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A new “strategic toolkit” has been launched laying out the actions that are needed globally to ensure the nursing workforce is properly invested in and that nurses’ safety, health and wellbeing are prioritised.

The International Council of Nurses (ICN) has today published a new report outlining its key concerns for the nursing profession, alongside several measures it believes are needed to help support and grow the workforce around the world.

The 60-page document marks International Nurses’ Day, held annually on Florence Nightingale’s birthday and led by the ICN, to celebrate the profession across the globe.

Every year it carries a theme and this year it is: “Nurses: A Voice to Lead – Invest in nursing and respect rights to secure global health”.

The ICN said its latest report should act as a “strategic toolkit” to help countries implement the World Health Organization’s (WHO) Global Strategic Directions for Nursing and Midwifery, covering education, jobs, leadership and service delivery.

As reported previously, the WHO’s global strategy for nursing aims to “empower” the world’s nurses and was adopted by its governing body, the World Health Assembly, last June.

The ICN’s new report outlines key actions for governments, professional bodies and health services to take to ensure this global strategy and its policies are properly enacted across the world.

In terms of nurse education, the ICN urged governments to “plan and invest in growing the domestic production of nurses to meet the health system demand” and to “establish standards for continuing professional development and [monitor] it”.

Meanwhile, health service providers were also asked to “invest in the continuing education of nurses” and “foster supportive environments that enable nurses to pursue education opportunities”.

Underinvestment in nursing education had contributed to the ICN’s estimated nursing shortfall of 13 million nurses around the world, noted the report.

It also warned that as a result of “insufficient domestic supply of nurses, many high-income countries are reliant on internationally educated nurses to fill their workforce gaps”.

The report, which was informed by the WHO’s State of the World’s Nursing report from 2020, also highlighted the need to invest in nursing jobs to ensure “a sufficient number and proper skill mix of nurses” and to help meet the “changing health needs and rising expectations of individuals and communities”.

The ICN raised concerns that “80% of nurses report that they are over-skilled for the roles they are performing”, according to research from 2016.

In addition, it flagged issues around an increased number of nurses who had either left or intended to leave the profession because of “heavy workloads” and “insufficient resourcing” experienced during the coronavirus pandemic.

“Governments should be urgently prioritising investment in nursing and the health workforce”

Howard Catton

As part of its calls to action, the report demanded that health service providers ensured a “safe working environment and better working conditions” for staff and that nurses felt properly recognised, rewarded and remunerated for their work.

The report also called on key stakeholders, including governments, to develop and fund nursing workforce plans and policies to support safe staffing, and to take action to improve nurse retention.

In terms of nurse leadership, the ICN goes on to highlight how nurses are “significantly underrepresented in global and national health leadership roles”.

A 2021 survey carried out by the ICN showed how one in four national nursing associations believed senior nurse leaders had “not been involved in high level decision making during the pandemic”.

Concerningly, it added that while women form 70% of the global health workforce, just 25% have leadership roles.

To address these issues, the ICN once again stressed the need for the recruitment of chief nurses across all countries who sit within government and the need for nurses to be involved in “policy development and political engagement”.

Health service providers were also urged to “create an environment whose organisational culture values nursing leadership” and to “support leadership programmes for nurses”.

Meanwhile, the report claimed that regulatory systems “often prevent nurses working to their full scope of practice” and also suggested “thousands of lives could have been saved with adequate levels of staffing and skill mix”.

Governments across the globe were therefore asked to “remove regulatory barriers” and “adopt systems and processes that ensure safe staffing and manageable workloads”.

In addition to the WHO’s global policies, the report also focussed on two other priorities, devised by the ICN, around investing in and prioritising the safety of nurses and caring for their health and wellbeing.

Research highlighted within the report suggested that nurses and physicians are “16 times more likely to experience violence in the workplace as compared to other service workers”.

The high numbers of health workers who died to Covid-19 was also flagged by the ICN which pointed to research suggesting that “while health workers represent less than 3% of the global population, they represented around 14% of Covid-19 cases”.

The issue of nurse mental health was also raised, as the report warned that post-traumatic stress disorder, depression and anxiety was more common among nurses that the general population even before the pandemic.

Nursing Times continues to run its Covid-19: Are You OK? campaign to highlight the mental health needs of nursing staff.

Among its recommendations, the ICN highlighted the need to invest in “training, tools and resources for a safer healthcare workforce” and for staff safety and wellbeing to be protected through measures such as “zero tolerance to violence” policies.

The ICN said investing in safe staffing would also improve nurse wellbeing and that action should be taken to ensure staff have adequate breaks, access to online support services and that they felt recognised and celebrated for the work they do.

ICN president Dr Pamela Cipriano said: “We need to move on from the talk and see action to support our nurses – and that is exactly what ICN’s [International Nurses’ Day] toolkit provides.”

Howard Catton

Meanwhile, ICN chief executive Howard Catton added: “The scale of the world-wide nursing shortage is one of the greatest threats to health globally, but governments are not giving it the attention it deserves.

“Access to healthcare is central to safe, secure, economically successful and equitable societies, but it cannot be achieved unless there are enough nurses to provide the care needed.

“Governments should be urgently prioritising investment in nursing and the health workforce on that basis and proportionate to its importance for the future of societies everywhere.”

Responding to the report, a Department of Health and Social Care spokesperson said: “We are grateful to nurses for their tireless work during the pandemic and are committed to supporting them.”

They claimed there were “record numbers of nurses working in the NHS” and that the government was more than halfway towards meeting its commitment for 50,000 more nurses in England by 2024.

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