Thursday February 23rd 2017

Nurses at the table: in the United States and around the world

Pamela Cipriano

A few words to the wise—if you are having a discussion about health care, look to your left and to your right. If one (or more) of those individuals is not an RN, there is a serious and inexcusable gap in the conversation. Any conversation about health care without the voice of a nurse is incomplete, and excludes the very advocacy requisite to addressing the health needs and preferences of persons and families.

Nurses around the world are competing to have a voice in health care leadership decisions at local and national policy tables. At the International Council of Nurses conference and the Council of National Nursing Association Representatives meeting in Seoul, South Korea, in June, nurses’ discussions of their efforts to influence their governments, health care organizations and professional societies buzzed in multiple languages.

Opening keynote speaker, Margaret Chan, MD, director-general of the World Health Organization, captured the interest of 7,000 nurses in attendance, when she shared the saying, “A person who saves a life is a hero. A person who saves hundreds of lives is obviously a nurse.” She also got rousing applause when she continued, “That person is likely to be overworked, underpaid and vastly underappreciated, especially at the policymaking level. Yet that person is saving lives, all the same.”

Chan asserted that nurses are pivotal to transforming the way health services are organized and how health care is delivered, including their vast potential to change things for the better as the providers of more cost- and care-effective services. She cited the 2010 Institute of Medicine’s (National Academy of Medicine) Future of Nursing report as reminiscent of a 1986 WHO report that concluded regulatory and institutional barriers were preventing nurses from exercising their full knowledge and skills. Yet, 24 years later, we are still chipping away at the constraints that deny nurses full practice authority.

The United States is not alone in this struggle. Nurses will no longer be placated by the moniker “angels of mercy.” It is true, we relieve suffering and often share the most intimate moments of another’s life or death. But while we cherish the compassion that distinguishes the art of nursing and our exalted status as the most trusted and ethical professionals, we must not ignore the qualities that reflect the depth and breadth of knowledge as well as critical thinking that nurses bring to the table or the point of care. Throughout the ICN meetings, we focused repeatedly on nurses leading change, whether by addressing the determinants of health, or improving the health of women and their children as a path to raise the health of the nation.

Citizens of all countries share universal goals of addressing poverty, nutrition, education, gender equality and employment. At the same time, workforce issues of migration and mobility, socio-economic status and working conditions present similar challenges. To tackle these issues, I participated in a panel moderated by American Nurses Credentialing Center President Michael L. Evans, PhD, RN, NEA-BC, FACHE, FAAN, and presented strategies for nurses to build national-level leadership skills. Joined by ICN President Judith Shamian, PhD, RN, FAAN; Sigma Theta Tau International President Hester Klopper, PhD, MBA, RN, RM, FANSA; WHO Nursing and Midwifery Technical Officer Annette Mwansa Nkowane, MA, BSc Nurs, RN, RM, Cert. Mgt; and ICN Advanced Practice Nursing Network representative Anna Green, MNSc, RN, we emphasized the governance skills, partnerships, human resources
planning and leadership acumen required to achieve the desired future state of nurses leading in reformed health systems to meet population needs.

Without question, the ICN theme, “Global Citizen, Global Nursing” called for global solidarity of the world’s 16 million nurses to advance and improve the coverage and quality of health services, and demonstrate nursing’s contribution to the health of individuals, families and communities. The world can reap the benefits of an engaged nursing workforce with millions of voices advancing the health of nations. Sheila Tlou, PhD, RN, FAAN, the UNAIDS regional director, Eastern and Southern Africa, and former minister of health, Botswana, summed it up nicely when she asserted, “Nurses carry the world in their hands.”

— Pamela F. Cipriano

Coalition to place nurses in leadership roles

The Nurses on Boards Coalition, of which the American Nurses Association, the American Nurses Foundation and the American Academy of Nursing are founding members, together with 19 other national organizations, is working to increase nurses’ presence on corporate and nonprofit health-related boards of directors throughout the country with the goal of having 10,000 nurses on boards by the year 2020. To become involved and learn more, visit

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