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Nursing and Sustainable Development: Furthering the Global Agenda in Uncertain Times

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William E. Rosa, MS, APRN-BC, FCCM, FAAN
Michele J. Upvall, PhD, RN, CNE, FAAN
Deva M. Beck, PhD, RN
Barbara M. Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC


These are fragile and uncertain times for the health and survival of both humanity and the planet at large. The outlook may appear bleak, but there is hope. The rapidly evolving field of global health calls for wisdom and advocacy firmly rooted in a nursing perspective and integrative lens. Global nurses have long been leaders and agents of measurable change in the advancement of physiologic, social, environmental, and economic health determinants. It has been noted that nurses have the potential to make vital contributions toward achieving the United Nations (UN) 2030 Agenda 17 Sustainable Development Goals (SDGs) across settings. The purpose of this article is to make explicit the multifaceted links between nursing and the SDGs. The article first discusses the background and significance of current challenges and the UN 2030 Agenda for Sustainable Development. The authors explain the importance of good health and partnerships, and note the legacy of Nightingale and the Agenda. Finally, they review both opportunities and challenges and ethical considerations related to the SDGs and offer implications for nurses to take action. In its highest form, the UN 2030 Agenda is a holistic framework to eradicate inequity, preserve the well-being of all species, and engage health from whole-system and whole-planet perspectives – work so desperately needed in this era of future uncertainties.

Citation: Rosa, W.E., Upvall, M.J., Beck, D.M., Dossey, B.M., (May 31, 2019) "Nursing and Sustainable Development: Furthering the Global Agenda in Uncertain Times" OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 1.

DOI: 10.3912/OJIN.Vol24No02Man01

Key Words: global health; global nursing; SDGs; Sustainable Development Goals; United Nations; planetary health; social determinants; global citizen; Nightingale; partnerships

These are fragile and uncertain times for the health and survival of both humanity and the planet at large. These are fragile and uncertain times for the health and survival of both humanity and the planet-at-large. The overall picture of human well-being is unacceptable, at best, and possibilities for individuals to create and sustain health for themselves, as well as for their families, communities, and countries, continue to be out of reach for many. The United Nations (UN, 2018) estimates about 11% of the world’s population, roughly 783 million people, live in extreme poverty; 815 million are undernourished; 58% of children and early adolescents of primary or lower secondary school age worldwide fall below minimum reading and mathematics proficiency standards; 29% of the global population lack safe drinking water; and 61% go without safe sanitation services. There are staggering inequalities within and between nations and injustices based on age, gender, sexual orientation, disability, and a host of other factors. Over 44,000 people are forced to flee their homes daily, due to persecution or conflict, with an estimated total of 68.5 million forcibly displaced people worldwide (UN High Commissioner for Refugees, 2001-2018). These many hindrances to social justice keep humanity from progressing toward a world of inclusion and equity. More than 1,000 human rights activists and journalists have been killed since 2015 in 61 nations, “...equivalent to one person killed every day while working to inform the public and build a world free from fear and want” (UN, 2018, p. 12).

The planet is also suffering. Extensive evidence suggests our planet is losing capacity to sustain the human population due to rapidly dwindling natural resources, such as insults to air, water, and land integrity; substantial biodiversity degradation; and multidimensional threats to ecological sustainability (Whitmee et al., 2015). The World Meteorological Organization (2018) confirms 2015-2017 as the three warmest years on record, while 2017 became the most expensive year for the United States, due to extreme weather events and climate disasters. Of paramount concern, it is estimated that global warming of roughly 1.5° Celsius is expected between 2030-2052 with devastating implications for worldwide populations (Intergovernmental Panel on Climate Change, 2018). Furthermore, such climate-related floods and storms slowed global developmental progress in many nations. Global marine fishstocks are plummeting, coastal waters are deteriorating, continued deforestation is threatening many species’ survival, and the earth’s worldwide vegetative productivity is on the decline, endangering the livelihood of over 1 billion people who depend on subsistence agriculture for survival (UN, 2018).

