Commentary on 2020 and 2021, Years of the Nurse and Midwife

From: Meleis, A.I. (2021). Commentary on 2020 and 2021 Years of the Nurse and Midwife. Nursing School of Coimbra (Ed.) Education and Interprofessional Work in Health, (p. 11-15).

In an unprecedented action, WHO declared 2020 the year of the Nurse and Midwife, and indeed it was an incredible year!

The COVID-19 Pandemic ravaged the world, causing many sorrows and much grief. It challenged health care services and health care delivery. But, it also shed an incredible light on the centrality of nurses’ roles in all aspects of the pandemic, from prevention, to diagnosis, to treatment, to healing, to managing the end of life transition. While nurses have always been at the center of health care, and in many ways have always played significant roles in health care, the global visibility and the challenges associated with the uncertainty of a new pandemic highlighted nurses’ caring and healing roles. Nurses’ knowledge, practice, voice, advocacy and caring shined.

Two other aspects of nursing practice became very apparent. One is qualitative and the other is quantitative. The severe shortage of nurses, which has been well known and much discussed, in the face of the heightened needs for expert caring in hospitals and in intensive care units, put a face on these shortages. The second highlighted aspect about nurses was the central roles they played in palliative care and in the end of life process. Due to isolation because of COVID-19 contagiousness, families could not be with patients during end of life care. But nurses were there to virtually connect their patients with families and to provide evidence-based quality care to patients during their last hours. They provided family care as well, which was virtually delivered. Telehealth acquired a different meaning and importance during this pandemic. Bravo nurses!

Policy makers saw firsthand how the shortages of nurses devastated health care delivery systems and how nurses’ expertise in family health and end of life was instrumental to provided care. What nurse leaders have always discussed and highlighted for policy makers became a tangible reality.

WHO made another unprecedented decision - to declare the continuation of the year of the nurse and midwife through 2021. Now it is imperative to take full advantage of the visibility of nurses’ roles and science in global health, as well as the declaration of WHO, to press on toward universal health policies, to insure equitable and quality health care.

Two particular areas that could benefit from the timing, the context and the touch needed for quality care are, first, nurses’ educational opportunities, and second, nurses’ leadership roles in health care policies.

Building on the platform and the goals of Nursing Now recommendations and strategic goals, which are endorsed globally, countries must provide university education for nurses that prepare them to deliver evidence-based models of care. Portugal must promptly move all educational programs for nursing to universities. Countries are expected to insure that nurses are well prepared for leadership roles and that health care policy bodies include nurses’ voices. Nurses should be expected and allowed to work up to their full capacity, and their scope of practice should be congruent with their educational levels. Nurses should be well positioned to influence health care policies globally.

I wish for my Portuguese nursing colleagues a year of leadership marked by actions, beginning with the inclusion of all nursing schools within the halls of universities as full partners and with the appointment of nurses to every policy making body in the country.

The year 2021 should be an action year for nurses who are very well positioned to use nursing knowledge in the development of the best care models and policies that will enhance the quality of care.

References

Meleis, A.I. (2021). Commentary on 2020 and 2021 Years of the Nurse and Midwife. Nursing School of Coimbra (Ed.) Education and Interprofessional Work in Health, (p. 11-15).

Nursing Now: https://www.nursingnow.org/

WHO. (2020). State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership: https://www.who.int/publications/i/item/9789240003279

Momentum of Change: Passion to Make 2020 Action Plans a Reality

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.