With more than 33 million cases and over 1 million lives lost, COVID-19 has devastated health systems and weakened social and economic cohesion on a global scale. It has also sparked deep appreciation for health care workers. Nurses are being seen anew for their unique contributions to population health outcomes.
Predominantly female and accounting for 59% of the global health care workforce, the world’s 28 million nurses deliver the preponderance of primary health service worldwide. Yet despite its humanistic training and scientific expertise, the nursing profession is as poorly understood as it is undervalued.
2020—the WHO-designated Year of the Nurse and the Midwife—was intended to celebrate the lifesaving work of nurses, acknowledge their reputation as the most ethical and honest of professions, and highlight the critical need for millions of additional qualified nurses and midwives globally if universal health coverage is to be achieved by 2030. As the COVID-19 pandemic unfolds, it continues to bring even greater attention to the critical role of nurses across care settings.
Prior to the pandemic, the British Parliament released the 2016 Triple Impact Report based on a decade of global nursing research. It concluded that fundamental changes are needed in the way that nurses are regarded for them to optimize their roles in achieving UHC and the Sustainable Development Goals. The international Nursing Now campaign took up the Triple Impact Report recommendations and called for the following by the end of this year:
- Increased investment in nursing;
- Changes in global policy to enable nurses to practice to the full extent of their licensure and education;
- Strengthened nurse leadership and influence;
- Better evidence of nursing impact on health outcomes;
- Improved ways of sharing effective practice, especially with those who are not nurses.
These goals have been supported by several empirical reports:
- A 2018 Nursing Now survey of 7 countries showed that the public is open to an increase in nurse-led services with over 80% perceiving nurses and physicians as equally valuable.
- In the first-ever State of the World’s Nursing Report, released in April, WHO emphasized the need for substantial investment in nursing education; the creation of at least 6 million new nursing job opportunities by 2030, mostly in low- and middle-income countries; and a robust strengthening of nursing leadership to ensure their active participation in policy and decision-making.
- Around the same time, the International Council of Nurses (ICN)—a federation of over 130 national nursing associations—published the report, Nurses: A Voice to Lead: Nursing the World to Health. The ICN called for safe staffing, the integration of technology to improve health outcomes, increased nursing workforce capacity building, and improved partnerships across disciplines and sectors to move the world toward a proactive state of health versus a reactive state of stressed health systems and communities.
Despite compelling evidence and increased visibility of nurses during the pandemic, nurses are not often seen as spokespersons in public nor are they considered integral to ministerial briefings or scientific advisory groups. Once again, nurses are struggling to be seen, and the impact of their work rendered invisible.
At this pivotal moment, can policymakers and politicians support translation of the previously discussed recommendations into practice? Perhaps it’s more important to ask: Given the need to adapt health services during the COVID-19 response, could our future health care models be nurse-led and nurse-designed to achieve more person-, family-, and community-centered care? Can we collaborate to make this happen and put to rest the limiting and dangerous falsehoods about nursing once and for all?
The world has seen what a pandemic can do—and what nurses can do. Old “certainties” are being shaken to the core. A deep desire for stronger social solidarity has emerged, with a rising clamor of voices for progress. Nursing is a crucial part of that story—during COVID-19 and beyond.
William E. Rosa, PhD, MBE, NP, is a postdoctoral research fellow in Psycho-Oncology at Memorial Sloan Kettering Cancer Center; Sheila Tlou, PhD, MA, RN, is co-chair of Nursing Now and co-chair of the Global HIV Prevention Coalition; and former Minister of Health of Botswana (2004-2008); Barbara Stilwell, PhD, RN, FRCN, is global campaign executive director of Nursing Now; Howard Catton, MA, BScEcon (Hons), RN, is chief executive officer of the International Council of Nurses; and Ann Kurth, PhD, CNM, MPH, is dean and the Linda Lorimer Professor of the Yale School of Nursing.
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