Message to Nurses Globally for the International Day for Nurses and Midwives

Dear nurses and midwives across the globe,

I salute you and applaud you during this special month in which you, we, are acknowledged and celebrated.

To continue to move forward and upward we must pause to acknowledge our history and the leaders who carried us on their shoulders. Among them are Rufaida Al Islamiyah, Florence Nightingale, as well as the more contemporary ones around the world who amplified our discipline’s mission and brought us to this point where the whole world is thinking and celebrating nurses. They knew exactly what our mission was: alleviating suffering of patients and their families, uncovering illness experiences, caring, comforting and facilitating transitions, promoting self-care, enhancing wellness, managing and coordinating care, as well as empowering themselves (and us) to function up to their, and our, fullest capacities.

But it took years and perhaps decades for our healthcare colleagues, for organizations and for populations to recognize and acknowledge our centrality in healthcare teams and systems, and to value our roles in quality care, and to position and compensate us appropriately and equally.

As we look forward, we must continue to have a strong collective voice, to advance nursing knowledge through careful research and theory building and to develop the most effective models of care that ensure the quality care that we, as professionals, strive for. We must also continue to insist on providing the highest levels of education that prepares graduates who are innovative, collaborative leaders and policy makers.

Sixty years ago, I made one of the best decisions of my life, to become a nurse. Every year since has added to my pride and passion for nursing and midwifery. Over the years I traveled to different parts of the world and I met and saw nurses in action, which added to my extreme pride for our discipline and how it impacts populations’ health globally.

Happy Nurses and Midwives Day, every day of the year!

Afaf Ibrahim Meleis, PhD, FAAN, LL
Professor of Nursing and Sociology
Dean Emerita, School of Nursing, University of Pennsylvania

A Reluctant Leader: Reflections on My Leadership Roles

The question about what career accomplishments I am most proud of makes me reflect on the answer I readily give. My answer has always been that I am most proud of my mentees, who reside in different parts of the world, and their amazing leadership. However, a recent question posed by my Philadelphia Transitions group was more targeted toward leadership journeys. My immediate answer to this question is that my journey as a reluctant leader, who held many leadership roles, such as deanships, chairmanships and directorships, stems from accepting serendipitous opportunities and integrating those opportunities with the needs of my family at different life stages. While I did plan my educational trajectory and academic path, in contrast, I did not chart nor design my leadership path.

While deeply rethinking what I am most proud of, I realized I am most proud of finding my own authentic voice and using it to make a difference in the lives of women and nurses. Two articles I published earlier in my career reflect what I really wanted to achieve without deliberately articulating specific goals. The titles of these articles were “A passion for making a difference: ReVisions for empowerment” and “Does nursing intervention make a difference? A test of the ROSP,” which I wrote to convince legislators of the significant role nurses play based on a clinical trial for nursing interventions.

Reflecting on what helped develop my voice, I uncovered three main strategies:

1. First, I developed my voice through listening. As a child, I listened to women who came to my mother’s midwifery office. Then I listened to my childhood friend, Saidia, the daughter of the doorman who suddenly disappeared when she was 12-years-old. I found out her family sent her back to their village to marry her cousin. Girl/child marriages are still practiced in many countries. I also listened to women in Colombia, Brazil, Sweden, Egypt, and many more countries, where I continued to hear similar messages. Women felt oppressed, violated, burdened, undervalued, under-supported and definitely under compensated. Then I listened to nurses, and I heard about their sense of devaluation, the lack of equitable compensation and disciplinary oppression by physicians and administrators. I listened to caregivers and heard about their uncertainty, under-supported transitions when becoming caregivers, as well as the paradox of being burdened and transformed by caregiving. These messages profoundly affected me and shaped my goals, my research and my academic and leadership roles. I pondered what could be done?
   
   
2. The second strategy involved building connections, investing in partnerships, nurturing relationships globally, and then leveraging them to facilitate and support others. My colleagues and I developed global conferences that empowered women and forged connections. I continue leveraging my global connections in my current roles as a board member and a trustee. While mentoring deans and faculty in nursing, medicine and other health fields, I make use of the wonderful global relations I forged and nurtured by connecting mentors and mentees, facilitating connections between experts and those who can benefit from their expertise. I connect those in need of developing certain capacities to those who can meet their needs through my global networks. The vast repertoire of incredibly accomplished colleagues in my life and the relationships I cultivated are assets to those who benefit from shared wisdom and experience. 
   
   
3. The third strategy that led to leadership roles developed from a lesson I learned from my parents, to step outside of my comfort zone and indulge in new roles that require abilities and actions I know little about. I had to develop these uncertain capacities while always finding ways to enjoy and embrace the processes and the outcomes, uncertainties and all.

I have been privileged to get amazing leadership roles that provided me with platforms for my voice. Several instrumental milestones in my career allowed me to gain the necessary skills to lead and to have a voice that made a difference. When Mahmoud finished his Ph.D., I was already an established assistant professor at UCLA, just beginning to develop my academic portfolio, and I had no plans to leave. From his several employment offers, he wanted to accept a position in San Francisco, so we needed to move. I thought I would get a lateral move, from UCLA to UCSF (the UC system has 9 campuses). The dean and faculty at UCSF insisted the only open position I could move to was as an assistant dean. I reluctantly interviewed and got the offer for this difficult new role, particularly for someone like me who just completed my Ph.D. three years earlier, with two babies under 3-years-old, and with a minimal readily available support system for childcare, which was the norm at that time. The challenges of the new administrative role and the challenges of integrating these demands with a growing family taught me a great deal about organization, finding resources, garnering support, management, leadership and the importance of having a strong voice.

