A qualitative study of fourteen African countries' nursing workforce and labour market

AIM

The aim of this study was to describe factors affecting nursing education and labour markets in countries in East, Central, and Southern Africa, and critical areas for investment.

BACKGROUND

An understanding about the relationship between the supply of nurses (determined by types of educational programmes, and the quantity and quality of nurse graduates), and workforce demand is critical to health policy development.

METHODS

Six focus groups and 14 key informant interviews with nursing leaders and experts were conducted. Participants included government chief nursing officers, registrars of regulatory bodies, association leaders and heads of nursing education. The data were transcribed, coded and analysed using inductive techniques.

FINDINGS

Participants discussed challenges and strengths of nursing education, school and regulatory infrastructure, financing mechanisms for the nursing workforce, the state of nursing jobs and scope of nursing practice.

CONCLUSION

Strengthened regulations and leadership are needed to improve investment in nursing, the quality of nursing education, and working conditions and to promote the achievement of better health outcomes.

IMPLICATIONS FOR NURSING POLICY

Clarifying scope of practice for nurses in the health sector and creating competency-based requirements is important. Governments should establish positions that align with updated competencies and provide fair and safe working conditions. The current and ongoing investment case for nursing requires improved data systems and a commitment to use labour market data for decision-making.

COVID-19: The future of nursing will determine the fate of our health services

Preparing the world to manage future pandemics must take priority. It is clear that we were not prepared for the COVID‐19 pandemic which continues to cause great suffering around the world. Nurses and other health professionals everywhere must be involved in health policy planning and implementation of public health measures to combat this and future pandemics. Such preparation needs community policy involvement at grassroots levels and needs to be collaboratively instigated at international levels. The death so far of over 2000 nurses is unacceptable in this pandemic, and we need to better protect and sustain the workforce. The International Council of Nurses has been instrumental in data gathering of nurses' experiences during COVID‐19. Key points from analysis of this data have been included in Second Progress Report of the World Health Organization's Independent Panel for Pandemic Preparedness and Response. This paper summarises the key messages from this report, as well as the nursing shortage. The International Council of Nurses resounds the call for massive investment in nursing education, leadership and jobs, as well as protection for our nurses on the frontlines of the pandemic.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond

Aim

To argue that nurse practitioners have been under‐utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals.

Background

Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high‐quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID‐19 (SARS‐CoV‐2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic.

Sources of evidence

PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors.

Discussion

Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost‐effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels.

Conclusion

Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts.

Implications for nursing practice, and nursing and health policy

Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.

Global nursing leadership: alive and kicking in the midst of the COVID-19 pandemic

As the COVID-19 pandemic continues its journey around the world, it has triggered a global nursing response, with nurses everywhere working to save the lives of their extremely sick patients. In parallel with the frontline response, the International Council of Nurses, the World Health Authority and the International Confederation of Midwives have used their biennial Triad meetings to set out what needs to be done from a global perspective to protect nurses and the people they serve. At a time of crisis, it is imperative that the world's nursing leaders, through ICN's National Nursing Associations, step up to give support and guidance at this historically unsettling time.

The practice doctorate approach to assessing advanced nursing practice in Ireland

AIM

To describe the practice doctorate scholarly approach to assess advanced nursing practice in Ireland to address healthcare and nursing policy initiatives.

BACKGROUND

A global team from Ireland and the United States collaborated with stakeholders, using a practice doctorate approach to identify geographic healthcare needs, the current state of the education and the evolving roles of advanced nursing practice. In Ireland, current policy initiatives call for expanding the capacity for advanced nurse practitioners to meet healthcare needs in community settings.

SOURCES OF EVIDENCE

Further assessment data were required from stakeholders to inform graduate nursing education to prepare advanced practice nurses to fulfil increasingly complex healthcare needs. The practice doctorate approach included review of literature, current policy and assessment with interviews, dialogue and the development of working relationships with policymakers, academics and practitioners.