The rapidly evolving field of global health requires wisdom and advocacy firmly rooted in a nursing perspective and integrative lens. The rapidly evolving field of global health requires wisdom and advocacy firmly rooted in a nursing perspective and integrative lens. The outlook may appear bleak, but there is hope. Global nurses have long been leaders and agents of measurable change in the advancement of physiologic, social, environmental, and economic health determinants. Nurses in this field possess an understanding of humanity as interconnected and interdependent and health as holistic; the skills to develop person-/population-centered interventions; and the leadership ability to foster sustainable transdisciplinary partnerships built on mutual benefit and respect (Dossey & Keegan, 2016; Upvall & Leffers, 2014; Wilson et al., 2016). At this juncture in planetary existence, there has never been a more pressing need for the intersection of nursing philosophy, the embodiment of professional ethics, and a staunch commitment to social justice. These pillars are no longer optional extras in nurses’ personal and professional lives. These are imperatives to procure health and well-being for the whole of the global village and to restore ecological integrity across the natural systems that govern all of life.

The purpose of this article is to make explicit the multifaceted links between nursing and the singular most visionary, ambitious, and wide-scoping international initiative of our time: the United Nations 2030 Agenda for Sustainable Development. It’s been suggested that nurses play vital roles in advancing myriad aspects of the 2030 Agenda across settings, from the individual and family to the national and transnational, from local to planetary (Rosa, 2017a). In its highest form, this UN vision is a holistic framework for eradicating inequity, preserving the survival of all animal species, and engaging health from whole-system and whole-planet perspectives. By attending to the 17 Sustainable Development Goals (SDGs) made explicit in the UN Agenda, nurses can lead with globally informed clarity and purpose in these uncertain times; and they can do so while embodying the disciplinary values and caring foundations inherent to Nightingale’s legacy to better facilitate healing and health for all people everywhere.

Background and Significance

In this time of change and uncertainty, our discipline continues to adopt ethical principles and guidelines to engage local, national, and international needs...The profession of nursing continues to mature and expand its scope of priorities in order to meet the health demands of the global village and the planet as a whole. Planetary health is taking priority as scholars identify opportunities for nurses to improve the well-being of the planet and heighten professional and population awareness of planetary health (Kurth, 2017a, 2017b; Myers, 2017); advance nurse-led climate change research to identify the impact on vulnerable populations (George, Bruzzesse, & Matura, 2017; Leffers et al., 2017; Leffers & Butterfield, 2018); and recognize the sequelae of declining environmental health as a climate justice issue of notable proportion (Nicholas & Breakey, 2017). In this time of change and uncertainty, our discipline continues to employ ethical principles and guidelines to engage local, national, and international needs (McDermott, Leffers, & Mayaka, 2018); revise models of partnership to be more inclusive and respectful (Upvall & Leffers, 2018); and prepare nurses to mitigate the impacts of complex humanitarian emergencies and natural disasters (Williams & Downes, 2017). As nursing continues to be at the forefront of health and well-being for society, global health agendas provide a necessary guidepost to frame our interventions locally, globally, and at the planetary level.

The UN 2030 Agenda for Sustainable Development

...the UN 2030 Agenda for Sustainable Development provides strategic directions to meet the health needs of society, animal species, ecological systems, and the planet Unanimously adopted by 193 UN General Assembly Member States in September 2015 and officially enacted since January 1, 2016, the UN 2030 Agenda for Sustainable Development provides strategic directions to meet the health needs of society, animal species, ecological systems, and the planet (UN, 2016). The 2030 Agenda is comprised of 17 SDGs with 169 targets that address social, economic, and environmental determinants of health. The 17 SDGs are listed in Figure 1. The SDGs aim to create a just, peaceful, and inclusive society, organized into five key thematic areas: People, Planet, Peace, Prosperity, and Partnership. Of note, this Agenda is not legally-binding and each country prioritizes the SDGs and targets they will focus on within their boundaries. This Agenda will be in place until 2030 and follows in the footsteps of the eight UN Millennium Development Goals (MDGs), which were in place from 2000-2015 (UNDP, 2019).

Figure 1. The 17 Sustainable Development Goals

[View full size]

(UN, n.d.).

