Nurses can and should be global leaders on big picture issues 

9 August 2021

Article from July 2021 edition of INPractice

Ask International Council of Nurses CEO Howard Catton if 2020 was a tad exasperating given the gigantic and divisive presence of one Donald J Trump in the whole COVID debate and he "will and won't give you an answer".

"You know, we're non-political, and we're not aligned," he says. "But I often look at WHO (Trump withdrew the US from the World Health Organization before Biden reinstated it) and I saw during the pandemic, yes, there were moments where there were people who were being incredibly, extremely critical of WHO and how effective it was, whether it was partial to certain countries, whether it's soft on certain countries or not as well.

"I saw up close and personal and continue to see up close and personal the work WHO do and there's some phenomenal, incredible work, in terms of some big calls, as well as the advice and the support throughout this period. We've been proud to work with WHO and I've been impressed by very much of their leadership.

"We have heard a lot about solidarity over recent months and for me that means strengthening cooperation, collaboration and multilateralism, not the opposite. WHO, like ICN, is a member organization. They have countries, we have national nursing associations, and WHO, like ICN, can only be at its most effective when its members are strong and working together to lead a global response.

"And at the end of the day WHO cannot implement changed health policies in countries, only governments can do that."

Mr Catton, a former Registered Nurse from the UK, is a firm believer that nurses should be at the heart of health policy decision-­making and leading health care systems and delivery.

As the Geneva-based CEO of the International Council of Nurses - a federation of more than 130 national nurses associations including the ANMF, and representing more than 27 million nurses worldwide - he is committed to ensuring the ICN effectively represents nursing worldwide, advances the nursing profession and promotes the wellbeing of nurses and advocates for health in all policies.

He will also be one of the key speakers at next month's ANMF (SA Branch) Annual Professional Conference via Zoom.

"I think clearly one of the things that I want to do is to give a global overview of the nursing response to the pandemic. Because I think that it's a game-changer for the nursing profession. We have used a phrase called the COVID Effect in terms of the nursing workforce, issues in terms of infections, death, mental health, people leaving, the impact on pay and education," he says.

"So everywhere that we have looked internationally, we've seen the pandemic having a hugely significant impact.

"The pandemic has, I think, exposed some long-standing frailties and weaknesses in our health systems, but also in nursing and the job that we had to do before the pandemic to strengthen and support the nursing workforce is now even bigger, significantly bigger because of the impact of the COVID Effect.

"We can't afford not to do that investment and do that strengthening. The prospects for the nursing profession are absolutely intimately tied to what we want for health care globally and our health systems. And that sort of means that there are, and I say this guardedly and cautiously because I don't want people to take me the wrong way, but there are also opportunities to strengthen nursing, which I say we have to take. We cannot afford to not take them, butt think potentially we're in a stronger position to take them.

The ICN estimates the COVID-19 Effect, added to the current shortages and ageing of the nursing workforce, could lead to a potential shortfall of up to 13 million nurses by 2030. The longer-term impacts of COVID-19 including PTSD are currently unknown but could be extremely significant.

Close to 80% of ICN's national nursing associations (NNAs) have received reports of mental health distress from nurses working in the COVID-19 response. The ICN called this phenomenon the "mass traumatisation" of the global nursing workforce and called on governments to act immediately to support nurses and address these issues. The COVID Effect is real and risks damaging the nursing profession for generations to come, it says.

As of early this year, the cumulative number of reported COVID-19 deaths of nurses in 59 countries exceeded 3,000, with more than 1.6 million health care workers in 34 countries infected. However, the real figure globally is expected to be much, much higher. In late May, the WHO announced 115,000 health care workers have died during the pandemic to date and singled out the 'scanty reporting' on deaths and infection rates.

"The lack of a systematic data collection worldwide is a big issue we have called out... I've called its absence a scandal," Mr Catton said.

He called the lack of reporting a"catastrophic failure" to take health care worker safety seriously.

About 90% of NNAs are somewhat or extremely concerned that heavy workloads, and insufficient resourcing, burnout and stress related to pandemic response are the drivers resulting in increased numbers of nurses who have left the profession and increased reported rates of intention to leave this year and when the pandemic is over.

"You could be looking at having to replace about half the global nursing workforce.

Those are eye-watering numbers and make you stop in your tracks to think about the scale of the challenge," Mr Catton says.

"But one of the things that we've been trying to do is try and point to some solutions. And one of the solutions that we've raised was what we called a HERO fund.

"People might not like the term, but it caught the attention of the people whose attention we wanted to catch. We call it a Health, Education and Retraining Opportunity (HERO) fund."

The ICN has called on governments to make available dedicated additional funding and resources to increase health education and retraining opportunities.

"The guts of the idea of that, is that whilst we're talking about these big numbers of nurses who are leaving, we know that the pandemic has resulted in huge unemployment in other sectors of our economies, in retail, in transport, " Mr Catton said. "So why aren't we looking at trying to support people who are losing jobs in some sectors of our economy, to retrain or to be educated? To move into nursing, not exclusively nursing, into health care as well.

