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Nursing Now: developing nations show what nurses can achieve

The three-year campaign aims to inspire nurses around the world to fulfil their potential by challenging traditional roles and claiming their seat at the decision-making table

The three-year campaign aims to inspire nurses around the world to fulfil their potential by challenging traditional roles and claiming their seat at the decision-making table


Picture: iStock

Nigel Crisp has a far from modest ambition: he wants to ‘turn the world upside down’, and he sees nursing as the key to making that happen.

The founder and co-chair of Nursing Now, a global campaign to raise the profile of the profession, believes that as the health professionals closest to their communities, nurses should be at the heart of new models of care and prevention.

Challenging the status quo

If that means tackling what he calls the ‘baggage’ of traditional roles in healthcare, and ‘vested interests’ such as professional groups who want to maintain the status quo, then so be it.

It’s quite a challenge, but Lord Crisp, who was chief executive of the NHS in England from 2000-06, is convinced that supporting and empowering nurses is the way forward.

‘I really believe that nursing is on the point of coming into its own,’ he says. ‘Disease has changed. If we look at epidemiology globally, there has been a shift from communicable disease to long-term conditions.

‘Care and models of care are different from what they were in the past; there used to be biomedical approaches, but now we need a more holistic view of people, and biopsychosocial approaches. That means nursing is more important than it has ever been.’

What is Nursing Now?

  • A three-year global campaign founded by nurses and other health experts. It is based on the findings of the 2016 Triple Impact report by the UK's All Party Parliamentary Group on Global Health, co-chaired by Lord Crisp. This report concluded that developing nursing would have the ‘triple impact’ of improving health, promoting gender equality and building stronger economies
  • Launched in cities including London, Geneva and Kampala, Uganda on 27 February, and runs until the end of 2020
  • Has five programmes designed to persuade countries and organisations to strengthen and develop their nursing workforces
  • Aims include: involving more nurses in policy making and leadership roles; supporting development and leadership programmes within the profession; and collating and publicising evidence about the impact of nursing
  • Is a programme of the Burdett Trust for Nursing, in collaboration with the International Council of Nurses and the World Health Organization

 

The Nursing Now message has been taken up with enthusiasm across the world, in countries across the economic spectrum. Since its launch in February, with support from campaign patron the Duchess of Cambridge, Nursing Now has seen events held in countries including Uganda, Qatar and the US, and more are in the pipeline.

The campaign provides guidelines for countries hoping to set up their own Nursing Now ‘franchise’, but will not be involved in a hands-on way. The idea is to encourage local ownership and activities, although the local campaigns will be expected to share global Nursing Now values and aims. These include ensuring that nurse leaders are at the decision-making tables, and that they feel empowered to speak up.

‘The campaign has got virtually no money or staff,’ says Lord Crisp. ‘But what we’re trying to do is influence global policy, and support local endeavours.’

‘Speak up for nursing’

The international nature of the initiative is reflected in the make-up of its board, which has representatives from 16 countries, says Catherine Hannaway, campaign project manager and lead for leadership and development. Two thirds of the board are nurses and two thirds are female, she adds.

There is huge enthusiasm for the initiative, says Rose Nanyonga Clarke, vice-chancellor of the International Health Sciences University in Kampala, who spoke at the launch of Nursing Now in Uganda.

‘Nurses in Uganda were asked if we were ready for the challenge,’ she says. ‘We responded that yes, we are ready.’

Encouraging nurses to value themselves is crucial, says Sheila Tlou, Nursing Now co-chair. Having trained as a nurse, her impressive CV includes a stint as minister for health in Botswana and as a director with UNAIDS, the joint United Nations programme on HIV/AIDS. She is currently co-chair of the Global HIV Prevention Coalition.

‘When I was in parliament I was able to persuade my colleagues to look at things through a health lens,’ she says. ‘I encouraged nurses to stand for political positions. These nurses could speak up for nursing and for women’s health. But one of the issues for nurses is low self-esteem. I say to them, “look at what you have been doing, at what you have achieved: start appreciating yourselves”.’

Professor Tlou says that the success of Nursing Now will be measured on several criteria: improvements in universal health coverage; recognition of the value of nursing; greater gender equality, which in turn should help tackle gender-based violence; and more nurses in decision-making positions.