No nurse and no country can successfully attain the Agenda in its entirety. The 17 SDGs are merely a guide to enact real change through strategic measures. No nurse and no country can successfully attain the Agenda in its entirety. The 17 SDGs are merely a guide to enact real change through strategic measures. At first glance, the 2030 Agenda document can pose overwhelming challenges. At the same time, a key action step of nurses is to ‘localize’ or ‘contextualize’ the SDGs to their personal and professional environments by identifying population needs and organizational priorities, selecting relevant SDGs targets that are meaningful in their given context, and fostering partnerships to attain those priorities at local levels (Dossey, Rosa, & Beck, 2019).

A major focus of the SDGs is to ‘leave no one behind’ (UN, 2016). It is important to clarify what this means and how nurses should approach their local-to-planetary health strategies. According to the UN Development Programme (UNDP; 2018), nurses must consider the following in order to foster an inclusive world:

Discrimination: against those who face biases, exclusion, or mistreatment based on one or more features of their identity, from age and/or class to disability and/or migratory status.

Geography: where those who experience isolation or vulnerability, as well as lack of public services or infrastructure gaps, due to location or place of residence.

Governance: with those who experience disadvantaged circumstances due to unjust institutions at local, national, or global levels; those impacted by inequitable policies and laws; and those unable to participate or wield influence in the decision-making that governs them.

Socioeconomic status: of those who face deprivation or disadvantage in access to health, education, income, clean water and sanitation, energy sources, social protections, financial services, and experience overall poorer quality of life.

Shocks and fragility: of those with increased exposure to natural disasters, the effects of climate change, and other shocks, such as health emergencies and economic hazards.

The 2030 Agenda builds a strong case for inclusion and social justice; a case that is ultimately founded on two common threads - good health and partnerships.

Good Health and Partnerships: The Common Threads

Significant advances in global health have been made since the Millennium Development Goals (2000-2015) were adopted worldwide...The one SDG with comprehensive health outcome targets is SDG 3, “Ensure healthy lives and promote well-being for all at all ages” (UN, 2016). Significant advances in global health have been made since the MDGs (2000-2015) were adopted worldwide, particularly in the socioeconomic agendas of low and middle-income countries (LMICs). For example, maternal mortality and under age 5 mortality decreased by 37% and 47% respectively. In some of lowest income countries across sub-Saharan Africa, the under-5 mortality rate dropped by 50% (UN, 2018). Adolescent birth rates have also declined, along with a lower incidence of HIV infections and newly diagnosed cases of tuberculosis, and with decreased Hepatitis B infections among the under-5 population. However, these successes are also mitigated by challenges, specifically the increase in noncommunicable diseases (NCDs) across the globe; the scarce number of healthcare providers available in LMICs; and the increased financial burdens placed upon households to pay for health services (Crisp & Chen, 2014; Mboi et al., 2018; UN, 2018; World Health Organization [WHO], 2016a).

While some LMICs realize remarkable success in meeting some of the targets for SDG 3, this success remains uneven across countries. There is a chasm between progress made and what still needs to be accomplished for global health through the SDGs (National Academies of Sciences, Engineering, and Medicine, 2018). But this chasm can be bridged through partnerships. The focus of SDG 17- Partnerships for the Goals- provides the pathway to meet the remaining SDG targets.

More dynamic models of partnership are Global South to Global South partnerships. Partnerships can be established between economically disadvantaged countries (i.e., the ‘Global South’) and countries that are classified as high income or the ‘Global North,’ as well as through triangulated partnerships where multilateral agencies provide external funding (UN, 2015). The traditional model of global health partnership has been a country from the Global North, which provides aid or capacity building efforts to Global South countries. But this model is not sufficient and too often ignores the voices of Global South stakeholders (Upvall & Leffers, 2018). More dynamic models of partnership are Global South to Global South partnerships. These Global South to Global South partnerships are more regional in nature among LMICs and possess a potential for success based on equality and mutual benefit (Bry, 2017).

Regardless of the types of partnership, transparency and bidirectional learning promote collaboration and the interests of all partners to emerge (Upvall & Leffers, 2018). Dias (2014) describes how one nursing school in Pakistan changed the profession of nursing in their country by partnering to provide continuing education and faculty development activities for nurse leaders and faculty across schools throughout their nation. This nursing school further influenced the profession in the surrounding regions when they were invited by nurse leaders of Kenya, Tanzania, and Uganda to partner in the development of advanced nursing studies programs in each of their nations.

