s attention is, quite understandably, on the global COVID-19 pandemic we face. The best because this situation has highlighted the vital role of nurses, without whom, the world would be unable to care for those affected by the outbreak. We hardly need to state the value of nurses at the moment – and yet we must. The data from 191 countries reported in the SOWN report reveals that the world will need an additional 4.6 million nurses by 2030 in order to ensure access to health for all.
We know that recruitment of young people, especially men, into nursing has not grown, nurse migration is a real problem for low-income countries, when their nurses find higher salaries and better prospects, and nurse education faces challenges of too few faculty members, high attrition of students and not enough clinical placements.
How can we change the picture painted in this report? The recommendations of the SOWN report are absolutely clear: to address the looming shortage of nurses in almost every country, governments will have to invest in recruiting and educating more nurses and then keep them in the workforce. These recommendations give some clues as to how policymakers should be thinking of investing and what we as nurses should be advocating for them to do.
The SOWN report takes a labour market approach to analysing the workforce. This is valuable because it shows the points at which there are policy options that might make a difference to the choices that are made about entering nursing.
Modernising nursing education & making it relevant
How can we get more people into the nursing profession? Education has to be attractive and so do job prospects. Firstly, there has to be investment in nursing education that brings it right up to date, using modern learning methods in a curriculum that is relevant to the context of practice, with enough teachers and good clinical placements. Entrants to nursing must be able to see how valuable they will be right from the start. And nursing has to be a career choice for women and men that is clearly ‘grounded in science, technology, teamwork, and health equity’ (State of the World’s Nursing report 2020), rather than the old model of a caring profession suitable mainly for women. Making the educational pathway relevant and dynamic will not only improve recruitment it will also mean that more students will stay in the programme until completion.
Working as a nurse: learning and leading
Once qualified, nurses have a number of choices – work in the public health sector in their own country, work in the private sector, leave their country altogether or leave the nursing profession for something else.
The first step is for governments to invest in job creation so that there are enough opportunities for newly qualified nurses. Moreover, these have to be positions where they will be supervised and able to consolidate their knowledge. This is more than good practice: being able to learn from experience creates masterful practitioners who can become effective clinical leaders. A good leader creates another leader. And the SOWN report reminds us that good leadership is essential in nursing to strengthen the workforce – beginning with young leaders.
Nursing Now has focused on supporting young nurses with two young nurse board members, a programme for young nurses at the World Health Assembly 2019, and the Nightingale Challenge – a programme for nurses and midwives under 35 to learn skills of influential leadership*. Nursing Now has offered young nurses a global platform to advocate for health and their profession, and they have enthusiastically embraced this opportunity to participate, engage, network, learn, coordinate, aspire and build a movement themselves.
To keep nurses in the workforce requires offering decent pay and conditions, and the SOWN report addresses this. A decent salary must be one that is the same for women and men and one that meets basic needs for rent, utilities, and food bills, paid on time. Decent conditions of work include the environment and equipment for practice. Nurses, as with other health workers, need to be safe at work with adequate equipment to do a good job. We have heard much in recent days about personal protective equipment being in short supply, endangering nurses’ and others’ lives as they risk infection. This is a prime example of what needs to change as we strengthen the nursing workforce and look to the future.
Safety at work also includes freedom from discrimination of any form or being bullied or harassed. As the majority of the nursing workforce is female, gender considerations should inform nursing policies. This needs to include gender transformative leadership development opportunities for women in the nursing workforce who are underrepresented in top management positions. Last year, Nursing Now reported on the challenges that women nurses face in leadership. You can access the full report here.
Realising nursing’s potential
The SOWN report is absolutely clear on the potential that nurses offer for achieving universal health coverage if they are enabled and supported to realise that potential. This means investing in education and jobs for nurses – but the kind of education and jobs that are created and how they are supported is critical to recruiting and keeping nurses.
Nursing is a complex science-based profession. If nurses can practice to the top of their license, they can provide safe care in many settings, including at primary care level. Indeed, studies reported in the SOWN report show that nurses can safely provide 80% of primary health care, including health promotion and the management of non-communicable disease.
Regulatory frameworks that include scope of practice, requirements for competency and continuous professional education, as well as systems for verification of qualification, are all essential for every country. However, nursing regulation and legislation is too often neglected. Nurses deserve nothing less and the reward will be nurses leading teams and demonstrating advanced clinical practice in many settings.
Nursing practice – especially advanced nursing practice – will take us into the future. Nurses are perfectly placed to be the world’s health guide, which indeed has been nursing’s model: we walk alongside the people we meet and treat, and help them find the best path for them. Sometimes this involves technical or medical treatment, and sometimes it does not, but it is in the skills to craft person-centered help that nursing has both its art and science. The huge need for care in our global society is pushing a new agenda, but so are nurses, who now more than ever demand to be heard. The SOWN report gives nurses around the world a voice, empowering them with evidence-based data to advocate, and shout louder for the investment and support we have long been asking for.
The future offers hope of greater respect for our profession and – most importantly – better health for the world, but this will not be our reality unless we continue to raise our voices and demand to be heard.
*We want the Nightingale Challenge to be as inclusive and flexible as possible. Employers are free to involve all cohorts of nurses and midwives in their programmes, as well as other groups of health professionals such as doctors and managers. However, these will not count towards the numbers that we collect as part of the Challenge.
