Nursing’s big moment: why 2020 will be a platform for the profession

The British nurse heading the globally influential ICN says it’s time to build on what Nursing Now has begun

Howard Catton, the British nurse heading the globally influential ICN, says it’s time to build on what Nursing Now has begun

  • ‘Year of the Nurse’ accolade from WHO would indicate a ‘shift in attitudes to nursing’ among senior policymakers 
  • Work needs to be done to change political thinking ‘so nursing is seen as an investment, not a cost’
  • The ICN is working with Nursing Now on its aim for 75% of countries to have a chief nursing officer

 International Council of Nursing chief executive Howard Catton. Picture: Barney Newman

The British nurse at the helm of the International Council of Nursing (ICN) has no doubt that 2020 is going to be a very big year for the profession, and not just because it’s the bicentennial of Florence Nightingale’s birth.

The ground has been prepared by Nursing Now, the global campaign to raise the status and influence of nursing, and now, in an unprecedented move, the World Health Organization is putting its clout behind nursing and emphasising its vital role in achieving improvements in healthcare around the world.

‘It’s a huge year,’ says ICN chief executive Howard Catton, the former head of policy and international affairs at the RCN. ‘It looks highly likely that WHO will officially designate 2020 the Year of the Nurse. The next 18 months will provide a real platform for the profession. I think we are at a huge moment of opportunity for nursing and midwifery globally.’

A genuine shift in attitudes to nursing

In his two decades at the RCN, Mr Catton built a golden reputation as one of the most astute policy brains around. If he says this is a huge moment of opportunity, then I am inclined to think that it is. A likeable and smart man, who wears his smartness lightly, his departure for the ICN in April 2016, initially as a nursing consultant on socioeconomic issues, was a real loss for the college.

His old employer has, of course, since endured a turbulent period, with miscommunication around the pay deal in England leading to the departure of the then general secretary Janet Davies. But his new berth at the ICN cannot have been easy either, with the past few years marked by a high turnover of chief executives.

Mr Catton has been asked by the ICN board to be chief executive for the next year. He says he has ‘given up predicting’ what will happen next at the organisation, which, as a federation of more than 130 nurses’ associations, represents more than 20 million nurses worldwide.

‘When I look at the global health agenda... it is nursing work, nursing practice, that is going to get this done’

He insists that ‘Year of the Nurse’ accolade from WHO – an organisation usually more associated with doctors and economists – is a sign of a genuine shift in attitudes to nursing among policymakers at the highest level. This is not just about warm words but ‘real, concrete changes or initiatives that haven’t existed in this way before’, he says. 

‘We have a chief nurse at WHO, which we have never had before, and the director-general is someone who gets the power and contribution of nurses. Work has also started on the very first global report on the state of nursing. The aim is to publish that at the World Health Assembly in May next year.

‘When I look at the global health agenda – primary healthcare, non-communicable diseases, health education, patient safety, access [to healthcare], responding to disasters – it is nursing work, nursing practice, that is going to get this done.’

‘We need to max out the opportunities’

Though the ‘stars have aligned’ to create a period of opportunity, he warns that it won’t last forever. ‘We have next year and maybe the year after, but it may well be that by 2022 the potential for leadership will have moved on. We need to max out all the opportunities that are in front of us.’ 

A key priority is getting more nurses in senior leadership positions, in organisations providing healthcare and at policy and political level: ‘We should be pushing really hard on this.’ 

The ICN is committed to growing its leadership development programme to support the pipeline of future leaders. Nursing Now has set a target for 75% of countries to have a chief nursing officer, and the ICN is working with the campaign to track appointments. Mr Catton wants to gather as many of the CNOs together as possible at this and next year’s World Health Assembly.

The WHO state of nursing report will collate figures on the nursing labour market around
the world, ​including where nurses work, their roles and job titles. Picture: Alamy

He is also co-chairing, with Nursing Now’s Baroness Mary Watkins, the WHO state of nursing report. This will pull together data on the global nursing labour market, providing evidence on the numbers of nurses, their level of education, the types of roles they are working in, their job titles and how they are regulated.

The report is intended to be a catalyst for change that will give nurse leaders new clout at national level. ‘I’m excited about how we can use the report,’ says Mr Catton. ‘To cut through in terms of global policymaking and gaining consensus from different countries on action to be taken, evidence is critical.’  

Does demand match capacity?

The report will also analyse the demand for nursing services and how it matches up with the nursing workforce. It should raise ‘big questions’ about whether new service models are built on the capability and capacity of the nursing workforce.

It is also intended to drive much-needed investment in nursing. ‘In many places the global economic downturn had a significant impact on the employment of nurses,’ says Mr Catton. ‘There is work that needs to be done to change political thinking, so nursing is seen as an investment and not as a cost.’ He is working with the World Bank to achieve this change in perception.

But he is not simply proposing that nurse leaders lobby governments to improve the funding of nursing and healthcare: ‘Governments are not going to be in a position to fund nursing and health at the level we would like, at least not for many years. We have to be realistic. I know this is going to be controversial, but we need to look at how we bring in funding from other sources.’

Building relationships outside nursing

He cites major philanthropic organisations such as the Bill and Melinda Gates Foundation, the pharma industry and, increasingly, the tech industry, as the kind of sources that have a role supporting nursing and healthcare.