DISCUSSION

The current state and future vision of graduate nursing education are evolving. A force field analysis identified promoting and restraining factors to the desired state of development of the primary care advanced practice role. Relationship building with stakeholders and sharing of expertise was key to engage academia and policymakers to address identified restraining forces. Short-term outcomes included development of collaborative relationships between practice, academia and policymakers, curricular development for the primary care nurse practitioner and intentionally shared dissemination to promote community graduate nursing education.

IMPLICATIONS FOR NURSING PRACTICE

This innovative practice scholarship approach was used to assess and promote advanced nursing practice impact and promote the nursing profession globally.

IMPLICATIONS FOR POLICY

Successful collaboration between two global partners was achieved to promote policy objectives for both nursing and health care, with the ultimate goal of improving health outcomes and population health.

Roles of nurses and National Nurses Associations in combating COVID-19: Taiwan experience

As the COVID‐19 pandemic continues to expand worldwide, Taiwan has effectively contained the spread domestically and protected its citizens after registering its first case relatively early on 21 January 2020. Proactive preparedness and deployment by the national government, timely evidence and experience‐based judgements and decision‐making, information transparency, rapid response, and effective communication and measures have all been critical to combating COVID‐19 in Taiwan. Nurses play a pivotal role in providing direct health care as well as providing contact tracing and care for the quarantined clients and community care services. The Taiwan Nurses Association and other nurses’ associations serve a vital leadership role in advocating for nurses, raising public awareness, enhancing nursing’s professional profile, and sharing experiences via national and international platforms. The implications for nursing and health policy are that we need to well prepare for any unpredicted emerging pandemic in the future. Providing adequate personal protective equipment and safe staffing should be the highest priority for the governments and policymakers around the world to combat pandemic successfully.

The association between nationality and nurse job satisfaction in Saudi Arabian hospitals

BACKGROUND

Job satisfaction is important for increasing nurse retention rates. However, there is little research examining whether there is an association between nationality and job satisfaction among nurses.

AIM

To examine whether there is an association between nationality and nurse job satisfaction.

METHODS/DESIGN

A cross-sectional survey design was utilized, and 743 nurses from three major government hospitals in Saudi Arabia participated in the survey. Job satisfaction was measured using McCloskey/Mueller Satisfaction Scale. Data were collected between May 2014 and February 2015.

RESULTS

Compared with Saudi nurses, expatriate nurses had overall lower job satisfaction after controlling for other predictors. While expatriates were less satisfied than Saudi nurses about extrinsic rewards and family-work balance, however, Saudi nurses were less satisfied than expatriate nurses about their professional opportunities, praise and recognition, and co-worker relationships.

CONCLUSION

For some subscales, Saudi nurses were more satisfied than expatriate nurses, while for other subscales, the opposite was true. Nationality should be included in job satisfaction studies in countries with migrant workforces, as nationality-based differences may have been present but masked in earlier international studies by aggregating satisfaction across national groups.

IMPLICATIONS FOR NURSING & HEALTH POLICY

Policy makers in Saudi Arabia and other countries with migrant nursing workforces should have effective induction programmes that help newly employed nurses - migrant and local - clearly understand their jobs, roles and responsibilities. Policy makers must have sufficient evidence to modify the reward system to ensure fairness and equality for all.

The health of the nursing workforce. A survey of National Nurse Associations

AIM

This investigation explored the extent to which nurses' own health is a priority for global National Nursing Associations.

BACKGROUND

There is a growing body of evidence linking staff health and well-being and key dimensions of service quality, including patient safety, patient experience and the effectiveness of patient care.

INTRODUCTION

The International Council of Nurses is a federation of more than 130 National Nurses Associations, representing more than 20 million nurses worldwide. Representatives from these Associations attended a Congress in Singapore in 2019 at which a survey was conducted.

METHODS

A convenience sample of 37 leaders of National Nurse Associations from 33 countries and 61 nurse representatives took part in a survey.

RESULTS

The majority of nurse leaders and participants believed that nurses' own health should be a priority to be addressed, principally because a healthy nurse is better able to provide good patient care. All of the examples offered about how these Associations address nurses' own health were about actions to prompt individual health behaviour change.

DISCUSSION

The National Nurses Associations did not have a common terminology to talk about nurses' own health. Taking care of one's own health was included as part of the professional role and most nurse leaders thought that working conditions contributed to ill health.