No SDG supersedes another SDG.No SDG supersedes another SDG. All SDGs should be a priority for all countries, but SDG targets cannot be achieved unless there is a healthy population (SDG 3) able to work toward all goals. Furthermore, these goals cannot be achieved alone or in isolation. Partnerships (SDG 17) based on mutual trust and respect facilitate each country’s ability to meet the targets of the SDGs. Regardless of partnership type, whether Global South to Global South or Global North to Global South, power must be shared among and between the partners with full transparency and accountability in meeting SDG targets.

The Legacy of Nightingale and the UN 2030 Agenda

The 2030 Agenda is historically and distinctly a nursing agenda. The 2030 Agenda is historically and distinctly a nursing agenda. As we prepare to globally celebrate the Bicentenary of Florence Nightingale's birth in the year 2020, her insights still have fresh relevance toward a new vision for achieving a healthy world community, through ‘we the peoples of the United Nations’ and with the 17 UN SDGs as modern approaches to light the way.

In fact, Nightingale’s life and work anticipated these SDGs, all as factors in recovering and maintaining health. For instance, SDG 1 aims to “End poverty in all its forms everywhere.” In the 1860s, Nightingale worked to reform the Liverpool Workhouse Infirmary where 1,200 impoverished and hungry people were crowded into unsafe, unsanitary conditions. Because of this effort, and at Nightingale’s urging, reform of the entire British workhouse system included placing salaried nurses who addressed these conditions in workhouse settings for the very first time.

Good health and well-being continue to drive the work of nurses and midwives globally. SDG 3 most reflects a lifetime of Nightingale’s effort and contributions. Good health and well-being continue to drive the work of nurses and midwives globally. Moreover, Nightingale saw health as a dynamic phenomenon, resultant of myriad influences, and beyond the ‘sick-care’ model of the day. She was a holistic advocate for health and well-being. She wrote, “When we obey all [of nature’s] laws as to cleanliness, fresh air, pure water, good habits, good dwellings, good drains, food and drink, work and exercise, health is the result: when we disobey, sickness.” (Nightingale, 1876, p. 5).

Building upon her own service to soldiers during the Crimean War and for many years thereafter, Nightingale was also keenly aware of the measures needed to prevent war and to promote peace. With this experience and knowledge, she was called upon to write (anonymously) the British government’s official text submitted to craft the First Geneva Convention, which subsequently informed the formation of the League of Nations and later the UN. Her early insights and passionate commitment to this field of human concern and welfare inherently influenced the therefore led directly to the establishment of SDG 16: “Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.”

Attention to Achieving the SDGs: Opportunities and Challenges

Nurses in high-income countries (HICs) like the United States are often challenged to focus attention on the SDGs and to translate the SDGs into upstream, purposeful action; challenged to expand their consciousness as ‘global citizens’; and challenged to recognize that strengthening global partnerships for sustainable development first requires becoming more aware of how individuals and communities define ‘health.’ This requires cultural sensitivity, understanding that health beliefs and values vary between cultures, and respecting these differences in theory, practice, and policy (Beck, Dossey, & Rosa, 2018).

As nurses articulate their mission and vision toward accomplishing the 17 SDGs, they are seen as leaders and advocates who are cultivating and motivating citizens and communities to be more engaged in SDG attainment. Thus, nurses can instill confidence and create cohesive nursing and interprofessional teams and environments of authentic caring in institutions, clinics, and communities. These endeavors can spark new insights about vulnerable populations and lead to informed action toward universal health coverage (UHC) and health equity as well (WHO, 2016b).

Nurses in HICs can become SDG change agents as they use their voices to address social injustice and provide hope across the globe. They can create environments that foster positive personal and professional development, inclusive networking, mutually beneficial collaboration, and mobilize collective efforts to inspire ‘planetary thinking’ (Rosa, 2017b). When this is realized, nurses fill gaps in practice, education, research, and healthcare policy toward transformation and healing from local to global and planetary levels (Rosa & Upvall, 2018). 