Several other events were instrumental in shaping the next 10 years of my life. My academic file went up for a university wide committee review, by what was called pre-tenure by CAP, the Committee for Academic Personnel Promotions and Tenure. This vital milestone predetermined if I would eventually qualify for tenure and stay at the university. After the review, they warned that if I continued working on a book I proposed, for which I had a contract from a top publishing company, and if I stayed in my administrative role, I would definitely fail to attain tenure - an important warning and a Iesson I listened to very carefully. It prompted me to give up the book, resign from my administrative role and re-invest my time in my women’s health research program. It was imperative and timely to put in a request for sabbatical leave, for which I was approved. I chose to go to Kuwait during my sabbatical, to continue with my research program by listening to more women’s stories.

Within a year of returning from sabbatical, with renewed energy for my research program, I was actively pursued and recruited for another administrative role, this time for a deanship in Kuwait. Because of our family goals to provide opportunities for global experiences for our 5 and 7-year-old sons, my husband and I accepted to take leaves of absence from our employers, UCSF and Bechtel Corp., so I could accept this new leadership position – yet another opportunity I did not seek nor prepare for. It turned out to be an instrumental position for cultivating my global voice and gaining more insights into global health and women’s issues. In that new role, I led multinational faculty, developed curricula, dealt with multisector organizations, promoted research agendas, listened to women’s stories of trials and tribulations and resilience and transformation and traveled to some 10 countries in the Middle East and Europe – all packed into a two year deanship appointment. 

When I returned to UCSF, I was adamant about declining every deanship and/or administrative role that came my way, and opted to focus on teaching and research and on having a voice that represented the faculty and the academic mission of our university. I did that through leadership roles with the University of California’s strong Academic Senate. I chaired system-wide academic personnel committees, listened to women faculty and students and became one of the thunderous voices for promoting equity and justice for women faculty and minorities. I testified in front of California legislators about inequity in promotions and financial compensations for women in the University of California system and about the limited resources available to support the multiple demands on their energy and time. I absorbed new skills concerning where and how to exercise my voice, and where and when to ask for policy changes. I also learned a great deal about legislative processes that drive change.   

Another milestone that was serendipitous and contributed to making my scholarly voice more impactful – I created and taught a series of three new theory, philosophy and epistemology courses for Ph.D. students. I was thoroughly invested in and enjoyed these full year courses of learning and teaching. I was settling back in, doing what I love, research and teaching. And one day, a vice president of a top publishing house for health professional education walked into my office and asked me to put those courses in a book, as he heard about my innovative theory/philosophy courses everywhere he went, nationally and internationally. Reluctantly, I agreed and I wrote the textbook, which provided approaches to viewing and studying theories and strategies for developing them by using my unique analyses. The book reflected a very different voice with regard to our discipline, about the theoretical foundation of nursing, and it provided frameworks that considered how nurses make major differences in people’s lives. I honored our discipline’s history in theory development through new approaches to viewing nursing scholarship.

This book, written from a feminist, post colonialist perspective, was used by almost every graduate program, nationally and globally. It provided more visibility for my voice and for the hundreds of journal articles I previously published. It made my ideas more accessible, and interestingly, more accepted and relevant. It expanded my scholarly voice in nursing circles globally and contributed to dialogues and deliberations about nurses as women between international organizations (such as WHO, ICN and the UN).

Another important milestone was the proactive role I played in the only organization, at the time, focused on research and practice in global women’s health issues. I became president of this organization and we held conferences all over the world, which brought clinicians, researchers, policy makers and the public together to dialogue about global women’s health issues. This organization allowed me to develop even more global relationships, investing in multidisciplinary connections with scholars and clinicians and empowering them to influence their governments to devote more attention to women’s health issues, beyond reproductive health. This organization was another platform for my voice.

With dedicated listening to women and nurses’ experiences and global relationships forged through various positions, I developed more leadership skills and increased my ability to take risks by getting out of my comfort zone, allowing me to accept the challenges in formal leadership positions, such as the deanship of The University of Pennsylvania’s School of Nursing. However, one skill I still needed to develop once accepting that position was fundraising for a private university. This was another role/skill falling totally outside of my comfort zone. This deanship position gave me the platform to not only master fundraising, but also to thoroughly embrace and enjoy it.

After reviewing this narrative, I would say the following more accurately describes my leadership trajectory. I have been a lifelong learner and listener and a reluctant adopter of formal leadership roles, who has been privileged to take advantage of and accept many serendipitous positions and opportunities. I definitely lived a life outside of my comfort zones - leaving my home and my family in Alexandria at the age of 20, becoming a citizen of a country I grew to love and immersing myself in a discipline I am proud to be a member of. I hope I made some difference and that I will continue to make an impact, however miniscule it is compared to the needs that exist for insuring justice, equity and valuation for women and nurses.

Lessons Learned From a Global Pandemic

As the world emerges from the grip of a pandemic that created so much suffering through lost lives, long-term illnesses and economic devastation, we must pause and reflect on lessons learned to inform the future. Here are a several takeaways I believe should shepherd future plans. 

