At no other time has the importance of nursing been more evident or vital to the safety, accessibility, and affordability of quality healthcare in the United States (US) and across the world than the present. The global COVID-19 pandemic and myriad social concerns (e.g., systemic racism, civil unrest, health inequities, “truth” decay, and the eroding of women’s rights) are daily concerns. Healthcare organizational consequences of the pandemic (e.g., high nurse turnover, the exodus of early career nurses, rapid shifts healthcare delivery practices) and responses to these concerns, such as the hiring of nurse travelers and opposition to nurses practicing to the top of their education/training, have coalesced to create a “tsunami” in the nursing workforce. Nurses report signs of burnout (American Nurses Foundation [ANF], 2022; Howell, 2021), exposure to workplace violence (Davis, 2022), and dissatisfaction with their jobs (Heidari et al., 2022). They are working challenging conditions (ANF, 2022) such as inadequate and unsafe staffing levels (Andel et al., 2021); and report being under-paid, undervalued and lacking organizational support (Radfar et al., 2021; Ralph et al., 2021; Sharif et al, 2022). Many subsequently intend to leave their positions or the workforce altogether (Raso et al., 2021). Projections of a nursing shortage unlike any in recent memory are being reported (Yang & Mason, 2022).
This Special Topic of OJIN is devoted to presenting state-of-the science-focused articles that were supported through Nursing Now USA™ (NNUSA). The products reported from these initiatives address current problems in the nursing workforce and offer solutions that can be implemented to address them. The purpose of this article, the first of two “bookend” articles for this topic, describes the context for these works, including brief descriptions of the Nursing Now global movement, and the innovative efforts undertaken by NNUSA to spotlight nurse-led solutions. The final bookend article provides a synthesis of these papers, a summary of future needs and actions to guide the field. The three peer reviewed articles in between present organizational and policy/systems-level innovations to empower nurses and engage the full nursing workforce.
Launched in February 2018, before the global pandemic, Nursing Now (All-Party Parliamentary Group on Global Health [APPG], 2016) was a 3-year global campaign, developed through a collaboration among the International Council of Nurses (ICN) and the World Health Organization (WHO) and supported by the Burdett Trust for Nursing. To avoid confusion between the activities of Nursing Now global and those undertaken by Nursing Now USA™ reported in this topic, we use the acronym “NNUSA” to reflects efforts undertaken across the US.
Nursing Now arose in response to a report by the All-Party Parliamentary Group on Global Health, Triple Impact (APPG), which recommended an effort to improve health globally by raising the status and profile of nursing; and it is a health campaign as much as it is a nursing one (APPG). In an effort to spur what has been called the “first global, social movement in nursing” (Holloway et al., 2021; Irwin, 2021), Nursing Now included the creation of a large social media footprint, and the rapid uptake of Nursing Now groups in countries across the world. In 2019, Nursing Now launched the Nightingale Challenge to encourage employers of nurses and midwives to rise to the challenge of providing early career nurses with development opportunities that would prepare them for leadership roles.
At its’ outset, the intent was to celebrate and bring Nursing Now to a close in October 2020 in honor of Florence Nightingale’s 100th birthday, but the pandemic upended that plan. Although Nursing Now officially ended in May 2021, the movement continues via the Nursing Now Challenge, which extends the work of the Nightingale Challenge. At its close, Nursing Now had spread to approximately 126 countries, and to over 800 employers who had committed to the Nursing Now (ne Nightingale) Challenge.
Led by the University of North Carolina Chapel Hill School of Nursing (UNC-CH SON), the American Nurses Association (ANA), and the United States Public Health Service (USPHS) Chief Nurse, the Nursing Now USA™ (NNUSA) leadership team was identified in late 2018. Recognition as an “official” Nursing Now group required that U.S. leaders: register NNUSA™ as a country-level group; agree to uphold the vision of Nursing Now; include the U.S. ICN-affiliated national nursing association (ANA) and the country’s senior nurse in the government (Chief Nurse of the USPHS); engage early career nurses (National Student Nurses Association [NSNA]); and collaborate with representatives of the WHO office (via ICN and ANA).
