As we begin 2020, we welcome the eagerly anticipated World Health Organization (WHO)-designated “Year of the Nurse and Midwife.” The year 2020 will also bring the launch of the first WHO State of the World’s Nursing report that will be released on World Health Day in April, just ahead of the 73rd World Health Assembly. These inaugural efforts will highlight and advance nurses’ and midwives’ vital position in upholding and transforming healthcare around the world (WHO, 2020b).
The Year of the Nurse and Midwife comes at an opportune and a critical time. Global trends are driving the need for models of care to address fragmentation of healthcare services and to promote quality, integrated care coordination. Forecasts on future healthcare requirements show pronounced shifts in population profiles with the world's older population growing at an unprecedented rate; rapidly accelerating growth of non-communicable diseases and multimorbidity; and mounting complexity of needs. Between 2000 and 2050, the proportion of persons older than 60 years is estimated to double from approximately 11% to 22%, and the number of individuals 80 years and older will quadruple (WHO, 2014). Further, there are pressures arising from other spheres that are expected to add to the complexities of healthcare delivery, including accelerating technological advances, environmental changes, and global health emergencies (Crisp & Iro, 2018).
There are many ways in which the health and well-being of people and populations can be enhanced and improved by nurses. This may be in clinical practice; working with individuals and their families; through community support and development programs; national health initiatives and policy; conducting research and evaluating program effectiveness; or implementing international commitments and agreements to improve access to and quality of healthcare. Nurses and midwives account for nearly 50% of the global health workforce and are often the first and only point of care in their communities (WHO, 2020b). At every level, nurses have a significant role to play, including fulfilling the need for a far more holistic and person-centered healthcare system and advocating for vulnerable populations, each commensurate with the ethical mandate and competencies of nurses.
In this topic, the OJIN: The Online Journal of Issues in Nursing celebrates the leadership and important contributions of nurses in the United States and Canada with exemplars in the domains of policy, practice research, and education.
In the introductory article, Nurses Leading the Way to Better Support Family Caregivers, Reinhard and Brassard examine the considerable challenges that are faced by family caregivers. They note that family caregivers in the United States provide an estimated 34 billion hours of unpaid and often complex care to adults with chronic or serious health conditions. The authors summarize current evidence to provide guidance to nurses and other providers about how to educate family caregivers, highlight useful resources and discuss proactive outreach strategies that can help family caregivers manage complex care.
In the next article, Beyond the Nurse Practice Act: Making a Difference through Advocacy, Martin and Zolnierek discuss how policy frames nursing practice. The authors address the critically important role of nurses in advocacy to advance professional practice. They discuss how several changes in the healthcare industry have influenced the advocacy efforts of individual nurses and nursing organizations. They provide examples of how the advocacy of nurses can make an importance difference in the quality and safety of patient care as well as the potential negative effects when advocacy fails. They conclude by arguing for advocacy protections, such as protections for whistleblowers.
Marcus discusses the critical problem of “vaccine hesitancy” in the next article, A Nursing Approach to the Largest Measles Outbreak in Recent U.S. History: Lessons Learned Battling Homegrown Vaccine Hesitancy. While immunization is widely lauded as public health’s greatest achievement, it has been identified by the World Health Organization as one of the top ten threats to global health for 2019. Marcus highlights the important role of nurses in addressing vaccine hesitancy and offers practical guidance for addressing this important problem.
Next, in the article, Nurses at the Table: Action Now! for Nursing Education, Aragon and colleagues highlight the success of Action Now!, a movement to secure sustainable financing for nursing programs. The program, led by the Washington Center for Nursing, the Washington Board Of Nursing, and the Council on Nursing Education in Washington State shows how a diverse coalition of nursing organizations collaborated with key stakeholders to address this implementation of the Action Now! program, an overview of the successes and lessons learned, and efforts to move forward with ongoing challenges to identify and address barriers in nursing education.
Mielke, Robertson, and Fehr, in Learning About Rurality: From Classroom to Community, address the important role of advanced practice registered nurses (APRNs) in meeting health needs in rural America and how they can be educated to best fulfill this need. The authors posit that it is important to prepare students for this role with both didactic and experiential learning experiences so that they may gain a fuller understanding of the health disparities and the strengths of the community. They provide an example of a novel community assessment tool that was used successfully to facilitate student exploration of a new rural clinical placement area in southern California.
Lastly, in the article Nurses, Nursing Associations, and Health Systems Evolution in Canada, Villeneuve and Betker discuss the considerable healthcare challenges faced in North America. With a focus on Canada. they provide an overview of the history of health system development and reform and consider nursing policy and advocacy in the 21st century. They provide examples of nurse-led solutions that have been used to overhaul and improve health systems and influence health policy in Canada. In an observation apt for the Year of the Nurse and Midwife, the authors argue that nothing about system transformation can happen without the right people involved and no group is more important than nurses.
As we celebrate the Year of the Nurse and Midwife in 2020, the journal editors invite you to share your responses to this OJIN topic by sending a Letter to the Editor or by submitting a manuscript that will further the discussion initiated by these introductory articles.
Nancy R. Reynolds, PhD, RN, FAAN
Dr. Nancy Reynolds is a Professor and the Associate Dean of Global Affairs at the Johns Hopkins University School of Nursing. She is the Director of the Johns Hopkins Center for Global Initiatives, the Co-Director of the WHO Collaborating Centre for Nursing Information, Knowledge Management (GANM) and the Co-Secretary General of the Global Network of the WHO Collaborating Centers of Nursing and Midwifery. She is on the WHO Steering Committee of the State of the World’s Nursing report. Formerly the Independence Foundation Professor of Nursing at Yale University, she is a researcher in the field of chronic illness self-management (especially HIV) with over 20 years of continuous funding from NIH. She is a Fellow of the American Academy of Nursing and the recipient of numerous research awards including induction into the Sigma Theta Tau International Researcher Hall of Fame.
Crisp, N., & Iro, E. (2018). Putting nursing and midwifery at the heart of the Alma-Ata vision. Lancet, 392(10156), 1377-1379. doi: 10.1016/S0140-6736(18)32341-9
World Health Organization. (2014). Facts about ageing. Retrieved from https://www.who.int/ageing/about/facts/en/
World Health Organization. (2020a). Nursing and midwifery. Retrieved from https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery
World Health Organization. (2020b). Year of the nurse and midwife. Retrieved from https://www.who.int/campaigns/year-of-the-nurse-and-the-midwife-2020