CONCLUSIONS

There is widespread agreement that nurses' own health matters but for most National Nurses Associations it is not a current priority.

IMPLICATIONS FOR NURSING POLICY

Going forward nurse health and wellbeing should be a core principle for health services and professional associations, and additional research is needed that demonstrates if improving working environments contributes to nurse retention and recruitment.

Systems leadership doctor of nursing practice: global relevance

AIM

This article considers the systems leadership doctor of nursing practice degree as an option to increase nursing leadership roles and heighten presence at policy tables globally, particularly in low- and middle-income countries. Recent global reports emphasize core competencies needed for nursing leadership, particularly systems leadership and health policy, to successfully move the global health agenda forward. Using the Yale University School of Nursing programme as an exemplar, this paper is focused on the elements directly linked to leadership competencies and relevance of a systems leadership doctor of nursing practice programme globally.

BACKGROUND/INTRODUCTION

The dramatic growth and wide variability of doctor of nursing practice programmes offered in all 50 US States have generated questions and debate. According to the American Association of Colleges of Nursing as of May 2018, there are 121 schools that reported having a leadership focus in postmaster's doctor of nursing practice degree offering. Yet there has not been the same enthusiasm for development and implementation for a practice doctorate in nursing across the globe.

SOURCES OF EVIDENCE

A narrative literature review was conducted aimed at addressing the relevance of a practice doctorate globally. This analysis of the literature included a search of peer-reviewed and grey literature. Nursing school websites were visited, and opinions of nurse leaders and students were sought. In addition, global reports that supported nursing leadership and their role in policy development were reviewed.

DISCUSSION/CONCLUSION

Globally, nurses have a critical role in leading health systems. Developing a cadre of nurse leaders educated at the doctoral level who can communicate with policymakers and develop strategies to meet health systems' goals is necessary.

IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY

In recent global health reports and campaigns, strengthening nursing leadership and presence at policymaking tables are recurring themes. Offering a systems leadership doctor of nursing practice degree is one viable option to increase doctorally prepared nurse leaders for nursing policy and practice engagement. This calls for work with country and regional governments, regulatory bodies and nursing associations to empower nursing to contribute fully.

The nursing profession in Sri Lanka: time for policy changes

AIM

We address issues and challenges in nursing in Sri Lanka with the aim of identifying where and how policy changes need to be made.

BACKGROUND

Increased global interconnectivity calls for professional leadership, research, education, and policy reform in nursing as these are identified as enhancing health workforce performance and professionalization, thereby improving health systems.

SOURCES OF EVIDENCE

We draw on first-hand knowledge of health care and nursing in Sri Lanka and a recent survey of nurses at a large urban government hospital in Sri Lanka, followed by discussion and proposed action on themes identified through analysis of published and unpublished literature about the nursing profession.

DISCUSSION

Policy and action are needed to: (a) establish mandatory nurse licensure in the public and private healthcare sectors; (b) implement realistic policies to further develop nursing education; (c) develop a professionalization process to support nursing autonomy and voice; and (d) promote systematic processes for educational accreditation, curriculum revision, continuing professional development, evidence-based practice, research, leadership, and information systems.

CONCLUSION

There is a policy vacuum that requires careful analysis and strategic planning by formal nurse leaders.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Implementing change will require political and professional power and strategic, innovative, and evolutionary policy initiatives as well as organizational infrastructure modifications best achieved through committed multidisciplinary collaboration, augmented research capacity, bolstered nursing leadership, and promotion of partnerships with policy makers.

The ICN Leadership For Change™ Programme--20 years of growing influence

AIM

The aim of this article was to present experiences from the field in the context of the International Council of Nurses' Leadership for Change™ programme, which celebrates 20 years of excellence in 2016 for developing the leadership and management capacity of nurses worldwide.

BACKGROUND

The programme was launched in 1996 in order to boost nurse participation in the healthcare policy-making process, globally, and to foster within the nursing profession the requisite skills for nurses to lobby for and assume a greater responsibility in the leadership and management of health care services.

