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

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.’

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.

• RELATED: Duchess of Cambridge tells nurses ‘you’re awe-inspiring’

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

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

• What events are happening near you? Find out on Nursing Now’s interactive global map

Jennifer Trueland is a freelance health journalist