Research into the relationship between the healthcare workforce and patient outcomes shows that a satisfied staff leads to satisfied patients. While it may sound trite, the evidence base demonstrates that when nurses feel valued and respected, have a voice in organisational decision-making and career development opportunities, the result for patients is an improvement in both outcomes and their experience of care.

Fundamentally, investing in nurses is investing in patient care and that is why the International Council of Nurses (ICN) stands at the forefront of efforts to improve the working conditions of nurses around the world. The ICN organises annual workforce forums with its member national nurses associations (NNAs) to monitor workforce developments, share the latest evidence and good practice, and consider issues common worldwide to nurses, such as shortages, migration and safe staffing levels.

In 2016 two ICN forums met. Nurse leaders from Australia, Canada, China, Denmark, Ireland, Japan, New Zealand, Sweden and the US participated in the 22nd International Workforce Forum held in Washington DC. The 17th ICN Asia Workforce Forum, convened in Beijing, was attended by nurse leaders from China, Hong Kong, Indonesia, Japan, Korea, Macau, Malaysia, Singapore, Taiwan and Thailand.

Participants at the Washington and Beijing forums authored communiqués outlining the issues they believe are critical to the delivery of high-quality patient care (available at www.icn.ch/what-we-do/icn-workforce-forums). The two communiqués, developed by nurses on different continents, share striking similarities.

Lack of investment

One concern is disinvestment in nursing and failure to both train a sufficient number of nurses and to retain those we have. Today’s levels of migration and mobility are only a symptom of the global nursing shortage. We hear warm words of support for nurses and nursing from politicians, yet sadly this often does not translate into hard cash investments.

When digging deeper into different countries’ decisions, we find a similar prevailing attitude and ethos: investment in healthcare is a cost only affordable when economies are buoyant. In tough times, such spending is subject to short-term and short-sighted cost reductions.

The ICN and its member NNAs therefore welcomed the report of the United Nations High-Level Commission on Health Employment and Economic Growth.¹ The Commission rightly called for a change in the political mindset to recognize that investment in health actually drives rather than drains economic prosperity. More information on the Commission’s report and recommendations is available at:
 www.who.int/hrh/com-heeg/en. 

Think about it for a moment – health services keep the population working and productive, support families and communities, invest enormously in educating women and young people, provide a huge market for other economic sectors’ goods and services, and drive research and innovation. Cuts in health are also cuts to other sectors, creating a major impact on the economy’s overall health.

Low pay and understaffing

Lack of funding for health also means that nurses’ wages remain low. According to forum participants, a large gap still exists in wages and budgets for nursing compared to other healthcare professions. Many nurses do not want to talk publicly about low wages, and frequently some policymakers call nursing a vocation to subtly justify poor salaries. However, nurses need to live and survive like everyone else, and they make difficult economic choices about whether to accept or remain in a job. Nurses have market power, particularly in times of shortage. We all know that the profession is ageing, a human resource challenge in itself. If nurses also make early quit decisions, it will seriously compromise the ability to deliver many health services.

In addition to low wages, many forum participants identified low and inadequate staffing levels as the most significant challenge facing the profession in their country. The issue of staffing levels is where the rubber hits the road and the consequences of shortages impact both the workforce and patient health. Both forums emphasised that understaffing commonly leads to overworked and burnt out nurses, resulting in high sickness and turnover rates and, most significantly, increased numbers of untoward patient incidents including trips, falls and medication errors. Around the world, a wide range of attempts are underway to deliver safe staffing levels. Forum participants analysed examples from Australia, New Zealand, Japan and European countries. Safe staffing will be a major topic when thousands of nurses from around the world gather at the 2017 ICN Congress to be held in Barcelona, Spain from May 27 to  June 1, 2017.

Better outcomes

Forum participants recognised that by making the right investments and actions, countries and regions will have healthier people, and healthier people translate to healthier and more sustainable economies. Financial investment is needed to scale up socially accountable education, train appropriate numbers of nurses, create decent working conditions and stimulate health sector jobs, particularly for women and youth. All forum participants agreed that tackling the complex, challenging agenda facing both the profession and healthcare requires nurses being at the heart of policy decision-making. As the saying goes, if you aren’t at the table, you’re likely to be on the menu. The ICN works with NNAs to develop nurses’ leadership and negotiation skills, and to develop strategies.

Strategic influence

These skills empower the profession to influence national/regional health and education strategic plans and to lobby the government and others to increase workforce investment. Healthcare delivery is a complex and dynamic process, with connected and interrelated policy decisions. The workforce sits at the heart of health policy and political decision-making. 

We can link nursing investment to patient outcome and safety issues and to increased access to health care. The impacts of Zika and Ebola reinforce why affordable and accessible health care must be available to all.

We can demonstrate the relationship between health and economic growth. Using research evidence, we can prove that an empowered, well-educated and appropriately remunerated nursing workforce is vital to a country or region’s prosperity and security. By doing so, we cannot be dismissed as arguing purely on grounds of professional protectionism. Most importantly, it is how we will deliver change and reap the largest health gains for the patients and populations that
we serve.

Reference

1. World Health Organization (2016) Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Available at: http://www.who.int/hrh/com-heeg/en/ (accessed 22 December 2016)