Has the move to the ICN, based in Geneva and with global reach, necessarily broadened his horizons? ‘It’s a different way of working,’ he says. ‘It’s the sheer number of players in global health and the complexity of players as well. I was talking to Zanofi the other day about how they can support some work. We reach out to tech organisations.

‘If you want to get things done on behalf of nursing the way you position yourself needs to be more flexible, building relationships you may not have had before’

‘To be effective in global health we have to manage and think about a wide array of different sorts of relationships and be flexible. If we want to move on nurse prescribing, it might be pharma and WHO we are working with. But then we go to our next project, how we can support the development of education in Africa, and of course we’ll be working with universities – or the World Bank. On a personal level, it’s a different experience. I worked with different partners [at the RCN] but this is on a different level.

‘It’s a new reality – if you want to get things done on behalf of nursing the way you position yourself needs to be much more flexible and dynamic, building relationships you may not have had before.’

Picture: iStock

The door is ‘wide open’ for the RCN’s return to the ICN

RCN members voted to leave the ICN in 2013 following a dispute over the £500,000-plus annual membership fee. Since then the ICN has changed its membership fee structure and in 2015 then ICN president Judith Shamian told RCNi that the college would pay a maximum of £340,000 if it rejoins.

In October 2017 a group of RCN members from the campaign group We Are Global Nurses signed a letter to the chair of RCN Council calling for the RCN to re-join the ICN. The issue is due to be debated at RCN Congress later this month (May). 

‘I would love to have the college back in,’ says Mr Catton. ‘The ICN would undoubtedly be an even stronger and more influential organisation if it had the RCN back in its membership.

‘There was a legitimate challenge [from the RCN] about how the ICN does business, and the ICN has changed its approach. But it is for RCN members to determine where they want to go. You trust the members and they lead you down the right path. If, as a result of discussion at RCN congress, anyone wants to talk to us about what is possible, our doors are open wide. We would love to do that.’

What does membership offer?

Can he explain to RCN members why some of the money they pay to the college should go to an organisation based in Switzerland? ‘Through the ICN we are working to get nursing not just a voice, but actions and commitments that countries sign up to. We provide experts to WHO to support policy developments.  And we are always looking for experts, so there is that level of influence.

‘But it is also about what you learn, and the relationships and networks you can build up – it can help with learning and sharing good practice.

‘The reality is the ICN is the internationally recognised voice of nursing. If you want to talk to some of the big international organisations, they will look for the recognised body.’

There is also a ‘humanitarian aspect’ to the ICN’s work, for example in the charitable support it gives to the children of deceased nurses. Mr Catton says it has a crucial role in speaking out about violence and atrocities against nurses who face terrible risks in war zones. Mr Catton insists he is ‘not being naïve’ in thinking that speaking out makes a difference: ‘If some of the dreadful things happening in the world happen and no one says anything, it normalises it.

‘I think nurses do want to help their sister and brother nurses working in different countries in challenging conditions.’

Has British nursing gone backwards since breaking from the ICN?

‘I’m not going to say that – there are still connections,’ he says. ‘But there is no doubt in my mind that organisations that are members are stronger for their participation in the global nursing community.

‘The ICN is an obvious way to facilitate that.’


‘The NHS is a model others aspire to’

Do we need to be more flexible about funding healthcare in the UK? Is it time to question some of our old certainties about the taxpayer-funded NHS? Mr Catton is far too politically canny to be unaware that he needs to choose his words carefully. 

I get the sense that his appreciation of the NHS model has, if anything, been deepened by his exposure to other systems since moving to the ICN.

‘Brexit is a game-changer... If the country is looking inwards, health leaders need to look outwards even more than they have in the past’

‘What the NHS delivers in outcomes, access and coverage is a stand-out model that many, many countries still aspire to. Within that context you do see NHS providers working with charitable or voluntary organisations, there has been a plurality of providers – the likes of BUPA and Nuffield and Virgin are quite well established. But I would not in any way suggest there should be a fundamental shift away from the NHS.’

The ICN was founded by a British nurse, and Mr Catton believes UK nursing retains a
global outlook. Picture: Barney Newman

The big issue for the UK, he suggests, is the future impact of Brexit. ‘Brexit is a game-changer. Health is a global phenomenon, you can’t isolate yourself even if you want to.’

So how serious is the risk of British nurses becoming isolated? ‘It is vital that health leaders in the UK work to grow and strengthen their relationships, their connections, their collaborations with other countries in a post-Brexit environment. If the country is looking inwards, health leaders need to look outwards even more than they have in the past.’

‘International outlook in our DNA’

Mr Catton points out that the ICN was founded, 129 years ago, by a British nurse, and historically many British nurse leaders have recognised the importance of global connections. This tradition – having ‘an international outlook in its DNA’ – is something he believes UK nursing needs to build on, now more than ever.

The challenge for UK nursing after Brexit will not be just to stay involved internationally, but rather to continue to show leadership. ‘Other countries pay attention to developments that come out of nursing in the UK. If UK nursing supports a new policy or role or innovation, many other countries notice – and more than notice, they take a lead from the UK. It still really matters what UK nursing does.’

Thelma Agnew is commissioning editor, Nursing Standard

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