NNUSA was officially launched on April 9, 2019, at an event held at the National Press Club in Washington, DC. Interdisciplinary attendees at this launch included key nursing groups from across the US (see Table 1), early career nurses and experienced leaders from across the US, invited panelists and guest speakers, policymakers, and numerous non-nursing grassroots organizations and attendees who were committed to influencing national policy related to the education, practice, employment, and well-being of nurses. The vision, mission, and priorities of Nursing Now USA™ were as follows:
- Vision: Nurses Lead America to Health
- Mission: Educate consumers, families, and communities about how nurses affect their health and well-being and ensure that nurses are positioned to drive changes to improve health for all people.
- Promote Innovation: Fully engage nurses in providing innovative solutions through research, education, and care delivery to bring a return on investments in health.
- Lead and Develop Policy: Prepare nurses to assume vital roles in influencing and creating public policies that promote and protect the health of all, and that advocate for conditions to support safe and healthy communities.
Table 1. Key Nursing Individuals and Groups Participating in Nursing Now USA™
NNUSA Working Group
Nursing Now USA™ Steering Committee
At the outset of NNUSA™, immediate efforts focused on engaging groups and organizations to support the Nightingale Challenge. Subsequently, NNUSA organizers held national meetings, convening national leaders around NNUSA goals and various events to promote the vision of NNUSA and support the work of local groups across the US. Through the Nursing Now global campaign, we actively engaged organizations and employers to support the Nightingale Challenge. By focusing on the critical need for nurse leaders, NNUSA worked with others to drive innovative nurse leader development, including convening panels of early-, mid-, and advanced-career nurses to share, learn, and grow together by identifying leadership development needs for future nurse leaders.
A funding campaign was launched to encourage commitment of tax-deductible contributions from nursing organizational, group, and individual stakeholders at any level to support these efforts. At the close of the NNUSA initiative, although these statistics were tracked by Nursing Now global, numerous local and regional groups had engaged in NNUSA, including Nurses Everywhere – Grassroots to Local, Nurses International, the National Association of Indian Nurses of America, Stony Brook University School of Nursing, the Nell Hodgson Woodruff School of Nursing at Emory, and Global Health Access (GHA) Institute in Boston. Additionally, about 50 U.S. employers had been reported by Nursing Now as committing to the Nightingale Challenge.
Nursing Now USA™ Culminating Works
As Nursing Now was drawing to a close in 2020 and 2021, NNUSA leaders turned attention to how our work could be celebrated, commemorated, and used to support public good and raise issues of concern to U.S. nursing. The desire was to portray and share a current and contemporary understanding of nursing in light of the pandemic, both within and outside the discipline, and to include other health professionals and the public. Toward this end, NNUSA announced a national “Call for Proposals” to support three commissioned papers spotlighting nursing innovations; addressing diversity, equity, inclusion, or social justice issues; and recognizing the role of nurses during an unprecedented time; and in support of 2020 The Year of the Nurse. Paper topics aligned with activities championed by NNUSA, the global Nursing Now campaign, the WHO, and the ICN. State of the science papers were sought and ultimately commissioned in the areas of nursing practice, education, and leadership, focused on ways nurses contributed to innovation, and how the innovation improved societal health and health care.
The following questions were offered to stimulate ideas:
What evidence-based nursing practice innovations have had a major influence on the health and well-being of society or a specific population?
- What educational innovations have fostered nursing practice, leadership, and research development?
- What nurse-driven models of care best reflect nurse leadership in activating system change?
- What leadership innovations have been implemented to ease the impact of COVID-19 on frontline nurses and other health care workers? What is the evidence of impact?
- How has telehealth or telenursing improved care for patients and changed nursing practice?
- What important evidence gaps exist for decision-makers in [a chosen area of focus]?
- What best practices reflect equitable, just, and fair leadership in [a chosen area]?
Proposals were received in January 2021, subjected to peer-review by a national panel of experts, and three were selected to represent culminating outcomes of NNUSA. We are pleased to highlight the following teams selected for commissioned papers
- Innovations in Nursing Practice: Mary Ann Schultz, PhD, RN, examined Telehealth and Remote Patient Monitoring Innovations in Nursing Practice: State of the Science.
- Innovations in Nursing Education: The team led by Jill Forcina PhD, RN and Meg Zomorodi, PhD, RN, FAAN focused on, Demonstrating a Nurse-Driven Model for Interprofessional Academic-Practice Partnerships.
- Innovations in Nursing Leadership: Melissa Ojemeni, PhD, RN; Jin, PhD, RN; and Caroline Dorsen, PhD, RN, FAAN led a team to prepare, A Scoping Review of Nursing and Midwifery Activism in the United States.
