In an interview, World Health Organization Chief Nursing Officer Elizabeth Iro mentioned nursing during the COVID-19 epidemic and how nurses have risen to the challenges they face. Despite the cancellation of all activities planned to mark 2020 as the International Year of Nurses and Midwives, she believes that nursing leadership, courage, compassion, commitment and professionalism have been exposed to the world as never before. However, it is important to nurture and support the next generation of nurses so that they can help bring about the necessary changes to health systems around the world.
Prior to the announcement of the COVID-19 pandemic, the novel coronavirus was recognized as a public health problem of global concern by the World Health Organization. There were many expectations at this time, and there was a process in the WHO before the pandemic was confirmed.
It sounded very difficult. We had just celebrated the International Year of Nurses and Midwives with great ideas. We were expecting to restart the global agenda in the first of January. At the same time, we were coming up with a report from the State of the World’s Nursing (WHO 2020), on data collection, so it was very worrying. I remember feeling very anxious about how countries would respond, especially those that did not have a critical number of nurses to treat, or [were] already struggling with their pre-epidemic status.
We were very clear that we would continue with our planned plan, but we knew that some things would have to be postponed, some activities would continue but need to be reviewed, and some would have to be canceled. I think we were lucky, looking back because we had set up a committee to monitor the Year of Nurses and Midwives. That consideration and collaboration were key to keeping the pressure on certain issues, but there were some differences in the way we handled things within the organization.
There were some key issues that needed to be addressed: The State of the World’s Nursing report was the only one that needed to be finalized and implemented – it was really critical. We had a TRIAD meeting [of WHO, ICN, and the International Confederation of Midwives with world-class nurses and midwives], which was to continue, and we were in the middle of starting the State Government data collection. Global Maternity Report, as well as consultation on Strategic Directions for Nursing and Midwifery. These were important work areas that we could not take away from our eyes.
At WHO, our Director-General was very clear that normal work and activities would continue, but also that there would be a team that would respond to COVID-19 and all that goes with it, including the development of guidelines, media releases and all that. The work is divided between departments and partners across the organization. So we have been able to pass, but there are times when you have to respond internationally, participate in webinars, learn lessons from them: and I think working with the International Council of Nurses and the international nursing community was very important, as it continued to expose and share news around the world.
It was a very difficult year. What was expected of the nurses was to do the great work they always do? Obviously, some institutions and organizations had to stop the delivery of certain services, and some nurses were relocated to focus on the COVID response, but if not, I expected the nurses to continue their routine – and they did.
They answered very well. They continue to work under very trying conditions. In some countries, we have had striking nurses because working conditions were very bad, and the availability of protective equipment was not available. That to me sent a great message to governments and organizations about ensuring that we have the right equipment so that nurses can continue to provide the services they deserve. I don’t think nurses are evading their responsibilities, but I also think they are very clear in their intentions to be safe in the workplace.
Sadly, the nurses contracted the disease, and some of them died, and that was very bad. Surprisingly, the nurses have just continued to do what they have to do to take care of the people who are supposed to take care of them. The resilience was there, but their skills and knowledge, as well as their skills, show how they continued to be compassionate in the challenging environment in which they had to work.
The world has been made aware of the importance of nurses during the epidemic. That is important, but we are asking for more now. Not just acknowledging the importance of nurses, but seeing the investment now. That was the message of the International Year of Nurses and Midwives – raising the profile and creating action on investing in nurses because it is the best thing you can do to ensure the future of our health systems.
We need investments in nurses and midwives now. Thanks to COVID, we need to keep nurses active now. And we need to focus on training and educating more nurses to make sure we are dealing with shortages, and to make sure they have jobs to go to once they are trained. We want four important things as a result of the World Nurses’ report – education, jobs, leadership, and performance – because I’m worried that if we do nothing about it now, we won’t be in a better position to manage the next epidemic.
Time now. We need to do something now to start encouraging countries to really look at the options they have around nursing education, careers, leadership, and practice. This is the time to move that forward, and I feel we have aligned a few key components over the last few years. We have had the Nursing Now campaign, ICN and WHO as key partners in this implementation, we have the International Year of Nurses and Midwives, we have two key documents in the World Nursing Report and the State Report of the World Nursing Report, and soon there will be Global Strategic Directions for Nursing Midwifery, which will go before the World Health Assembly [May 2021] to assist ministers with their planning. I truly believe now is the time to make those changes.
Some countries are already starting to do some, or last year, which shows a certain increase in the number of nurses to nurses. We just need to have this policy dialogue with government nurses and midwives to import countries. That is one of the things we are doing right now, strengthening and supporting government nurses and midwives, creating a working society where we want to keep in touch with them about policy changes or problems, whether they educate, regulate or service issues they want to address. Once again, we will be focusing on the strategic direction of nursing and obstetrics and the policy options it offers. We don’t just have to rely on countries to do something: we need to be on their side to support them and make those changes and explain those requests to health departments. That is the role I am most determined to fulfill.
Some countries have nurses who work at the state level, and some do not, some countries have no one in this role, but they will have a “qualified one” in the institution as a focus area for nurses. I see my role as coming out and supporting countries that want to appoint a senior nurse, supporting those in office to help them improve and encouraging those countries that do not have [appointing someone].
It has been a very difficult year, and we have seen the leadership of nurses at various levels of practice and academics during COVID-19, coming forward and providing key documentation or guidance. My message is that nursing leadership is important, and the promotion of our young nurses will be as critical as the way forward. They are powerful; they can influence change. COVID-19’s vision of nursing leadership, commitment, compassion, courage, and professionalism – is what will provide the systematic change we want to see in our health systems. We have seen many changes in our work, but there are certain practices of nurses, such as data collection and infection prevention and control that have put us in a good position, and we need to continue with that.
I want to see the work done by the nurses. Let us celebrate their success, but let us acknowledge that they will be a change, a change for the better. I want to inform all the nurses of the world about their work in very challenging situations and thank them for their work ’.