• For any globalization and interconnectedness skeptics, we are a global community. What happens in one corner of the world effects everyone else, locally and globally. Nurses always have been a global force, working across nations. They can lead the planning for disasters.

• We were not ready to deal with the spread of the virus, nor to deal with its devastating effects on patients, families and communities. We did not have enough masks for the public, personal protective equipment (PPE) for health professionals, ventilators in our ICUs for patients or disaster plans in place for implementation. Can we do better in the future? Yes! Only if implementation plans are made, rehearsed, periodically modified and tested. 

• In every society, the vulnerable and the marginalized became more vulnerable and more marginalized. Note the higher percentage of illness and death among the elderly, the vaccination rate disparities between the majorities and the minorities, the rate of infection variabilities among different ethnic groups and the inability of the poor and frontline workers to shelter at home and to use distancing in their own communities. We saw how women suffered as caregivers, trying to hold jobs while monitoring their children’s education from home. Women were among those affected the most, and many either gave up their employment or significantly curtailed their careers. Systemic inequities must be addressed continuously. 

• We learned that partnerships and collaborations are vital for implementing viable prevention protocols, as well as for research to develop and produce vaccines. Competitive drug companies teamed together, countries collaborated to deal with border and sheltering policies and health care professionals saw the positive outcomes of working in egalitarian teams. Collaborations between countries were vital in the battle to decrease Covid’s spread. Partnerships and collaborations must be developed and fostered in education programs, as well as in health care organizations. Investments in interprofessional education and interdisciplinary research should become the norm. 

• We learned about different modes of communication, and that working, teaching and doing research remotely were possible. Zooming became a viable option and part of our lexicon. But again, disparities manifested, as students with limited Wi-Fi access could not connect, profoundly affecting their learning. The elderly, who were not computer literate, could not schedule or get to their health care appointments or vaccination sites. Creative solutions are needed to ensure access equity. 

Furthermore, I believe the pandemic amplified many take home messages for nurses:

• It became even more apparent that without the 24-hour care nurses provide, hospitals were not able to admit, care for and heal patients. Beds were closed and ICUs did not admit patients. The pandemic highlighted the severe global shortage of nurses. While the WHO’s 2020 State of the World’s Nursing Report presented compelling data on global shortages and highlighted the need for more nurses with higher education and more nurses in leadership roles, it took a global pandemic to make this data real. Because there was a shortage of nursing care, nurses traveled across the country to help in hospitals that lacked needed staff, ICUs closed beds and patients were sent home prematurely.

• Nurses’ creativity and innovation shined globally in the face of uncertainty about the virus and treatment. Nurses found ways to incorporate families in spite of mandated quarantine and isolation. To support their patients, they used virtual applications to ensure families were connected and able to support their loved ones and able to say goodbyes when patients were near death. Nurses celebrated weddings and birthdays, combining knowledge about social support and meaning of life with evidence about infection control and palliative care, all while providing compassionate care that was much needed in life and death situations. 

• Another important lesson was the incredible professional commitment of nurses to their patients. Nurses, physicians and other health care and frontline providers continued to fulfill their professional roles and never faltered in providing care at the expense of their own health and their families’ health. Many opted to stay in hotels, away from home, to protect their families while providing care to their Covid patients. Nurses are stoic, professional and loyal to the principles and values of our profession. They are creative and resilient.

• We learned that when policies are not protective of nurses - when there are compromised staffing levels and a scarcity of PPE to protect them - that nurses’ mental health is profoundly affected. Nurses care about their patients’ physical and psychological safety and health. Therefore, when patients suffered because of the lack of ventilators and the inability of families to visit, patients’ suffering was also nurses’ suffering, leading to mental meltdowns on top of the physical exhaustion they experienced.  

• The pandemic triggered educational changes that closed universities and opened up distance learning. This left faculty with quandaries as to how to provide virtual clinical rotations. The different experiences and responses to these major changes and their effect on graduating nurses who can safely transition into employment need to be carefully studied and warrant thoughtful planning for the future. Similarly, future research protocols also may require anticipation of unanticipated disruptions. 

The above are just some of the lessons that should inform planning and decision-making in preparing for a future in which other major disruptions may occur. 

CELEBRATING NURSES IN 2021

In 1961, I graduated from the University of Alexandria in Egypt and became a nurse. I never stopped being proud that I chose this profession. The month of May is a reminder to celebrate nurses and the discipline of nursing. Before I share my thoughts about what we are celebrating, and while we are beginning to see some rays of hope in some parts of the world about the containment of the Covid-19 global pandemic, we must pause to remember the millions affected, as well as the millions we lost.

I hope each one of us reflects on what you have and what you gleaned from living through and coping with Covid-19 during this prolonged period of the pandemic and in its aftermath. And, also reflect on what and why you are celebrating.

Here is what I believe we are celebrating today.

We celebrate today the many scientists from many parts of the world who collaborated in developing the vaccines that give us hope that we may reopen borders, schools and businesses.

We celebrate today the evidence nurse scientists developed, allowing ICU nurses to better manage lung functions for patients by proning them and the evidence based palliative models of care that helped patients die with dignity.

We celebrate today the WHO’s publication of the first world report about nursing, which provides robust global data and recommendations that should be used as a blueprint for the nursing workforce for years to come.

