State of the World’s Nursing: investing in education, jobs and leadership

downloadEven before we begin to delve into the immense detail of the document – one thing stands out: nurses make a huge difference wherever they are supported in their practice. Around the globe nurses are impacting on the health and well-being of individuals, communities and populations. Nurses are the largest professional group in health care globally – 27.9 million strong making up almost 59% of the health care workforce.  We matter – a lot!  The WHO, ICN and Nursing Now report provides a wealth of information – pages and pages of data that will take weeks to absorb, but from first glance the following seem particularly important issues to me.

First, there are already a lot of nurses – but we need more. The report identifies the need to add at least 5.9 million nurses to the global workforce. This increase is to meet the evolving health needs of diverse populations and to help progress towards sustainability goals. However, this takes investment and planning. Volume is important but the need to refocus nursing programmes toward primary care and public health is also important. The report makes the point about a necessary joining up between nursing preparation programmes and health system demands but does not shed much light on how this can be achieved. In terms of increasing the workforce the report highlights to ongoing gender differential in nursing – attracting more men is an important aspect of planning for a future workforce.

Second, and linked to the point above is the need for lots more to be done to make nursing an attractive career. Globally the increased workloads, poor staff and growing demands place pressure on nurses. The report stresses the need for workplace health and safety interventions to prevent nursing burnout and attrition. It also makes the point that nurses are often very poorly remunerated for their work – and that this needs to change if we are to grow the profession. This economic issue would also help with the issue of nursing as a migrating workforce. The report recognises we have yet to strike a balance between nurses being able to use their qualification to seek a better life and the dangers of depleting a nursing workforce where it is most needed. We need to be better at retention too.

Third, I was surprised and a little disappointed at the lack of a clear message about the importance of graduate education for nurses. The evidence for the value of this is clear and the report could have been more emphatic about this matter. However, the importance of science-based training and the value of inter-disciplinarily learning in nursing programmes is highlighted. The need for well-designed specialist preparation programmes for nurses is also stressed in the report – developed to recognise the huge value nurse practitioners bring to patient care outcomes. What was conspicuous by its absence in the report is the importance of nurses as researchers and the need to grow the global nursing evidence base. This seems like a missed opportunity to me.

Finally, the report makes a very important statements about nursing leadership. Only by nurses being involved in the highest echelons of government can we ensure that our profession grows and develops safely and securely. It is at the highest levels of health policy decision making that the nursing profession needs to make its mark and ensure the contribution of nursing is recognised and rewarded. This is the key areas for the development of nursing in the next decade. An essential part of this is the necessity to continuing to produce the evidence for the effectiveness of nurse led interventions. We are quite good at this at the individual patient care level – but we need to be far better at demonstrating, with rigour, the differences nurses can make at community and population level. We also need to gather more evidence of how nursing can be linked to other sustainability goals such as environmental health, structural inequality and economic impact. So – more work to do – but this report is a helpful contribution to the development of our profession.

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