INTRODUCTION

Over the course of two decades, the programme has been implemented in cooperation between ICN, national nurses associations, the World Health Organization, Ministries of Health and a variety of donor organizations such as the W.K. Kellogg Foundation and development agencies such as USAID and AUSAID. The programme has been implemented in more than 60 nations throughout Africa, Asia, Europe, the Middle East, Latin America and the Pacific Islands, to name a few regions.

METHODS

This article offers an overview of the impact that certified ICN LFC nurse trainers and their colleagues have had in the United Arab Emirates, Vietnam and the United States of America and is affiliated islands and the North Pacific Islands.

RESULTS

Twenty years of growth and empowerment are now the ongoing legacy of the ICN LFC Program, which has graduated and deployed nurse trainers around the world and achieved significant advances in the professional development of nurse leaders on an international scale.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse leaders can improve the health and well-being of their nations in collaboration with consumers and other key stakeholders. Nurse leaders are critical in improving health systems, their work places and broader societal challenges through sound nursing practice, education, research and evidence-based health and social policy change.

Creating academic structures to promote nursing's role in global health policy

AIM

We highlight key components of emerging academic structures in global health nursing and explain how this investment can expand nursing's broader engagement in global health policy development.

BACKGROUND

Engaging nursing in global health policy development is vital to ensure the scale-up of effective health programmes. Globally, nurses promote development of interprofessional healthcare teams who are responsible for translating sound global health policy and evidence-based programming into practice. However, the role of nurses within policy forums and on influential decision-making bodies within the global health space remains limited, which reinforces suboptimal global health policy implementation.

INTRODUCTION

Investment in globally engaged academic structures is an important way to expand participation of nursing in global health policy development.

SOURCES OF EVIDENCE

A review of the current knowledge and substantive findings related to academic structures promoting global health nursing was conducted, and included a directed search of institutional websites, related grey and peer-reviewed literature, and communication with top-tier schools of nursing in the United States, to identify specific developments in global health nursing academic structures.

DISCUSSION/CONCLUSION

Effective academic structures promoting global health nursing include a framework of four critical components - Research, Education, Policy and Partnership. Academic structure type and core activities vary depending on institutional priorities.

IMPLICATIONS FOR NURSING, HEALTH AND SOCIAL POLICY

Increasingly, global health research, driven by individual nursing investigators, is expanding; however, in order to translate these advances into expanded involvement in global health policy development, academic structures within schools of nursing need to systematically expand educational opportunities, bolster research capacity and promote partnership with policymakers.

Capacity building for global nursing leaders: challenges and experiences

AIM

The aim of this article is to describe our experience in operating a capacity-building programme, the Korea International Cooperation Project, for global nursing leaders from developing countries, held during the International Council of Nurses (ICN) Conference in 2015 in Seoul, Korea.

BACKGROUND

Globalization points to the importance of global leadership among nursing leaders. In accordance with the theme of 'Global Citizen, Global Nursing' at the ICN conference in 2015, a capacity-building programme for nursing leaders of developing countries was implemented.

INTRODUCTION

The global nursing leadership programme shared experiences during the preparation and operation of the conference. To prepare the programme, this paper describes selecting participants, working with invitation lists from 30 countries, and recruiting and training volunteers. The operation of the programme, orientation, organizing tailored programmes for participant groups, addressing unexpected issues and evaluating the programme are described.

IMPLICATIONS FOR NURSING POLICY

ICN could implement capacity-building programmes for nursing leaders of developing countries during its ICN conference for the nursing society. A programme tailored for each continent with similar sociocultural backgrounds and health issues would provide chances for collaboration and networking. A policy to compile global nursing indicators should be developed. This would allow nursing leaders to learn about the strengths and weaknesses of global nursing and provide evidence for collaboration.

CONCLUSION

The programme was successful in introducing and broadening global perspectives of participants on health and education as well as building a network among leaders and next-generation leaders in participating countries for future cooperation and collaboration.

Critical care nursing organizations and activities: a fourth worldwide review

AIM

To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns.

BACKGROUND

This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009.

METHODS

An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level.

RESULTS

Fifty-nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes.

CONCLUSIONS

Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action.