Removing barriers to innovation


Lord Crisp: Developing nations can
show wealthier ones what is possible

A major part of the Nursing Now project will be sharing examples of good practice led by nurses or midwives. This is one area in which developing nations can show wealthier countries what is possible, says Lord Crisp.

‘You could say that necessity is the mother of invention; while it is expensive and takes a long time to train a doctor, it is cheaper and quicker to train nurses to do things,’ he says. ‘That has been a big influence in middle-income countries.’

He points to Mozambique, where 90% of caesareans are done by surgical technicians – trained nurses in extended roles. This dates back to Mozambique’s independence from Portugal in the 1970s, when the new minister for health realised many doctors were returning to Portugal.

‘They found that training nurses was just as successful as doctors doing it,’ says Lord Crisp.

It is an example of looking at healthcare in a different way, without being hampered by vested interests – common in wealthier countries – where professional defensiveness can get in the way of innovation.

He is blunt about why nursing as a profession has not been given the status it should: ‘Nurses are [mostly] women, and they are not doctors – and in some countries they have been seen as little more than servants,’ he says. ‘This has to change.’

Lord Crisp hails the appointment of Elizabeth Iro as the World Health Organization’s first chief nursing officer as an important step forward, but points out that only 30-40 of the world’s countries have a chief nurse. One of Nursing Now’s targets is to raise that figure to 75%.

‘A lot we can learn’

Catherine Odeke, the former Ugandan commissioner for nursing and midwifery, also cites examples of nurse and midwife-led initiatives making a difference, but adds that their involvement has often been ‘masked’ by a focus on other health professionals. For example, it is nurses and midwives, not just doctors, who now initiate treatment for HIV/AIDS.

‘This has greatly improved access to antiretrovirals across the country,’ she says. ‘HIV/AIDS care, treatment and support services are predominantly provided by nurses and midwives.’ Nurses and midwives are also involved in screening for non-communicable diseases, she adds.

‘Nurses and midwives in Uganda have also successfully led the immunisation programme, which has registered a good result in terms of reducing incidences of immunisable diseases in the country. Immunisation coverage across the country remains at 78%.’

Lord Crisp says while it's important not to gloss over the very real problems in developing countries, there is ‘a huge amount of innovation going on’ that other countries could benefit from learning about.

‘I don't want to paint a rosy picture. But there isn’t the same baggage of vested interests and so I think there’s a lot that we can learn.’

  • To find out more and get involved in the Nursing Now campaign click here

Making nurses champions of change

When Catherine Odeke was a child, she dreamed of being a nurse. Now retired from her position as chief nursing officer for Uganda, she is determined to inspire a new generation of nurses and midwives to fulfill their potential and improve the country’s health and health services.

‘I entered nursing as a career of choice,’ she says. ‘I had an aunt who was a nurse and she was very smart in her white spotless pleated uniform. She had a special way of calming down children who were afraid of nurses and injections.

‘I made up my mind to be a nurse like her. I have never regretted making that decision.’

She says the status of nursing in Uganda has already transformed; nursing has grown to be recognised as a profession of scientists, and university nursing programmes now compete with medicine. ‘The career has grown from certificate-level education to PhD level.’

Building confidence and increasing advocacy 

But more needs to be done. There are strategic roles for nurses and midwives at local and national level, she adds, but strengthening the role of the professions will help to drive improvements in the nation’s health services.

‘The biggest challenges faced in delivering healthcare in Uganda are limited financial resources, poor basic infrastructure, inadequate human resource and shortage of equipment,’ she says. ‘These affect delivery of quality healthcare services. Emerging trends of new diseases and re-emerging diseases, communicable and non-communicable, are posing challenges to the healthcare system as they require high costs to manage.’

She believes that nurses should be supported to increase their voice and become champions of change, and hopes that Nursing Now will help make this happen.

‘Nurses and midwives form up to 73% of the healthcare workforce in Uganda; raising the profile and building the nursing and midwifery status will bring them to the limelight, strengthen their confidence to address the prevailing health problems and increase their advocacy capacity.

‘Nursing Now will provide the opportunity for them to be listened to and motivated. Their public image will be built and confidence restored.’


 

Jennifer Trueland is a freelance health journalist

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