2020 will go down in history as a memorable year, and perhaps as a pivotal turning point for nurses and midwives. I believe we must take full advantage of this momentum to achieve what we always wanted to accomplish. I believe we should strive for the following outcomes:
- Ensure quality, equitable care for populations, enabling them to function up to their full capacity.
- Empower nurses and midwives to assume leadership roles in all health care policy decisions.
- Ensure policies allow nurses to work up to their full educational preparation and experiential capacity.
- Create and ensure healthy, safe and protective environments for providers and recipients of care.
There are many important reports and events creating the momentum for change and requiring accountability from governments and health care systems.
- This year, 2020, is declared by WHO as the year for nurses and midwives, a first in WHO history for any profession, and we are in the midst of an unprecedented global campaign - Nursing NOW 2020.
- WHO followed this designation by investing in a first-time global report that focusses on the status of nurses and midwives globally. The report highlights, with data and documentation, the global shortage of nurses, as well as issues and opportunities for equitable health care delivery. It provides a blueprint for the future with 10 major action plans.
- The organization for Women Leaders in Global Health discussed these reports, endorsed them and called for a 5-point action plan.
- And finally, there is the Covid-19 pandemic, which highlights nurses’ vital roles as front and center in prevention and patient care.
There are common themes in all of these events and reports. Among them, and most importantly, is that quality care for all will not happen unless countries deliberately invest in nurses’ education and leadership. Moreover:
- The reports emphasize and highlight what we already know, that nursing is a female dominated profession, based on gendered constructs of caring and compassion, and that because there is global gender inequity, nurses are impacted by inequity as well. Therefore, an investment in nursing is an investment in gender equity.
- The reports urge governments to invest in creating healthy environments for nurses and midwives, environments that are devoid of violence, harassment and bullying. Healthy environments for nurses are healthy environment for patients.
- The action plans call for positioning nurses and midwives in decision-making roles in health care.
I have been a nurse since I graduated 60 years ago. I strongly believe we are at a global turning point with regard to nurses’ status, roles and contributions in health care. We should recognize and celebrate this turning point, but more importantly, we should take advantage of this momentum.
There are three concepts that have guided my own work in nursing - Theory, Equity and Transitions. You may want to reflect on them as you think about how you wish to take advantage of this momentum.
First, Theory. Our nursing discipline has a rich theoretical heritage that helped us define our perspective, our mission and the outcomes we want to achieve from the care we provide. Theories helped in the development of models for self-care, for symptom management, for initiating and maintaining breast-feeding, for prevention of adverse reactions to hospitalizations, for developing healthy environments, among many other models and strategies.
Our rich theoretical heritage gave us the language to define our discipline’s perspective, our social mission and the contract we have with societies, which is to provide equitable care, to enhance the quality of life for patients, families and communities and to ensure they function up to their full capacities.
It is because of the progress we made in defining and advancing nursing knowledge that global organizations such as the WHO, the United Nations, the International Council for Women’s Health Issues, among others, acknowledged and recognized our profession and the centrality of nurses’ roles in universal health care.
This brings me to my second guiding concept, Equity. We know and understand inequity in an embodied way because we suffer from it. We are a female dominated profession (90% of us are women) who suffer from the same gender inequality all women experience. We also experience discipline inequity as a gendered-constructed-discipline based on caring and compassion. Health care systems and the public tend to invest, acknowledge and compensate medicine more than nursing.
We should not tolerate any form of inequity for us as nurses, nor in the care our patients receive. We should deliberately expect to co-create and work in healthy environments that are free from harassment, incivility and bulling, or from any form of violence toward us or toward our patients. We should expect to function in equitable teams, in education, in practice and in research. And, we should enable our colleagues and our students to recognize unhealthy environments and all forms of implicit and explicit inequities and provide them with strategies and the voice to change them. As we know well, equitable teams deliver quality care with better health outcomes, fewer infections, complications and falls, and lead to healthier transitions with fewer re-hospitalizations and better long-term self-care. Students educated in supportive, healthy environments learn better and become more effective nurses.
After all, the health of environments is part of our nursing heritage. Nursing care is about providing the best environment for healing. Healthy environments are civil, respectful, safe and protected from infections, falls and violence.
Because we are at the cusp of major transitions, this brings me to my third guiding concept. Changes trigger processes of transition. Transitions are internal processes that lead to transformation and identity changes. We nurses understand change and transitions well because nurses are always facilitating the transitions patients and families experience as they move into and out of hospitals, into and out of ICU’s, into managing and living with chronic illness, into learning and mastering self-care and into managing disasters and adverse events.
It is because of nurses’ central role in managing changes for patients that, with my colleagues, we developed Transitions Theory, which helps in understanding the processes people go through when they encounter changes and identify the conditions that empower and enable the implementation of those changes.
During this time of pivotal change, accompanied by the momentum of major global recommendations and reports and the world’s focus on nursing, nurses should be empowered to use their voices to advocate for equity in enhancing the valuation of nurses, in creating healthy and caring work environments, in ensuring diversity and inclusiveness and in speaking out against all forms of “isms” affecting the health of populations. We want to see the recommendations in these timely reports taken seriously and implemented.
We have a momentum that we must take advantage of and I believe Theory, Equity and Transitions provide us with the reminders to have a voice to pivot during these troubling times. Each one of us has a role and a voice and can strengthen the fragile systems in our societies. It is up to you, to me, individually and collectively, to ensure the recommendations and action plans are not wasted.
We should pause, reflect and question ourselves about the ways we can use our voices to ensure our nursing perspective and our mission for equitable care is included in all health care decisions, and that we continue to maintain our strong passion to see the actions in these significant reports implemented and sustained.
