Let’s show the whole world what nurses can do
Nursing Now leader Barbara Stilwell wants nurses to look beyond the demands of the job
Nursing Now leader Barbara Stilwell wants nurses to look beyond the demands of the job
Barbara Stilwell knows how to get things done. Her daunting list of achievements include introducing the nurse practitioner role to the UK, developing healthcare systems and health workforces internationally and – her new role – leading the Nursing Now campaign to increase the influence and impact of nurses globally.
I go into our meeting thinking ‘how on earth did she do all that?’ The first clue comes more or less immediately: she radiates positivity.
We meet at the RCN HQ in London; it is the morning after she had a late night out with colleagues, a rare event these days, she tells me. But if she is tired, it doesn’t show. I’m struck by her energy and warmth. Promoting Nursing Now comes with her job as the campaign’s executive director, but there is no hint of going through the motions. I don’t feel she’s selling me the Nursing Now campaign message, rather that we are having a conversation – it just happens to be a conversation about something very important.
A worldwide perspective
I expect her to be passionate about nursing, and she is, but she is also passionate about the world beyond nursing. At one point, discussing the need for nurses to look further than the daily pressures of the job, she quotes from Hamlet (‘There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy’). She’s very good company.
The story of her career shows that she is also, clearly, one of those rare people who will deliberately put themselves outside their comfort zone and who is able to extract some success from unpromising circumstances.
'There was a macho culture when I worked at the WHO… but I battled on and learned a lot'
Take her ten-year stint with the World Health Organization, which she joined in 1996. Based in Geneva, she was pitched into an overwhelmingly male world of physicians and economists.
‘I called them the public health marines. It was incredibly hard, the macho culture. My boss was a Frenchman who I came to respect deeply, and who is still a friend, but, boy, he had no empathy for me. He kept sending me out on impossible things and being mad with me if I couldn’t achieve them. I battled on, I learned a lot.’
Learning along the way
One of the eye-opening experiences from that period was a three-week stay in Laos where her attempt to audit the country’s immunisation service and train healthcare staff was largely thwarted by politics. The government ‘forbade’ her team from going where it needed to go.
It was not a wasted trip, however. ‘I did learn something very important. What I learned is that nobody listens to anybody else. It was partly a man-thing – everybody wanted to talk. After a while, I would say in meetings: “It sounds like you want a, b and c – is that right?”
‘Eventually some of the senior people said “you are amazing at this”. I thought no I’m not, the only difference is that I’m listening.’
The good impression she made in Laos led to her being offered the ‘wonderful opportunity’ to go to Harvard in the US to undertake a programme on negotiating skills. ‘One of the scenarios I dealt with was to imagine dealing with a warlord in Afghanistan. Imagine my amazement when I found myself, 15 years later, in Afghanistan dealing with a warlord.’
Dr Stilwell says there are huge benefits to be had from working with people who are not your natural allies. She can’t say much about her work in Afghanistan, but it is worth mentioning as probably the most extreme example she has had of working with people who were not her natural allies.
It was at WHO, from a physician colleague who had a PhD in economics, that she learned how to think about the cost of healthcare, and the importance of getting a good return on the investment made in the healthcare workforce. This means working out how to keep healthcare professionals in the workforce, showing the outcomes and health gains they are delivering for their populations and, crucially, ensuring they are working to the limit of their competence.
Helping nurses achieve their potential
Enabling nurses to work to ‘the top of their licence’ is what Dr Stilwell has been doing for decades. It is an obvious theme in her pioneering work on the nurse practitioner role; it features again in her health workforce development work around the world, and it is central to the Nursing Now campaign.
It is the common thread running through her entire career, isn’t it? ‘It is,’ she agrees. ‘It’s the golden thread – getting nurses to do everything they can do. Which is a lot.’
'We are saying to nurses "don’t just talk to nurses, talk to policy makers". We want to help nurses take a disruptive leadership role'
Many nurses around the world, she says, are effectively working at an advanced level as nurse practitioners but, particularly in low-income countries, they are doing so without the recognition of a legal and policy framework – a framework Nursing Now aims to implement globally. ‘And we are saying to nurses "don’t just talk to nurses, talk to policy makers". We want to help nurses take a disruptive leadership role and say “Okay, we are going to change things”.’
Nursing is underestimated
Another campaign aim is to have a chief nurse in every country that doesn’t have one and improved nursing representation on the boards of health organisations.
In a searing paper she co-wrote this year with fellow nurse leader Jane Salvage, Breaking the silence: A new story of nursing, she points out that the problems facing nursing today were identified by expert committees in the 1960s. Yet ‘despite all the lip-service, our potential to improve health and well-being has never been fully acknowledged or developed'. There have been some advances but nurses ‘remain mostly invisible, and in some respects things are going backwards’.
Dr Stilwell is clearly exasperated that old battles are still having to be fought, over and over again. ‘For example, we had a conversation the other day with WHO about a conference and I said “Are the chief nurses invited?” And they said, “Oh, that’s a very good point”. We shouldn’t be doing this in 2018.’ She adds that the panels at conferences ‘are too often all doctors and all men’.
Nursing Now is based on the findings of the Triple Impact report, which concluded that empowering nurses would improve health globally, contribute to gender equality – as the vast majority of nurses are still women – and build stronger economies.
How recognising what nurses can achieve will improve the health of nations
The three-year Nursing Now global campaign began in February 2018, and is in collaboration with the International Council of Nurses and the World Health Organization. The campaign is a programme of the Burdett Trust.
The campaign board is made up of nurses and others from 16 countries. Work is going on in more than 40 countries, including Uganda, Mexico, Malaysia, the Bahamas and Germany and the UK.
