Nurses: our silent heroes

While they are often in the background, nurses are at the heart of every national health system. They do everything, whether it involves caring for patients, administering lifesaving treatments in emergency situations, supervising health workers or ensuring that the correct information is passed between doctors and patients. Nurses are, in effect, the silent heroes of the healthcare system.

This week, a new global campaign, titled ‘Nursing Now’, was kicked off to celebrate the critical role that nurses play in delivering health services across the world. The campaign also seeks to ensure that recognition for nurses translates into leadership positions at all levels of the health decision-making system. ‘Nursing Now’ will run until the end of 2020, which is when nurses will be celebrated worldwide to commemorate the 200th anniversary of Florence Nightingale’s birth.

‘Nursing Now’ is an evidence based-campaign. It was conceptualised following a global review of nursing by the UK’s All-Party Parliamentary Group on Global Health, which concluded simply by reiterating that universal health coverage – the central pillar of the health-related Sustainable Development Goal 3 – cannot be achieved without developing the nursing sector across the globe.

It is no secret that the world’s health system is struggling to cope with old and new problems. Infectious killers like HIV, TB and malaria are still a major challenge in low- and middle-income countries. In addition, growing antibiotic resistance and the risk of a pandemic are presenting a tranche of new challenges that are threatening the progress made over the last few decades.

At the same time, every country in the world has seen a rise in noncommunicable diseases (NCD) that are largely driven by the global epidemic of obesity and other lifestyle-related risks. Cancer, diabetes as well as lung and heart diseases are now the leading killers of a vast segment of the population. This has presented new challenges along with climate change, new patterns of migration and the risk of new disease pandemics. Suitable reforms within the national health systems are needed to address the changing global burden of disease.

One of the fundamental principles for delivering quality health services for all is a solid workforce of well-trained and adequately supported community health workers, nurses and doctors. In order to ensure that the health workforce can tackle the new health challenges of the 21st century, it is estimated that nine million more nurses and midwives are needed by 2030. In Pakistan, there is a critical need to address this gap, where the current doctor-nurse ratio has been 2.5:1 for some time as opposed to the recommended 1:4.

This gap in the number of nurses isn’t the only issue that needs to be addressed. More often than not, nurses are undervalued and, therefore, unable to fulfil their desired potential. There are a variety of reasons for this. Since nursing is mainly a female-oriented profession, nurses are disadvantaged by traditional patriarchal structures. Despite their holistic understanding of the health system, nurses are often shut out of the health decision-making system owing to strict hierarchies and ingrained ideas about the role of nurses.

Investing in nurses in Pakistan and across the world will enhance their potential and improve their working conditions. Training and leadership skills can deliver the triple impact of improving healthcare, empowering women and strengthening local economies. As a trusted part of their communities, nurses are a key element of the process that can help us overcome today’s health challenges.

If they are properly deployed, valued and included in decision-making processes, nurses can play a critical role in promoting good health; identifying and preventing disease outbreaks; and providing care at the community level. When nurses are trained well and given greater scope to expand their roles, they deliver impressive results for patients. Maximising this potential will be vital to achieve the UN- approved goal for universal health coverage.

We are committed to ensuring that we don’t just recognise nurses but are also able to develop pathways of growth for them. We are keen on breaking the patriarchal and hierarchal systems that keep nurses from becoming key elements of the health decision-making system at all levels. One of us, as co-chair of UK’s All-Party Parliamentary Group on Global Health, is leading the global drive to mainstream the role of nursing in health systems. The other, as the co-chair of WHO’s Independent Global High-Level Commission on Noncommunicable Diseases, supported the idea that a nurse was included in the commission. Nurses are on the frontlines of the battle to tackle NCDs and drawing upon their skills and experience is critical as it determines how the commission will develop and give action to new policy recommendations to turn the tide against fatal diseases.

Nurses have been on the periphery of decision-making in the health system for too long. As the world’s health changes, we must ensure that nurses are leading the charge in how we restructure health systems to tackle the challenges of the 21st century.

Lord Nigel Crisp co-chairs UK’s All-Party Parliamentary Group on Global Health.

Dr Sania Nishtar is the co-chair of a High-Level Global Commission on NCDs.