We celebrate today that 2020 and 2021 were designated the years of the nurse and midwife by the WHO, ICN and many other organizations. That is also a first in global nursing.

We celebrate today that the world now knows what we always knew, that nurses are the heart and soul of health care systems. The severe shortage of nurses globally and the closure of ICU beds that were much needed for Covid-19 victims was due to the fact that were not enough nurses or that there were not enough educated or qualified nurses to care for patients. This is reminding ministries and universities to increase the numbers of well-prepared advanced practice nurses. We already see the outcomes through increasing applications and admissions to schools of nursing.

We celebrate today you, wherever you are, frontline nurses for your dedication, commitment and professionalism in using evidence-based science to manage pain, ventilation, difficulties in daily life activities, discomfort, loneliness and the emotional support needs of patients infected with Covid-19.

We celebrate today frontline nurses everywhere for their compassion in caring for families who could not be with loved ones, and for their vital role in supporting their patients’ admission, discharge and end of life transitions. We celebrate them knowing that, in spite of their passion and nursing education, they too suffered from anxiety and faced many risks to their wellbeing and their families’ wellbeing. But, they demonstrated grit, resilience and creativity in a time of uncertainty.

We celebrate today nursing educators for how quickly they pivoted to using new innovative strategies, some they had to invent. They ensured their nursing students continued to receive quality education and to graduate, learning essential theoretical and clinical knowledge that prepared them to provide safe, quality care.

We celebrate today nurse scientists for continuing their programs of research with human subjects in spite of many restrictions and many precautions. They created new strategies and goals to insure science productivity continued because of their strong belief in the importance of advancing the needed evidence that translated into impactful, quality care.

We celebrate today hospital administrators who reorganized with warp speed to accommodate, heal and care for an unknown virus for which there were no known treatments. We celebrate their staff for creatively developing new protocols and routines.

We celebrate today health care teams that put the care of patients above mediocre paternalistic and hierarchal teams. We celebrate the new global emphasis on interprofessional education and interdisciplinary, equitable teams that place more emphasis on addressing the needs of patients and their care and less emphasis on the needs of team members. 

We celebrate today organizational leaders who realized health care policies must be informed by nurses’ wisdom, knowledge, expertise and voices. We celebrate them for their inclusiveness of nurse leaders in all decision-making bodies.

We celebrate today nurses’ strong advocacy voices for better policies to create and safeguard equitable working environments for nurses.

We celebrate today nurses who use theory to guide their practice, who are able to articulate the paradigms that drive their assessment of patients and the framing of the interventions they give. 

We celebrate today nurses who are mothers and fathers whose professional commitment and moral compass drove them to continue to care for Covid-19 patients in spite of the limited resources and treatments, and fear of infections for themselves and their families. This commitment has been at the expense of their psychological and physical wellbeing.

Lots that cause us to celebrate - but, celebrations are only a short stop for reflection. We nurses and midwives must continue in the long journey toward insuring access to quality care for the most vulnerable populations and insuring a healthy and equitable environment in health care for providers and recipients of care.

I am so proud to be a nurse.

Based on speeches given in Pakistan, Switzerland and Portugal.

 

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.

Valued and Enabled Nurses: A Gendered Vision for 2030

World Academy of Nursing Science Conference
Presented in the Future, in February 2030

Osaka, Japan

At the turn of the decade, as we welcomed 2020, designated the Year of the Nurse and the Midwife by the World Health Organization (WHO), we looked forward to showing the world what nurses actually do and to demonstrating their impact on the health and wellbeing of populations. We also looked forward to accomplishing the Nursing Now goals, as well as the Sustainable Development Goals (SDG’s). With 20 million nurses globally, we wanted to have a collective voice in developing and providing appropriate policies to deal with health care challenges that populations faced globally. Two such challenges were providing quality care for older populations and ameliorating the effects of environmental changes within an equity and justice framework.

We considered that since nurses were made up of 90% women globally, the issues and the challenges that women faced were similar to those that nurses encountered in their practice, as well as in their scholarship. Therefore, to have a voice and presence in making a global and a local impact on populations’ health, nurses had to acknowledge and own historical gender and sex differentials that created marginalization, oppression and subjugation of nurses and women. These, in turn, contributed to nurses’ and women’s’ limited presence and participation in affecting policies that supported women, their work conditions and their wellbeing. These issues also may have constrained nurses from working up to their full capacity in their advocacy and caring roles for patients and families, and in ensuring policies for the delivery of quality care driven by nursing evidence and nursing perspectives.

It is now 2030, and we are reviewing our accomplishments in the previous decade. We have a strong collective voice that contributes to the continuity of care and wellbeing for the elderly and for all vulnerable populations. Nurses now work in environments that are healthy and supportive of leadership and have an impact on the quality of health care. Equity for women, allowing them to function up to their full capacity and integrate all of their multiple roles through appropriate resources, benefits, compensation and flexibility, is monitored globally by the United Nations and WHO.

We achieved all of this through integrating our practice with academia, leading interprofessional education and practice, supporting nurses’ health care innovations, enhancing representation at policy tables and insuring the development and implementation of systems for accountability that support equity, safety and civility where women/nurses live and work. We adopted an equity and justice framework, advocated for and demanded gender equity at all organizational and societal levels. Our “different voices” for change were valued and we made a difference. 