Nursing Now is based on the findings of the 2016 Triple Impact report by the All-Party Parliamentary Group on Global Health, chaired by former NHS chief executive Lord Nigel Crisp. The report says universal health coverage – a goal signed up to by the nations of the world in September 2015 – cannot be achieved without strengthening nursing globally.
It argues that strengthening nursing will have the triple impact of improving health, promoting gender equality and supporting economic growth.
Strengthening nursing means not only increasing nurse numbers, but enabling them to work at the top of their licence, releasing their potential and improving the efficiency of health systems.
Nursing Now aims to:
- Promote and develop nurse leaders
- Disseminate and share effective practice
- Create, identify and disseminate evidence on the impact of nursing
- Encourage investment in nursing
Action is being organised through national as well as transnational groups such as Nursing Now Scandinavia or Nursing Now Africa.
Sexual exploitation of nurses
Dr Stilwell argues that nursing’s woes are rooted in gender inequality. In the Breaking the silence paper, she points out that patriarchal societies worldwide undervalue nursing because it is ‘the archetypal female profession’.
Nurse leaders are struggling to function in ‘the macho atmosphere of many boardrooms’, while front-line nurses and midwives are silenced, ignored when they do speak up, or subjected to abuse, including sexual abuse.
She tells me that in one country (she won't identify it) where she has worked recently, nursing students were being asked for sexual favours before being allowed to qualify; and when they did qualify, they were again expected to trade sex for promotion.
I ask her if Nursing Now is a political and feminist movement. She says it is political but adds: ‘In a way I don’t think of myself as a feminist because I think of myself as entirely equal’. I’m surprised and a bit disappointed. She has no trouble calling out patriarchy, indeed her entire career could be viewed as a reproach to sexist attitudes towards nurses and women. She went on the anti-Trump women’s march in the US – and, yes, she wore the pink, knitted ‘pussy’ hat (I checked).
So why the unwillingness to identify as a feminist? Don’t make me quote you saying you’re not a feminist, I plead. She laughs, and then explains she is not disavowing feminism, just wishing that a belief in the equality of women with men was a given rather than something which requires a label or a movement. ‘In an ideal world feminism should not be necessary but of course, it still is.’
#MeToo – a moment of opportunity
Her analysis of the current situation isn’t entirely bleak. On the contrary, she’s encouraged by the growth of activism she witnessed first-hand in the US (she was based in North Carolina until returning to London for the Nursing Now job) and that is reverberating around the world. The extreme nature of the threat to women’s rights represented by the Trump presidency, and the seismic shock of the Harvey Weinstein scandal has had a galvanising effect.
In the #MeToo era women are finding their voices and being listened to – and this is opening a great opportunity for nursing. ‘We have to be aware we have this opportunity, right at this moment. I see it as a big wave, we are on a surf board and we have to ride it down.’
Dr Stilwell believes nurses are held back not only because they are mainly women, but because they are exhausted women. Changing the status quo requires an energy that many simply don’t have. Her granddaughter is a nurse at Great Ormond Street who can’t afford to live in London so gets up at 4am to travel into London from Kent. ‘She’s a zombie. The idea of saying to her, “Okay, how about stepping up to volunteer [to take on even more]”, it’s a joke. Nurses are immersed in work.’
'What goes on in the world is important because it influences all of us'
To succeed despite all this, she says, nursing is going to have to reach out and work with champions outside the profession. And this may be getting easier. She points out that sexist attitudes are far less prevalent among young male doctors than in the older generation.
But nurses who are working ‘extremely hard’ are also going to have to find a way to look beyond the job. ‘They live in their own world, and I understand why, I’ve been there. But one thing WHO taught me is that what goes on in the world is important because it influences all of us.
‘For nurses it is terribly easy to get trapped in your bubble. But sometimes you need someone to say “let’s get out of here”. We need to be better advocates for ourselves. That’s what we are saying with Nursing Now: “Are you collecting the data [on the impact of nursing] and what are you doing with it?”’
Nursing Now, under Barbara Stilwell’s leadership, is not just a celebration of nursing but a challenge to nurses. It is time to look outside the bubble. Because if not now, when?
Barbara Stilwell – CV
- Born in Liverpool to a nursing family, qualified as a nurse in Birmingham in 1973, later worked as a health visitor
- While working with a general practice in Birmingham she developed a nurse-led service with a holistic approach to care that was hugely popular with patients, many of them women from Pakistan or Bangladesh who spoke little English
- After studying to become a nurse practitioner in the US, she became one of the first nurses to practise at this level in the UK. In 1991, as a principal lecturer at the Institute of Advanced Nursing Education at the Royal College of Nursing, she introduced the first UK-based nurse practitioner programme. She was made a Fellow of the RCN in 1994, in recognition of this work
- From 1996-2006 she worked with the World Health Organization in health systems development, co-writing the WHO’s 2006 Health Report, which examined the global crisis in the health workforce and proposed a ten-year plan of action to address the chronic shortages in trained health workers
- She continued her development work with IntraHealth International, a non-profit programme based at the University of North Carolina that worked to develop sustainable human resources for health and strengthen health systems worldwide. As director of a recent project in the West Bank/Gaza, she helped to improve healthcare for serious illnesses such as cancer
- She left IntraHealth in 2018 and returned to London to take up her post as executive director of Nursing Now
- In July, Dr Stilwell was named one of the 70 most influential nurses in NHS history in a joint project by Nursing Standard and NHS England to mark the NHS’s 70th anniversary
Thelma Agnew is commissioning editor, Nursing Standard