To translate the SDGs into personal action, nurses must also learn more about their own healing...To translate the SDGs into personal action, nurses must also learn more about their own healing, leading to more complex levels of personal understanding and meaning and insights (Dossey, 2016). Nurses are decisively advancing the way toward a reorientation of values and behaviors that promote wellness and the continuity of humanity on Earth and strategies and engagement to translate the SDGs. Nurses have the knowledge and skills, and the caring stance, to promote peaceful and inclusive societies for sustainable development where justice for all may be realized. Understanding healing as an emergent process of the whole system brings together aspects of one's self and the body-mind-emotion-spirit-environment-culture at the deeper levels of inner knowing. This leads nurses as individuals and professionals toward integration and balance, with each aspect having equal importance and value. 

...deep listening involves being present and focused with intent to understand what another person is or is not expressing. To profoundly understand how the SDGs are interrelated, nurses must enter a shared experience with each other and diverse disciplines to promote growth, healing, and an experience of well-being. This is to enter a space of ‘not knowing’ or being free of fixed ideas, allowing one’s state of presence to listen deeply and adapt to the needs at hand (Soulé, 2016). This deep listening involves being present and focused with intent to understand what another person is or is not expressing. A nurse’s empathy, caring, and respect flows when bearing witness to another, shifting an experience of separateness into one of connectedness. In this energetic space, the self and ego are transcended by a sense of indivisible unity, which is the underlying ethos of the UN 2030 Sustainable Development Agenda (Dossey, 2016; Dossey, Beck, Oerther, & Manjrekar, 2017).

The Nursing Code of Ethics: Global Considerations to Meet the SDGs

The American Nurses Association (ANA, 2015) Code of Ethics with Interpretive Statements offers the nursing profession nine provisions through which to create and deliver ethically sound care. As global nurses invested in attaining the 17 SDGs, our profession must continue to reflect on these provisions, expanding their implications by continuing to frame health beyond human needs, to include animal and planetary considerations. Table 1 provides ANA’s (2015) provisions of the Code of Ethics accompanied by reflections on a global scale. This table promotes the paradigm shifts needed to move from a human-based ‘sick-care’ health model toward an integrative and holistic preventive model of ‘One Health’ – interconnecting the health needs of humanity, animal species, and our planet (Lueddeke, 2016; Rosa & Upvall, 2018).

Table 1. Global Considerations Related to the Provisions of the American Nurses Association Code of Ethics

Provisions of the Code of Ethics
(ANA, 2015)

As global nurses, we recognize the following provisions as an ethical starting point for our work:

Global Considerations Related to the Provisions of the ANA Code of Ethics (2015)

As global nurses, we:

Provision 1

The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

  • Re-member all people everywhere by listening to their stories and including them in the conversations and decisions that matter to them.
  • Honor the contextual and unique characteristics of those we serve.
  • Acknowledge the inherent worth of all species and ecosystems with respect for the interdependence of a globalized world.

Provision 2

The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

  • Redefine ‘patient’ to include the planet, its natural resources, and all animal species.
  • Refine and recommit to our work as vanguards of planetary health on an ongoing basis.
  • Adjust personal practices and implement systems improvements that do not serve our ‘patient’s’ greater good.

Provision 3

The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

  • Strive to defend the rights of animals and ecosystems unable to advocate.
  • Advocate for policy changes that procure global safety and preservation of nature’s resources.
  • Protect the best interest of the ‘patient’ through scholarly contributions, environmental activism, and interprofessional best practice and ongoing education.

Provision 4

The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.

  • Bring a nursing sensibility to the global decision making tables.
  • Identify actions and methods that are not consistent with the promotion of health and optimal well-being for the ‘patient’.
  • Foster interprofessional alliances that create an accountable and responsible global health sector.

Provision 5

The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

  • Engage in regular self-care practices, understanding that the quality of care for self is the basis for how we are able to deliver care for others and for the planet.
  • Take deliberate steps to restore integrity where it is lost at personal and global levels.
  • Choose to live a life of immersion that promotes universal inclusion of the human/planetary narrative and takes accountability for reclaiming it.

Provision 6

The nurse, through individual and collective effort establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.