Incredible changes and achievements to celebrate at the turn of the decade in 2030!

Afaf Meleis and Noriko Katada

2019 NYU Rory Meyers College of Nursing Commencement Speech

Eileen Sullivan Marx and Afaf Meleis

Thank you Dean Eileen Sullivan Marx and thank you President Hamilton for your unwavering support of nursing.

Congratulations 2019 Graduates! I am truly honored to be here, not only because your dean, a dear friend, is one of the best in the country, not only because I am receiving the Helen Manzer Award, and not only because I consider your faculty members among the top knowledge producers in the country. I am truly honored to be here as a witness and a participant in celebrating this important milestone in the lives of the 2019 graduates.

You are graduating at an incredibly remarkable point in our history. While there is turmoil in the world affecting our core democratic values, and while we are living through global unrest and major demographic shifts, we are also at a critical junction in nursing’s history and future that provides the platform for us/for you to impact social and health policy changes.

You are graduating at a time when the world is recognizing and acknowledging that nurses have a vital role to play in achieving universal health care, in moving us closer to gender and cultural equities, and in improving economies by making populations healthier. This is the platform created by the “Nursing Now” campaign, which prompted the World Health Organization to declare next year, 2020, The Year of the Nurse globally. The world is ready for empowered, well-educated nurses to have a voice in the wellbeing of populations - ready for nurses to lead the way.

You are among those who received the best education and you are empowered. Because of that, I will assume you will want to have a voice when it comes to sexual harassment, trafficking, and work incivilities – and you will have a desire to insure health care is compassionate and humanistic, and that health care is the right of every human being. I will assume you will want to have a voice of intolerance for colonialism in all its forms, and against racism, sexism, homophobia and toxic environments. If that is the voice you want to cultivate, if you want to make a difference, if you want to impact social and health policies, and if you want to impact your institution’s policies, then I suggest you plan a future based on four guideposts for your career.

These four guideposts/goals all begin with the letter “C”, including a “C” to carve out and to create a captivating career. And, I promise not to mention the “C” in collusion! Instead, I hope you remember these 4 C’s, in credibility, coaching, collaboration, and comfort zones.

I will begin with credibility. While you already received a credible education, it is now imperative that you build your own individual platform for credibility, from which you can function up to your full potential, armed with evidence and experience. No job and no role is too small to give it your all. Strive for excellence in each and in all. Do not compromise. Do not take short cuts. Credibility in your practice, in your research, in your administration – credibility is developed through adhering to work ethics, integrity, systematic building on your expertise, and being open to continuous learning. Your voice will not be heard and you will not be able to make an impact without earning and demonstrating your credible expertise and accomplishments.

The second important “C” is coaching. Seek mentorship for every role you embark on. Make sure you cultivate relationships with nurturing, inspiring, and informative mentors, mentors who coach you and show you the ropes, open up doors, facilitate relationships, challenge you, provide you with honest evaluation, and coach you on the timing, the tools, and the hows in using your strong, impactful voice. But remember, we also continue to learn a great deal, not only from receiving coaching, but also from coaching others. Be generous in mentoring others.

The third “C” is collaboration. We all know the research findings supporting the powerful results achieved through collaborative and effective teamwork. It leads to more adherence to regimens, less infections, less falls, and on and on with many positive outcomes. But, the collaboration that I am speaking about is cultivating communities that share your value system and goals – collaboration that can help you achieve the changes you want to make happen. Empower yourself by creating collective voices by being part of a community. Find out what organizations you can join in which you can add your voice. For me, over the years, I joined organizations that focused on women’s health, others that focused on nursing knowledge, consortia for global health, as well as local and national chapters of associations for faculty members. These organizations were influenced by my passion for nursing and my compassion for vulnerable populations, and they, in turn, helped amplify and support my voice. It is through collaboration and partnership that we are empowered – they become our power engine.

The fourth “C” involves comfort zones. Know when you become too comfortable in a role or in a job, and be reflective on how to reach out, to grow, to continue to learn, and to get out of your comfort zones. Know how and when to take risks. And know your limitations and blind spots and how to mindfully transcend them. We all have biases, taken for granted implicit assumptions about people, roles, and situations – assumptions that should be questioned and challenged, and should be replaced by new evidence or by having assumptions carefully examined. Find out what makes you uncomfortable. Is it working with those who don’t look like you? Caring for patients from other cultures? Participating in a particular type of research over another? Going to a developing country? Becoming a leader? Or is it becoming a member of a group that is different because of gender, sexual orientation, or religion?

I have learnt a great deal about gender inequity by being in men’s groups, about ethnic inequity by being in multicultural groups, about disciplinary aggressions by being a member of interprofessional teams, and about international inequities by being in multinational organizations. I also learnt how to embrace my own multi-minority statuses, as an immigrant with an accent from a developing country, as a nurse in settings that defer to physicians, as a woman in a world built and run by men, and as a social scientist in academic environments that favor biological and physical scientists. Once I acknowledged my many minority statuses, I displayed and used each as a badge of honor to educate, to advocate, and to change assumptions. But, before I acknowledged and flaunted my marginalized position, I established my own credibility. I found out what is the gold standard in each of my roles and worked on reaching it.

