Opinion: The economic power of nursing enhances global resilience
Written by Howard Catton
Chief Executive Officer, International Council of Nurses.
First published in Nursing Times on May 7th 2024
Any country that is serious about meeting the United Nations Sustainable Development Goals and providing Universal Health Coverage needs to realize that it cannot be done without nurses. Nursing is the golden thread that runs through healthcare, but it is not just providing care when you are sick. Nursing is about the prevention of illness, health education, rehabilitation and supporting recovery and independence across the whole life cycle.
Health is a fundamental platform on which people build their lives and become active members of society. And that is why this year’s International Nurses Day theme highlights the benefits of access to nursing and the often-hidden economic power of care.
The value of nurses
Globally there are 28 million nurses working to provide for the majority of the world’s health care needs. In hospitals, higher registered nursing staffing levels are associated with lower mortality among patients, to the extent that increasing registered nursing staff by an hour for each patient per day could reduce the risk of death by 3% [1].
For me, while the hospital is a place of repair, true health comes from our daily behaviours and nurses hold an expertise that goes beyond treatment. Nurses, especially those working in primary healthcare, are integrated and embedded deep into their communities where they work hands-on with those most in need.
For example, infection control nurses in America and Australia are at the forefront of care for homeless people. Their contributions do not stop at the traditional boundaries of health care: instead, they are working with housing departments and employment agencies, going upstream from the problems that the patients manifest, and helping to get them off the streets and into dignified and affordable housing where they can truly regain their health [2].
Innovating to create new models of patient-centered care
By supporting a shift from a hospital-centred model to community-based care, nurses are able to address the root causes of health issues. This means they are well placed to empower people with tools to manage their own health, which helps prevent illness and stop the deterioration of existing conditions. It is in this way that nurses play a crucial role in building health literacy and trust in a population.
We recognize patients as partners and through self-care they have the tools to securely manage their health between checkups. Nurses can then play the role of care coordinator, helping people navigate health and social support systems to access the interventions they need.
Owing to this broader scope, we at the International Council of Nurses have updated our code of ethics for nurses, which outlines the role nurses play in promoting human rights, sharing unbiased information and balancing social injustices by placing patients’ needs first [3].
Barriers to providing appropriate care
What I hope to make clear here is that nursing is multifaceted and helps individuals who are sick, it drives advances in how we deliver healthcare, and in turn it promotes healthier, more stable, happier and wealthier societies.
But its potential to do all this is being undermined by a long-standing global shortage of at least six million nurses, which has been exacerbated by the effects of the COVID-19 pandemic. Alongside individual nurses being ill and burned out by the pandemic, increased international recruitment is widening disparities in the global burden of disease. For instance, while 16% of the world’s population is in the continent of Africa, Africa has 23% of the global disease burden, but only has access to 3% of the nursing workforce [4].
Too often, we hear governments discuss health sector spending as though it is a luxury. But research suggests that investing in health accelerates economic growth, reducing admissions to hospital and the cost of health care. It also allows people with long-term conditions to remain economically active.
The $2.7 trillion lost from the global economy during the pandemic should highlight the repercussions of weak health systems and why we need to direct resources into training, retaining, and replenishing our global nursing workforce [5].
Nursing often comes top of the list of the most trusted professions, and it is this highly trusted status that encourages people to follow the advice that nurses give them [6]. But this trust is built on having sufficient quality time spent understanding patient needs and desired health outcomes, which becomes more difficult if there are staff shortages and health care becomes a mechanical list of procedures.
The power of nursing
The pandemic showed us that economic resilience is built on health security, and that this is only possible through a properly funded and well-staffed nursing sector. Our 10-point Charter for Change highlights how we can reorient health systems to provide proper human care [7]. And our recently released report, with contributions from the OECD and World Bank, highlights the investment case that we want politicians to use to bring forward better policies.
If you take anything away from this International Nurses Day, it is that investing in the economic power of nurses is essential to building universal health coverage and achieving sustainable development for all. It’s to this end that the International Council of Nurses is part of the United for Self-Care Coalition, working collectively with other members to embed self-care in the healthcare continuum.
About the Author
Howard was appointed the Chief Executive Officer of the International Council of Nurses (ICN) in February 2019. He is committed to ensuring that ICN effectively represents nursing worldwide, advances the nursing profession, promotes the wellbeing of nurses and advocates for health in all policies. He believes that nurses should be at the heart of health policy decision making, and leading healthcare systems and delivery.
Throughout his career Howard has worked and written extensively on issues relating to the nursing and health care workforce and he co-chaired the first ever State of the World’s Nursing Report. He led ICN’s work to respond to and support nurses globally during the pandemic and has been at the forefront of advocating for the protection of and investment in the nursing profession.
Howard joined ICN in April 2016 as the Director, Nursing, Policy and Programmes. His team led the development of ICN policy and position statements, working closely with WHO and other International Organisations to provide nursing advice on global health challenges and input into formal WHO and UN decision making meetings and processes. He also co-ordinated ICN Programmes and projects, including Leadership development, and worked closely with other Non-Government Health Organisations, civil society and private sector organisations. Howard also oversaw the development of scientific programmes for ICN events, including its world congresses, which is held every two years.
In December 2019, the Royal College of Surgeons in Ireland appointed Howard as Fellow of the Faculty of Nursing and Midwifery. This Fellowship without examination is granted in exceptional circumstances to nurses who have rendered outstanding service to the profession.
[2] https://www.bbc.com/storyworks/specials/caring-with-courage/
[3] https://www.icn.ch/news/revised-icn-code-ethics-nurses-reflects-lessons-learned-covid-19-pandemic
[6] https://nurse.org/articles/nursing-ranked-most-honest-profession/
[7] https://www.icn.ch/sites/default/files/2023-05/IND_2023_Charter_EN.pdf