  • Infuse all work settings with an ethical commitment to the preservation of dignity for all (including self and planet).
  • Improve mechanisms to promote safety and ensure that all health care is of the highest quality possible given the context and resources available.
  • Hold authorities responsible for sustaining settings and policies that are unethically managed through a commitment to social and environmental justice.

Provision 7

The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

  • Maintain professional standards that expand the global scope of practice for nurses and create an environment for planetary health to flourish.
  • Identify planetary health determinants and collaborate with key stakeholders to improve the likelihood of good health for all.
  • Translate health ethics into health policy by educating policy makers and the general public about planetary considerations for well-being.

Provision 8

The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

  • Address inequities and disparities in health, education, economic opportunity, and politics.
  • Clarify nursing’s unique contributions to public and global health agendas through the dissemination of scholarly advancements and culturally inclusive health promotion.
  • Invite experts outside of the nursing profession to contribute to initiatives for a One Health approach to solutions that are attainable for all.

Provision 9

The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain integrity of the profession, and integrate principles of social justice into nursing and health policy.

  • Teach and practice social justice as a central component to global nursing, global health, and global well-being for all beings on the planet.
  • Support professional organizations that promote the positive and visionary image of global nurses as leaders in the journey toward global health equity.
  • Participate with ethically aligned interprofessional organizations in order to maximize our collective impact and mobilize global unity.

Reprinted with permission from Rosa, W. (2017c)

Implications: Nurses Taking Action

...the US is a notoriously poor performer in the achievement of SDG target measures...The UN 2030 Agenda for Sustainable Development provides a prescription to transform our world from its current state to one without poverty and inequality, a place where both people and the planet thrive. The pace and commitment of implementation varies greatly; implications for the US are strikingly similar to other countries. However, the United States is a poor performer in the achievement of SDG target measures and ranks only 35 of 156 in terms of implementation outcomes (SDG USA & Sustainable Development Solutions Network, 2018). U.S. statistical data that reflects progress toward achieving the SDGs (U.S. Office of Management and Budget, n.d.) reveal significant challenges as the country grapples with income inequality, conflicting views on climate change, and discord about providing UHC. While these conditions have existed for some time, nurses should not be deterred from aggressively pursuing actions to improve health and well-being.

Consistent with the prescient beliefs of Florence Nightingale, nursing organizations around the globe are helping to promote a nursing action agenda consistent with the SDGs. The International Council Nurses (ICN), with over 130 national nursing associations representing more than 20 million nurses, leads nurses worldwide to advance our profession and influence health policy. Among its many activities, ICN supports initiatives connected to the SDGs, including the WHO Independent High-Level Commission on Noncommunicable Diseases (NCDs), the Deliver for Good campaign, and Nursing Now (ICN & Nursing Now, 2018).

Nurses know firsthand the crippling effects of NCDs and mental health challenges, including premature death, disability, and diminished quality of life. The United States also feels the impacts of NCDs. From 2014 to 2016, life expectancy in the US declined from an average of 78.9 years to 78.6 years (Centers for Disease Control and Prevention, 2017). The NCD burden has also increased healthcare costs and threatens economic growth. Nurses are integral to addressing the root causes of major preventable NCD conditions, such as cardiovascular diseases, cancers, chronic respiratory diseases, and type 2 diabetes, and can do so by working to mitigate tobacco and alcohol use, encouraging physical activity, promoting healthy eating, and engaging in their own self-care (ANA, n.d.). Nurses are also on the front lines fighting other public health concerns, including mental and substance use. The WHO (2018) High Commission report, Time to Deliver, cited nurses as invaluable allies for action against NCDs and emphasized the roles they can play as clinicians, health coaches, educators, and spokespersons.

Empowering and investing in women and girls can accelerate prosperity. The Deliver for Good campaign (Women Deliver, 2018) aims to support the SDGs by encouraging investments in women and girls to promote gender equality and improve their access to healthcare, education, and economic opportunities. Empowering and investing in women and girls can accelerate prosperity. Partner organizations such as ICN and its members are amplifying the actions to help women and girls — actions that will create ripple effects of healthier people and communities, stronger economies, and progress across all the SDGs (Holguin, Hughes, & Shamian, 2017).