"We had a webinar with the International Labour Organization to talk a little bit more about that. So that a possible solution."

Mr Catton envisages the HERO fund as an example whereby the health and nursing professions can get involved in the bigger picture issues, "making sure you're in the dialogue and in the space that's outside of nursing ... the whole economy, the whole of society decisions that politicians are going to be making as well.

"And that's why we see the HERO fund as an example of that, not just saying 'You've got to do something about the nursing shortage. You've got to do something about that but if you look across the economy and all the challenges you're dealing with, here's a potential solution to it'.

"That's just an example I think of what we're trying to encourage, to make sure that nursing is in that broader picture and that's so important," he says.

"And I may well mention climate change as well. That for me, and for the ICN, is an example of something arguably even bigger than the pandemic, and nursing absolutely needs to be at the centre of that discussion as well.

"The debates around climate change, when I first remember hearing people say nurses are really important in all of this, the sorts of things that I'd hear were nurses are really important because they can make sure that you turn the lights off in hospital buildings, and reuse where you can, all of those sorts of issues, which, of course, all of us as individuals, the choices that we make can be greener, and should be greener, I'll accept that.

"But for me, the more powerful way in which nurses can and are entering the climate change debate are, firstly, that they see the impacts daily in their practice of the impact of climate change on people's health, whether it's their physical health, whether it's folk with lung conditions," Mr Catton says.

"Or it's too hot for people to get out and to exercise in parts of the world where we've seen climate-induced disasters as well, and all of the health needs that come from the mental health impacts as well.

"So I think that that's something, seeing the impact of climate change on people's health is a way in which nurses can have a very, very powerful voice.

"Our health systems have been tested by COVID and found to be failing in many, many areas. If we don't get a grip on climate, change, how are our health systems going to cope? How are they going to cope with that as well?

"And I think that also then gives nursing a really credible voice in some of the bigger macro decisions that governments have to make around fossil fuels and all sorts of things.

A report from the International Council of Nurses launched on International Nurses Day called for nurses to be the architects and designers of future health care systems. and not only the deliverers of care.

The report, Nurses: A Voice to Lead -A Vision for Future Healthcare, demonstrates the vital roles nurses play in successful health care services, and argues for greater involvement of nurse leaders in all health care organisations and at all levels, including government.

"The report underlines that nursing has been at the heart of the response to the pandemic and the COVID Effect has taken its toll underlining the case for investment," the ICN said.

"The pandemic has highlighted that it has been nurses who have been leading the response, with 90% of care undertaken by them, and it is nurses who have seen at close quarters the weaknesses, the fragilites and the fault-lines that must be addressed for the design of future health care systems."

The ICN report highlights the transformations that nurses have been leading during the pandemic, the support that the nursing workforce requires and the need for future health systems to go far beyond pandemic preparedness and be fit for purpose for all future health care needs.

Does Mr Catton envisage an end to the pandemic anytime soon?

"Last year people were talking about would we be past it this year, and we're not. I don't think that we're going to be past it next year," he says.

"What it currently looks like is that we've got some parts of the world who've moved ahead really very quickly to vaccinate. If they continue to have restrictions on travel and if the new variants don't evolve In a way that can escape or evade the vaccines that we have, then perhaps there might be some parts of the world who start to feel that they've gone within their borders back to a little bit more normal.

"But that won't really be normal, because we won't be able to be interconnected and travel and trade and do all of the global things that we've been doing, because of what we're seeing in other countries.
"Going back to anything that resembles the end of 2019 still seems some distance away for me, I have to say.

On a lighter note, does the ICN CEO have a favourite TV medical show?

"MASH was great. There used to be something called Casualty in the UK, that was filmed in Bristol. I think it still is filmed in Bristol and when it appeared on TV channels back in the '80s that was where I was training, Bristol," he says.

"And the one of the A&E (accident and emergency) charge nurses was a medical advisor for the show as well.

"When I look back on it now I think that was a show that first brought more reality (into its depiction).

"I've managed to get some of my UK channels still here in Switzerland. And there are now a lot more reality shows, fly on the wall, real life.

"I do think they have been important. And this is a more serious point, I do think they have been important in helping to shift people's attitudes about what nurses do as well, people seeing the reality, the complexity of what nurses do, the skills, the leadership, all of those things.

"I think that shift in those medical shows is a positive direction."

Listen to Howard Catton at the Annual Professional Conference.
The ANMF (SA Branch) Annual Professional Conference will now be held online from 9am to 5pm, September 22 and 23.

Aside from Howard Catton, guest speakers include nurse-comedian Georgie Carroll, ABC personality Dr Norman Swan and Linda Silas, President of the Canadian Federation of Nurses Union.

The Conference is free for WSRs and Elected delegates, $160 for members and $60 for student members.

If you haven’t booked your ticket yet, you can still register to attend below.

Register to attend

Click here to read the July 2021 edition of INPractice.