Improve health globally – by strengthening the role of nurses

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Thursday, 10 May 2018

Lord Nigel Crisp is the Co-chair of the Nursing Now campaign. He was Chief Executive of the NHS in England and Permanent Secretary of the Department of Heath from 2000 to 2006. Follow him on Twitter @lordnigelcrisp.

International Nurses Day (12 May) is a day for celebrating nursing, but it should also be a time to pause for reflection.

We all know the value of nursing – or we think we do. I recently led a study of nursing globally which undertook interviews with nurses from many countries.

One thing struck all the non-nurses on the group very forcibly – nurses told us that they are systematically undervalued and under-utilised. They are very busy and generally hard-working everywhere, of course, but they are all too often, unable to use their education, experience and skills to the full.

Undervalued and under-utilised

They are unable to work to the top of their licence, as the Americans say. We heard of well-trained nurses in India who were unable to take any sort of initiative without instructions from a doctor – they were cast in the role of handmaidens or servants.

And, only last week, I heard in Portugal that nurses in primary care have to have to be instructed – and have forms signed – by doctors before they can carry out any home visits.

The British nurses in our group weren’t at all surprised and explained to the rest of us that nurses were very often “invisible” or “taken for granted”; caring women rather than true professionals. This set of attitudes is simply outdated, if it were ever appropriate, but it is still very commonly seen for example in the questioning of whether nurses should have degrees.

A visit to any UK hospital will show just how out of date and foolish this is. We have come a long way in the UK in the last 30 years and now have specialist nurses of every sort (breast care nurses, wound care nurses, cardiac nurses) and nurse practitioners in primary care and A and E and many others who can prescribe and treat very many of the health problems we have.

Triple impact

As importantly, nurses on the wards and in primary care who don’t have these titles are daily undertaking very sophisticated care of their patients. The review was undertaken by the All Party Parliamentary Group on Global Health and its findings published in the report Triple Impact

It concluded that one of the biggest things to be done to improve health globally was to strengthen the role that nurses and midwives play. It also concluded that strengthening nursing would have the triple impact of improving health, promoting gender equity, and strengthening local economies – three of the Sustainable Development Goals.

We can all speculate about the reasons for undervaluing nurses as being about the role of women in society and the hegemony of the medical profession, for example, and that this is reinforced by history. The important point here, however, is that this undervaluing of nursing – and the related profession of midwifery, which has its own history and challenges – is an extraordinary waste of commitment and talent as well as precious resources.

Nurses well-placed to tackle NCDs

There are more than 20 million qualified nurses globally and they make up half the world’s health workforce. Put crudely, a 1% increase in the effectiveness of nurses equates to 200,000 more nurses.

The Group noted that nurses are also particularly well placed to tackle the growing global epidemic of non-communicable diseases and the increases in co-morbidities in ageing populations. Nurses are person-centred, and their philosophy and practice takes a holistic or bio-psycho-social-environmental approach to health – rather than simply a more reductionist bio-medical one. They are also attuned to the needs for promotion of health, prevention of diseases, increases in health literacy and early detection of diseases.

It seemed to us that nurses would play an even more important role in the future for a wide variety of reasons including the changing pattern of disease, economic considerations and the improving status of women in most countries of the world.

Armed with our findings, we tried to persuade the WHO, the UK Government, the Commonwealth and anyone who would listen that they should do something about this. They were all polite but none of them were prepared to change their priorities.

Nursing Now 

As a result, we decided to launch a global campaign, Nursing Now, to try to bring about change.

The campaign is run in collaboration with the International Council of Nursing (ICN) and the WHO and is fully global with people from 16 countries on its Board.

Its aim is “to improve health and healthcare globally by raising the status and profile of nursing, demonstrating what more can be achieved by enabling nurses to maximise their contribution to achieving universal health coverage.”

Nursing Now was launched at the end of February in simultaneous ceremonies, linked electronically in five different countries.

Our patron, the Duchess of Cambridge, was in London, the Director General of the WHO in Geneva and there were other leaders in Jordan, South Africa and the US.

Nursing Now groups in 40 countries

It seems that we have caught a tide and that the ideas behind the campaign are spreading virally. Two months later, by the end of April there were already nascent or actual Nursing Now groups in around 40 countries.

Our goal for the campaign which will end in 2020 with the bi-centenary celebrations for Florence Nightingale’s birthday is that we make a step change in nursing – that every country has a Chief Nursing Officer (we now have one for the WHO – an early achievement for the campaign); that nurses are involved in leadership positions around the world where they can bring their perspective and experience to bear on policy and decision-making; that global and national policy makers recognise the strengthened role that nurses can play – and the bigger contribution they can make; that we have better evidence of the impact of nursing; and that there are systematic plans – backed up by investment – to develop nursing to its true potential in countries around the world.

Change at the scale we envisage will take a generation, but we can make a step change in the next three years.

It’s a no-brainer. Join the campaign on the Nursing Now website.

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