Now I am back full circle in my remarks to you, congratulating you and celebrating your milestone by passing to you the advice I wish I had received at every junction in my own educational journey. To make a difference, to translate your passion for our disincline and your compassion for our patients, and to achieve your goals, it is imperative that you:

• Establish your own individual credibility, reaching every gold standard and reaching out and up for the stars.

• Coach and be coached.

• Cultivate collaboration, finding the power engine that makes your voice a powerhouse.

• And continue to step out of your comfort zone and take risks.

Congratulations to all the graduates of 2019!

I stand on the shoulders of many women - Comments from the 2019 Marin Women's Hall of Fame Induction and Celebration

2019 Marin Women’s Hall of Fame

Women of Distinction Induction and Celebration Dinner

Thursday, March 28, 2019, San Rafael, CA

www.mwhf.org

Recently, I was honored to be inducted into the Marin Women’s Hall of Fame during a gala attended by 450 guests in San Rafael, CA. I am truly humbled to be among an extraordinary group of awardees, who are not only highly accomplished, but who also contribute so much to our community and to the world. We all felt incredibly special following in the footsteps of such great leaders such as Senator Barbara Boxer. Moreover, my introduction by a high school senior, Makena Cusick, was unquestionably the highlight of my evening, as I witnessed her brimming with incredible sophistication, intellect and presence, characteristics of a future leader.

These were my comments upon my induction.

Whenever we receive such an honor, we pause and wonder how we got there? How did I get from Alexandria, Egypt to standing in front of a podium with such a select group? For me it is family, community and friends.

First and foremost, I have an incredible, loving family.

My husband, Mahmoud, my partner for 55 years, supported and enabled me. I will be forever grateful to him. This award is for him, as much as it is for me. Our sons Waleed and Sherief gave us such joy, which energized us and kept us moving forward. Then, they expanded our family through their soul mates, the amazing, loving and accomplished Dr. Deena Emera and Paula Meleis.

I am also here because Marin County was so hospitable and welcoming when we immigrated from Egypt and migrated from Los Angeles - and I hope it continues to be warm and hospitable toward today’s immigrants, legal or not!

Our dear Marin friends continued including us in their lives when we migrated to the East Coast during the past 16 years - and they quickly made sure we reintegrated in Marin when we returned. We are indebted to them for their generosity, love and support.

If our dear friend, Joan Brown, did not invite me to the Executive Women of Marin’s “Wednesday Morning Dialogues,” where I met their president, Margy Eller, also the president of the American Association of University Women (AAUW), she would not have known me or nominated me. I am grateful to her.

I am definitely here because of my passion for supporting nurses’ voices, work, education and research. Nurses - all 20 million of us around the world - are the heart and the soul of the health care system. We have been voted the most trusted professionals for at least the past 10 years.

I am also here because of my compassion for empowering women globally, and positioning their issues front and center. This is no coincidence since 90% of nurses are women and 70 % of family caregivers are women.

I am enabled to be here because I stand on the shoulders of 100’s of women who made it possible for me to act on this passion and compassion.

• I stand on the shoulders of the many housekeepers, who were immigrants and refugees. They cleaned our house, washed our laundry and freed me to do the work I cared about - and they inspired me with their can-do determination.
• I stand on the shoulders of the many administrative assistants and chiefs of my offices, who organized me and insured that I was always well prepared for all of my roles - including my global research.
• I stand here on the shoulders of the many fisherman’s wives in Brazil, Por Día maids in Columbia, nurse assistants in Mexico, immigrant women in California and clerical workers in Egypt, Kuwait and the USA, who entrusted me with narratives about their lives - narratives that included marginalization, oppression, devaluation, violence, trafficking and under compensation - and narratives about resilience and creativity in transcending all obstacles to raise healthy and accomplished children. Their can-do attitudes inspired me.
• I stand here on the shoulders of 100’s of mentees from all over the world, who taught me how to be a better mentor. They proceeded to exceed my capacity, as they became the best mentors and leaders and they continued to be an important and inspiring part of my life.

Because I stand on so many strong shoulders of so many strong women, I extend my deepest gratitude to them and I accept this award for all of them and on behalf of them.

This is really an award about women supporting women, and about women who continue to make the world a better place to live. What an incredible honor.

Afaf Meleis and her family, friends and mentees at the
2019 Marin Women's Hall of Fame Induction and Celebration

Malaysia – The Recurrent Themes and Challenges Nurses Face

I land in Kuala Lumpur at midnight, after a 22-hour journey from San Francisco, via Tokyo, and I enjoy a warm reception from a faculty member and an undergraduate student, who escort me in a University car for the hour drive to my hotel, which is close to the UKM Medical Center and University. New, modern and still under construction, my hotel has a well-equipped gym, an absolute must when I travel, and a magnificent pool overlooking the city.

The reason for this trip, and for most trips I make to many corners of the world, is to honor invitations, to inspire women, to empower nurses, to dialogue with colleagues and to learn about the progress and the challenges affecting nursing and health care. Another reason for my travels is to consider together, with my international colleagues, the progress made toward achieving the Sustainable Development Goals. In particular, how well are we progressing toward universal health care access, lower maternal and infant mortality rates, reduced disparities, the elimination of violence against women and equal participation of women, nurses and midwives in policy and decision making arenas. Thus begins my mission in each country, organization, conference and workshop I visit. I use this blog to share what I learn from my global colleagues, culturally, socially and intellectually.