...nurses are indispensable to promoting health, preventing disease, and managing NCDs. The Nursing Now (Burdett Trust, n.d.) campaign aims to raise the profile of nurses globally to improve health. Through country level organizations and global support, this project will influence investments in nurses to create opportunities, serve in leadership positions, access better education and training, enhance evidence-informed practice, and promote nurse-driven models of care that improve UHC without financial hardship. Increasing UHC is one of the key mechanisms to advance the SDGs. Joint pronouncements by ICN, Nursing Now and the WHO (ICN, 2018; Crisp & Iro, 2018) — in support of the Astana Declaration on Primary Health Care — reinforce the essential nature of UHC and primary care. As the most prevalent group of healthcare workers who provide effective primary healthcare in diverse settings, nurses are indispensable to promoting health, preventing disease, and managing NCDs. ICN and WHO lead Nursing Now in collaboration with the Burdett Trust (n.d.).

Sigma Theta Tau, the International Honor Society of Nursing is also elevating the voice of nurses and midwives globally to strengthen the profession and health systems and improve health outcomes through their Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON) (Sigma Theta Tau, International Honor Society of Nursing, 2019). GAPFON’s work with global regional stakeholders strategically aligns with accelerating progress on the SDGs. Their report, which highlights progress from 2014-2017 (Sigma Theta Tau, International Honor Society of Nursing, 2017), identifies five main global health issues: NCDs, including chronic diseases; mental health, including substance abuse and violence; communicable diseases; disaster preparedness and response; and maternal-child health. It further identifies strong leadership as the requisite professional foundation to advance nursing and midwifery.

For over two decades, the ANA has supported a transformative agenda to change American healthcare to ensure that all people have access to quality affordable care. ANA actively supported passage of the Affordable Care Act in 2010 which was directed toward providing coverage for over 40 million Americans who lacked health insurance. In 2016, the ANA issued their Principles for Health System Transformation laying out requirements for an effective system, consistent with SDG 3. These called for: access to a standard package of essential benefits; optimized primary, community-based and preventive services; cost-effective use of acute, hospital-based services; mechanisms to stimulate economical use of healthcare services, while supporting those unable to pay for care; and a sufficient supply of a skilled workforce (ANA, 2016).

ANA, together with other professional nursing associations, has also advocated for removing barriers and ensuring full practice authority for all registered nurses to improve access to care. Advanced practice nurses who deliver primary care and manage NCDs, RNs who provide care coordination, and RNs together with teams who address public health and other community-based services, are all positioned to impact the social determinants of health and, in turn, advance achievement of the SDGs. Most recently, the ANA Board of Directors unanimously approved the following statement: “ANA supports the Sustainable Development Goals - 2030 Agenda for Sustainable Development - and will align ongoing strategic policy and programmatic work to reinforce the need for investment in the nursing profession as critical to achieving the SDGs” (Pamela F. Cipriano, personal communication, November 30, 2018).

Table 2. Everyday Actions by Nurses to Advance the UN SDGs during Uncertain Times and in the Future

  • Make the SDGs a part of routine personal and professional conversations
  • Promote and educate about the need for universal health coverage
  • Advocate the full scope of nursing practice authority without barriers
  • Advance gender equality
  • Expand nursing roles to provide greater emphasis on public health, disease prevention, and the promotion of wellness
  • Partner with communities to leverage nurses’ voices in influencing healthy eating, exercise, clean air, safe water supplies, and the eradication of hunger and poverty
  • Participate in the Nursing Now campaign
  • Seek leadership positions to drive health-related decisions
  • Build and promote a diverse workforce


The health of individuals is inextricably linked to the state of the world around us.The health of individuals is inextricably linked to the state of the world around us. While much of the discussion in this article has focused on improving health, many socially-conscious nurses, professional associations, and healthcare organizations are committed to driving measurable progress related to the environment, socioeconomic issues affecting people and communities, and other drivers of equity and justice reflected in the SDG targets. All these activities, taken together, inform a blueprint for action that demands nurses’ contributions to global health at local and international levels in keeping with achievement of the SDGs. In alignment with Nightingale’s teachings and still-relevant wisdom, nurses can address the SDGs by asserting their knowledge, skills, and desire to lead (Table 2). Nurses are the largest healthcare cadre worldwide. When supported to advance and lead, nurses worldwide maintain the potential to wield a profound impact on improving health and well-being for all people, species, and our planet.


