2020; Volume 21, No 2, February


Nurses Are in a Unique, Essential Position
To Help Achieve Universal Health Coverage

By Prof. Julia Downing, Member of the Board, IAHPC; and
Chief Executive, International Children’s Palliative Care Network

As a nurse, I am excited that 2020 has been designated the International Year of the Nurse and the Midwife by the World Health Organization. This decision was made at the World Health Assembly in 2019, in honor of the 200th anniversary of the birth of Florence Nightingale.

Prof. Julia Downing

It coincides with the culmination of Nursing Now — a three-year campaign to improve health globally through raising the status of nursing and midwifery. The campaign, which began in 2018 and runs through 2020, was developed in response to the Triple Impact report, which found that as well as improving health globally, empowering nurses contributes to improved gender equality and stronger economies.

The Nursing Now campaign has five core facets.

  1. Ensure that nurses and midwives have a more prominent voice in health policy-making.
  2. Encourage greater investment in the nursing workforce.
  3. Advocate for more nurses in leadership positions.
  4. Encourage research that helps determine where nurses can have the greatest impact.
  5. Share examples of best nursing practice.
A group of Uganda nurses at a training session. Photo courtesy of Julia Downing. Used with permission.

According to the WHO, nurses and midwives account for nearly 50% of the health workforce. Nearly half of all 43.5 million health workers in the world are nurses and midwives. Despite this, at least 50% of countries have fewer than three nurses and midwives per 1,000 population; 25% have less than one per 1,000. Thus, in 2015 the WHO released global strategic directions to strengthen nursing and midwifery, outlining guiding principles and setting objectives; and for implementation at regional, national, and global levels.

State of the World’s Nursing report

At the World Health Assembly in May, the WHO will launch a “State of the World’s Nursing” report, recognizing that nurses and midwives are essential to the achievement of Universal Health Coverage (UHC).

Millions of the most vulnerable people are being left behind. UHC is crucial to ensure that everyone has access to needed health care throughout their lives without financial hardship. Access to palliative care is a vital part of UHC.

Nurses are at the forefront of PC integration

In order to provide palliative care, we need to be working together as a multidisciplinary team: nurses, doctors, clinical officers, social workers, therapists, teachers, etc. However, in this International Year of the Nurse and the Midwife I want to focus on the role that nurses play in the provision and development of palliative care. I believe that nurses are at the forefront of the integration of palliative care into all levels of care so that everyone in need of palliative care has access. Though this goal is a long way off, nurses are in a unique position. They have opportunities to show leadership, diversity, and innovation in shaping palliative care because the role of nurses is multifaceted: it includes clinical care, communication and counselling, health promotion, integration of services, teamwork, training and supervision, cultural sensitivity, advocacy, research, research monitoring and evaluation, leadership, and innovation.

We need to be heard
Nurses looking at guidelines during their training with Dr. Julia Downing. Photo used with permission.

In my work as Chief Executive of the International Children’s Palliative Care Network (ICPCN) and in the many different roles I have had over the past two decades, I have had the privilege of visiting many palliative care programs around the world, speaking with, educating, mentoring, and, hopefully, inspiring nurses to develop their skills, take up the mantle of leadership and innovation, and let their voices be heard. As nurses, we need to be innovative, resourceful, recognize diversities, recognize the valuable roles of team members, and think outside of the box as we try to ensure access to palliative care for all through UHC. Yet in many places, nurses lack opportunities and are unable to have their voices heard.

It’s time to shine a light
on the value of nurses

This year, as International Year of the Nurse and the Midwife, we strive to shine a light on the valuable role of nurses working in palliative care globally. ICPCN, IAHPC, and the Worldwide Hospice Palliative Care Alliance are collaborating on a report of the contribution of nurses to palliative care, highlighting their work, enabling their voices to be heard, and, hopefully, strengthening and empowering them. We will be liaising with regional and national associations to identify nurses who we can profile within the report.

Though we will cannot include every nurse, we hope that a broad representation will enable us to demonstrate their unique and valuable contribution. We plan to launch the report at the World Health Assembly and look forward to sharing it with you all.

I am a nurse and proud to be one, and proud of our contribution to palliative care. I hope that in this International Year of the Nurse and the Midwife the voice of palliative care nurses will be heard, and our contribution to the team both recognized and valued.

Together, let’s celebrate 200 years of nursing — how far we have come, and our determination to achieve even more!

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