On my first morning, while feasting my eyes on panoramic views of the high-rise buildings dotting the Kuala Lumpur skyline, I enjoy breakfast, where I listen to many conversations in Malaysian, Cantonese, English, Arabic and many Indian languages. It is here that I realize rice and noodles are staples for all meals of the day. It makes me wonder how rice affects health outcomes. I may ask my colleagues. But of course fruits and vegetables are also plentiful in this tropical climate.

Kuala Lumpur has well paved streets and highways, with close to 7 million inhabitants. It boasts traffic jams at all times of the day – not much different from the I-76 Schuylkill Expressway in Philadelphia, Route 101 in San Francisco or Abou Kir in Alexandria. The patience and enthusiasm of my hosts wipes away any of my frustrations about slow moving traffic and my fears of motorcycles zipping between cars (even though they all wear helmets).

The issues confronting nurses in Malaysia are similar to what I hear from colleagues in most other countries. The timing might be different, as these issues challenged U.S. nurses in the 70’s, and more countries may have identified them in the 80’s. Other countries, like Malaysia, face them in the present. Here are my top observations regarding the themes and challenges Malaysian nurses face:

• Diploma and degree graduates are divided by a sense of superiority of one group over the other, because of a confrontation between experience verses education. Haven’t we already lived through these internal oppressions???
• Salary classification reflects hospital preparation and educational advancement does not augment salary.
• Leadership positions are given to hospital graduates.
• There is a rift between hospital and university graduates, which is cultivating an environment that may stall progress in the nursing profession.
• The Board of Nursing, which creates and implements policies related to nurses and nursing, is chaired by physicians and is populated by hospital graduates – a powerful board that does not seem to value university education for nurses.
• Public universities formed a council consisting of two representatives from each university school of nursing. The council develops policies that the board reviews, accepts or ignores.
• Participants in the conference, who came from Malaysian universities, expressed frustration concerning the stagnant state of nursing education, practice and research.
• There are increasing numbers of university graduates, as well as Ph.D. graduates. Most of these graduates obtained their education in Malaysia and are ready to make a difference; however, they do not feel valued or appropriately compensated.
• The Minister of Health and Vice Chancellor of the University were very supportive and complimentary of nursing education. It was intriguing to hear them speak about the importance of nursing theory and scholarship.

Each of my global experiences reinforces for me how nurses continue to excel and struggle to improve health care for all. Nurses are resilient and never surrender their values for equitable education and quality health care. I raise all my hats to them. 

My Acceptance and Gratitude Speech for the Princess Srinagarindra Award

I am truly humbled and honored to receive the Princess Srinagarindra Award and to be here in the presence of her beloved granddaughter, Princess Maha Chakri Sirindhorn. It is a double honor for me to have Princess Sirindhorn presiding over the ceremony this afternoon. I know how much Princess Sirindhorn was influenced by her grandmother, and I know she was a role model to her and to all in this country and beyond. There are many similarities between both princesses.

But first, let me acknowledge the role of the trustees of the Princess Srinagarindra Award Foundation for selecting me. And a special expression of gratitude to Professor Tassana Boontang for her leadership in nursing and to Professor Somchit for creating an impactful journal that has become a leading journal in South East Asia.

Now, let me share my views of how Her Royal Highness Princess Srinagarindra and Her Royal Highness Princess Sirindhorn are alike.

The Princess's Grandmother, Srinagarindra, served the Country with love, loyalty, dignity, and with a focus on alleviating the suffering of many, particularly the underserved. She established schools, insured access to health care and instituted many preventative health programs. She worked on improving the life of the rural Thais. Her love for her country extended to rehabilitating the forests, and in that, she was a visionary and ahead of her time in thinking about the sustainability of our planet. She was a dedicated role model, who I know has inspired many to emulate her actions. She was honored by UNESCO as a distinguished leader in public service in the fields of education, applied science and human, social and environmental development.

Following in her footsteps, Her Royal Highness Princess Maha Chakri Sirindhorn realized the difficulty villagers faced in accessing health care, education and quality living, so she helped over 200 schools to improve education and health care access for children. Her work makes health care a right, not a luxury. Princess Sirindhorn is able to speak with children and the elderly and make them feel valued and cared for. She is invested in cultivating their best capacities to live quality lives and to succeed.

We know her in the USA as the “Angel Princess,” as she brings everyone humility and genuine caring, instilling hope in their lives - whether in times of peace, turmoil, disaster or conflict - just like her grandmother, Princess Srinagarindra. She continues to build on her grandmother’s vison and goals for the health and the education of the vulnerable among us. 

The love between them reminds me of my own grandmother, whose accomplishments were limited to her immediate family. A farmer from a small village in Egypt, she was never educated in a school - but she was educated by life experiences. She managed to raise a daughter, my mother, who achieved the highest education and the top leadership positions in the nursing profession, not only in Egypt, but in many parts of the Middle East. As a farmer, my grandmother delivered her own babies while in the field, losing many of them along the way. In spite of limited resources and no formal education, she instilled in me a love for education and a work ethic to care for other people, all of which propelled me to receive this incredible award. She would be so proud to know I am receiving an award that reflects the love between a grandmother and a granddaughter.  