We would like to thank Pamela F. Cipriano, PhD, RN, FAAN for her support in the writing of this article.


William E. Rosa, MS, APRN-BC, FCCM, FAAN

William Rosa is currently an RWJF Future of Nursing Scholar in the University of Pennsylvania School of Nursing PhD Program in Philadelphia, PA. Mr. Rosa received a BSN, magna cum laude, from NYU Rory Meyers College of Nursing (2009) and was valedictorian of his MSN class at Hunter College (2014). He is the editor of three books on leadership, global health, and caring science and has contributed more than 100 publications in a host of diverse forums. Mr. Rosa has been recognized with local, national, and international awards. He is a Fellow of the American Academy of Nursing, the American College of Critical Care Medicine, and the New York Academy of Medicine. Most recently he received the 2018 national Lillian Wald Service Award from the American Public Health Association’s Nursing Section and will be inducted as a Fellow to the American Association of Nurse Practitioners in June, 2019.

Michele J. Upvall, PhD, RN, CNE, FAAN

Michele Upvall is a professor at University of Central Florida College of Nursing in Orlando, FL. Dr. Upvall received a BSN from the Indiana University of Pennsylvania, an MSN from Penn State University, and a PhD from the University of Utah. She also completed certification as a Family Nurse Practitioner from Arizona State University. She has developed and facilitated innovative nursing programs for American Indians, and in countries including Pakistan and east Africa. Most recently, Dr. Upvall completed a Fulbright Specialist scholarship at Khon Kaen University in Thailand where she continues to mentor faculty and students developing their scholarship. She is an active volunteer for Health Volunteers Overseas and is a member of the ANA Center for Ethics and Human Rights Advisory Board.

Deva M. Beck, PhD, RN

Deva Beck has served as International Co-Director of the Nightingale Initiative for Global Health (NIGH) in Neepawa, Manitoba, Canada. Dr. Beck has led work on UN Briefings, group discussions, website updates, campaigns, projects, journal articles, book chapters, books and worldwide keynote presentations and, recently, to achieve NIGH’s ‘Special Consultative Status’, granted by the United Nations Economic & Social Council (UN ECOSOC) in 2018. She also serves on a multimedia team developing an independent feature film ‘Legacy of Light’ to share the epic Nightingale story—aimed to be launched, worldwide, for the 2020 Nightingale Bicentenary Year. Dr. Beck received a doctorate in 2002, from Union Institute & University, with groundbreaking research to articulate Florence Nightingale’s relevance to today’s international health, development, education and media.

Barbara M. Dossey, PhD, RN, AHN-BC, FAAN, HWNC-BC

Barbara M. Dossey is an internationally recognized integrative, holistic nursing pioneer; a nurse theorist (Theory of Integral Nursing; co-author, Theory of Integrative Nurse Coaching); and Florence Nightingale Scholar. Dr. Dossey is International Co-Director for the Nightingale Initiative for Global Health in Neepawa, Manitoba, Canada. She is Co-Director, International Nurse Coach Association (INCA) and Core Faculty, Integrative Nurse Coach Certificate Program (INCCP) in Miami, Florida; International Co-Director, Nightingale Initiative for Global Health (NIGH); and Director of Holistic Nursing Consultants (HNC), Santa Fe, New Mexico. She has authored or co-authored 25 books including Holistic Nursing: A Handbook for Practice (7th ed., 2016); Nurse Coaching: Integrative Approaches for Health and Wellbeing (2015); The Art and Science of Nurse Coaching: The Provider’s Guide for Coaching Scope and Competencies (2013); Florence Nightingale: Mystic, Visionary, Healer (2010, Commemorative Edition). She is a 12-time recipient of the prestigious American Journal of Nursing Book of the Year Award, and many other awards. She is on the ANA Healthy Nurse Healthy NationTM Advisory Board.


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© 2019 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2019

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