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What well-resourced nursing practice can achieve – if nations invest in it

We need a world where governments pay nurses more, and pay for more nurses

We need a world where governments pay nurses more, and pay for more nurses


The legacy of the 2020 Year of the Nurse and Midwife needs to include a greater
global supply of nurses and better pay and conditions for them Picture: Alamy

It is always important to remember our history, especially in this 120th anniversary of the foundation of the International Council of Nurses (ICN).

While ICN president Annette Kennedy was in China last month at the 110th anniversary celebrations of the Chinese Nurses Association, I was at the graduation ceremony for our Global Nursing Leadership Institute programme in Geneva.

Speaking to the 28 leading nurses from around the world who had attended the course, I talked about how, from the beginning, ICN has been working with national nursing associations to help nurses become the best they can be.

At the end of the 19th century, two of ICN’s founders, Lavinia Dock and Ethel Bedford Fenwick, were formulating our organisation's constitution and determining what it stood for.

ICN’s original aims for education and professional standards still hold true

They declared that the ICN would aim to raise standards of education and professional ethics of the profession and increase the ‘public usefulness and civic spirit’ of its members. The language is archaic but those aims hold true.

The founders were creating the ICN, and arguably a new profession, against a background of huge social change: a new century, technological advances, the end of the Victorian age and, of course, the struggle for the emancipation of women.

Nursing is still a gendered profession, and despite the passage of time and social change, this is still reflected in many ways, including in nurses’ pay and nurses’ power.


 A nurse with a young patient in Great Ormond Street Hospital, 1900 Picture: Alamy

We campaign for nursing and better healthcare at the highest level

The ICN is taking the fight over these and other issues to where global decisions about healthcare are made: when the WHO director-general says that countries that do not have enough nurses are delivering healthcare ‘with one hand tied behind their backs,’ you know our message is getting through.

We campaigned for the World Health Organization (WHO) to appoint a chief nursing officer and Elizabeth Iro has been in that post since 2017, raising the profile of nursing with member states and advocating for the profession around the globe. We will soon get a WHO chief nursing officer for Europe.

Last month, we lobbied the United Nations General Assembly’s High-level Meeting on Universal Health Coverage, emphasising the importance of nurses in WHO’s efforts to provide healthcare for all.

‘Governments should strive to find additional funds for nurses – whether they do or not will become clear in the next few years’

Our continued lobbying and growing influence at WHO has been reflected in its latest report, Primary Health Care on the Road to Universal Health Coverage, which states that what is required to tackle the growing shortage of nurses worldwide are ‘bold and innovative approaches to training and retaining health workers and, above all, a major increase in the investment in budgets for health workforce salaries’. 

This means governments should strive to find additional funds to pay nurses more and to pay for more nurses – whether they do or not will become clear in the next few years.

The challenge ahead is massive: WHO says the predicted shortfall of nurses and midwives worldwide will be nine million by 2030.

What is required now is a step change in funding, and a greater recognition of what nurses can achieve when they are enabled to work at the full extent of their abilities.

We know that when nurses are properly educated and supported and practising at advanced levels, they can provide as good or better care than traditional models. The care nurses provide is also more cost-effective, and patients are generally happier with the services they receive.

These changes will need to be supported by governments, and that is why it is so important to have nurses in powerful policy and decision-making positions in every country on the planet.

Shockingly, many countries still do not have a chief nursing officer, and ICN is campaigning hard to rectify that situation.

We are also providing practical help to that end by adding to the supply of the most senior nursing leaders around the world through the Global Nursing Leadership Institute and our other leadership programmes.

Creating a legacy for the 2020 Year of the Nurse celebrations

Next year’s 2020 Year of the Nurse and Midwife activities and celebrations will help raise the profile of nursing with governments and the people.

But we hope its long-term legacy will be increasing the size of the total nursing workforce and changing the way nurses are supported through educational opportunity, better working conditions and improved pay.

The 2016 UK All Party Parliamentary Group on Global Health Triple Impact Report stated clearly that ‘developing nursing will improve health, promote gender equality and support economic growth’.

Through our national nursing associations, the ICN is in the vanguard helping to make that vision a reality.


Howard Catton is chief executive of the International Council of Nurses

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