Receiving this award would not have been possible if I had not been involved in working with and learning from my many Thai colleagues and mentees. That being said, my involvement and love for Thailand developed because of the incredible leadership of Dr. Tassana Boontong. I met Dr. Boontong over 25 years ago, and her charismatic leadership and strategic vision for Thai nursing instantly struck me. Some people have a vision, but they do not follow up with proactive leadership and action. Dr. Boontong understood the connection between vision and action, and knew that without proper education, nurses would not be able to make a difference in health care. Through the Thai Parliament, she insured that nurses could get scholarship and fellowship support to obtain the highest education. She ventured even farther, establishing a pioneer doctoral program in collaboration with other schools of nursing in Thailand - a model program that benefitted from the teaching and expertise of the best minds from several Universities. I had the distinct honor to be invited to teach in that program. And now, as we look around, many of the movers and shakers in nursing in Thailand are a direct result of Dr. Boontong’s efforts.

It is also because of Dr. Boontong that I have enjoyed the good fortune of developing mentoring relationships with my many mentees here. To all of these mentees, I extend my deep appreciation for their diligent work and outstanding leadership in health care.  

I am genuinely grateful to receive the Princess Srinagarindra Award, and I would like to extend my appreciation to the Trustee Committee and to all who supported my nomination and selection. It is truly an honor to receive an award that reflects committed valuation of nursing contributions, not only in Thailand, but all over the world. So I thank you Princess Sirindhorn, on behalf of all nurses worldwide.

2018 Princess Srinagarindra Award Ceremony

Four hundred Thai dignitaries, including 50 representatives from 40 embassies, ministers of health, education and welfare, leaders in health care and nursing, and senators gathered on October 17, 2018 to celebrate a global nurse leader who received the Princess Srinagarindra Award. Attendees gathered under enormous, shimmering chandeliers surrounded by countless fragrant flowers, all while enjoying an exquisite and delectable high tea, presided over by Her Royal Highness Princess Maha Chakri Siridhorn, the beloved princess of Thailand and granddaughter of Her Royal Highness Princess Srinagarindra Mahidol.

This gathering followed an elaborate royal ceremony involving the giving and receiving of a plague and certificate, which required two rehearsals and the guidance of about one hundred palace protocol custodians. In a noble room, with dignitaries lined up on both sides, the awardee marched slowly, escorted by Dr. Somchit Hanucharurnkul, a nursing leader from Mahidol University, and the U.S.A. interim ambassador to Thailand, and curtsied twice before Her Royal Highness. After heartwarming citations were read by the President of the National Nursing Council, Dr. Tassana Boontong, and Her Royal Highness, the Princess presented the awardee with a stunning plaque, a certificate and a silver plate, all inscribed with both of their names. 

In my view, this memorable and once in a lifetime award has three purposes.

First, it celebrates and honors the life and the memory of the Princess's grandmother, Her Royal Highness Princess Srinagarindra Mahidol, for her unprecedented contributions to the Thai people. She understood the suffering of vulnerable populations, the need for access to health care and education, and she traveled throughout Thailand to provide it. She treated the young and the old with dignity, compassion and humanism. And, ahead of her time, she advocated for and led efforts pertaining to environmental sustainability. UNESCO gave her an award for her impactful contributions to human, social and cultural development.

The second purpose for this gathering is to affirm Princess Siridhorn’s continued and expanded support of her grandmother’s vision and goals. In many ways, it is a celebration of Princess Siridhorn as well. She brought education and health care to children in over 800 schools. She too insures that vulnerable populations receive the education and care that they need. She does so with dignity, respect, kindheartedness and incredible generosity of spirit.

The third outcome of this gathering, which honors the life achievements of one global nurse, is honoring ALL nurses globally. By televising the elegant and elaborate ceremony on all Thai news channels, and by taking the time to attend the celebration, all of these leaders in the government, embassies, health and education are acknowledging the centrality of nurses in insuring population’s health and wellbeing. The message is loud and clear - nurses as a major workforce matter to global health, and celebrating nursing royally affirms the discipline’s value and importance. By celebrating one nurse, they celebrate all nurses.

Having been humbled and honored by receiving this award, I understand and interpret its significance not in terms of my achievements. To me the award is an affirmation of the accomplishments and the impact of nurses all over the world. I accepted the award, basked in the celebration rituals and I will cherish the memory because it is embedded in the namesake of a late beloved Princess Srinagarindra, who was also a NURSE. I accepted it with pride because her granddaughter, Princess Siridhorn, supports and values women and nurses. Moreover, I accepted it with a great deal of humility and gratitude because my Thai colleagues, mentees and the global community chose me to receive it. The award’s significance was obvious to the nurses of Thailand and to the attendees who celebrated with me with joy and a great deal of pride.

And finally, I believe that the recommended color of yellow for the occasion’s attire, a royal color, added a sunny, bright and joyful note to the celebration.

Like many in the Thailand nursing community, I am most grateful to Dr. Tassana Boontong, Dean Emerita of Mahidol University and President of the Thailand Nursing Council, for her leadership in obtaining government funds to support nurses getting PhDs from national and international universities. I am convinced that I would not have received this tremendous honor if I had not had the privilege of mentoring many of those who pursued their PhD education due to the availability of those funds. Many of these mentees became leaders in their own right, including my dear friends, Dr. Siriorn Sindhu and Dr. Ameporn Ratinthorn. I also believe that this award was another visionary initiative by Dr. Boontong to acknowledge nursing and nurses worldwide.