These papers convey the spirit of NNUSA by highlighting unique aspects of each innovation-focused topic and provide a guide to inform the field across each of the topic areas into the future. The authors urge readers to consider future research questions that can be derived from these scholarly contributions, needed to drive nursing practice, education, and leadership innovations in the future. We hope you will digest these articles, take-away key findings, share your comments through the OJIN community, and ultimately use these works in your future research, practice, and scholarship. Based on the state of healthcare, society, and the workforce, now is the time. You hold the answers, and wherever you are is the place. There are many opportunities to make a difference in healthcare and the lives of others. Please thoughtfully consider this call to act.
Cheryl B. Jones, PhD, RN, FAAN
ORCID ID: 0000-0002-0200-3438
Cheryl Jones is the Sarah Frances Russell Distinguished Professor and Director in the University of North Carolina at Chapel Hill School of Nursing Hillman Scholars Program in Nursing Innovation.
G. Rumay Alexander, EdD, RN, FAAN
ORCID ID: 0000-0001-5703-5368
G. Rumay Alexander is Professor and Assistant Dean at the University of North Carolina at Chapel Hill School of Nursing and an ANA Scholar-in-Residence to Address Racism in Nursing.
Nena Peragallo Montano, DrPH, RN, FAAN
ORCID ID: 0000-0001-7947-3406
Nena is Dean Emeritus at the University of North Carolina at Chapel Hill School of Nursing.
Ernest Grant, PhD, RN, FAAN
Ernest Grant is the President of the American Nurses Association.
Cheryl A. Peterson, MSN, RN
Cheryl Peterson is Vice President for Nursing Programs at the American Nurses Association.
Aisha K. Mix, DNP, MPH, RN, NHDP-BC
Aisha Mix is a Rear Admiral, Assistant Surgeon General, and Chief Nursing Officer for the United States Public Health Service.
Margaret (Peggy) C. Wilmoth, PhD, MSS, RN, FAAN
ORCID ID: 0000-0002-8481-1905
Peggy Wilmoth is a Major General, U.S. Army (retired) and Professor and Executive Vice Dean/Associate Dean, Academic Affairs at University of North Carolina at Chapel Hill School of Nursing.
All-Party Parliamentary Group on Global Health. (2016, October). Triple impact: How developing nursing will improve health, promote gender equality and support economic growth. https://globalhealth.inparliament.uk/sites/globalhealth.inparliament.uk/files/2020-12/DIGITAL%20APPG%20Triple%20Impact%20%283%29.pdf
American Nurses Foundation. (2022, March 1). Pulse on the nation’s nurses survey series: COVID-19 two-year impact assessment survey. https://www.nursingworld.org/~4a2260/contentassets/872ebb13c63f44f6b11a1bd0c74907c9/covid-19-two-year-impact-assessment-written-report-final.pdf
Andel, S. A., Tedone, A. M., Shen, W., & Arvan, M. L. (2022). Safety implications of different forms of understaffing among nurses during the COVID-19 pandemic. Journal of Advanced Nursing, 78(1), 121-130. https://doi.org/10.1111/jan.14952
Davis, C. (2022, September 12). Analysis: 5,217 nurses were assaulted on the job just in Q2 2022. HealthLeaders. https://www.healthleadersmedia.com/nursing/5217-nurses-were-assaulted-job-just-q2-2022
Heidari, S., Parizad, N., Goli, R., Mam-Qaderi, M., & Hassanpour, A. (2022). Job satisfaction and its relationship with burnout among nurses working in COVID-19 wards: A descriptive correlational study. Annals of Medicine and Surgery, 82, 104591. https://doi.org/10.1016/j.amsu.2022.104591
Holloway, A., Thomson, A., Stilwell, B., Finch, H., Irwin, K., & Crisp, N. (2021). Agents of change: The story of the Nursing Now campaign. Nursing Now/Burdett Trust for Nursing, 2021. https://archive.nursingnow.org/nursing-now-final-report/
Howell, B.A.M. (2021). Battling burnout at the frontlines of health care amid COVID-19. AACN Advances in Critical Care, 32(2), 195-203. https://doi.org/10.4037/aacnacc2021454
Irwin, K. (2021, May 5). Nursing Now legacy: Nursing on the rise across the world. https://www.nursingtimes.net/news/leadership-news/nursing-on-the-rise-across-the-world-05-05-2021/
Radfar, M., Hemmati Maslak Pak, M., & Mohammadi, F. (2021). The organisational and managerial challenges experienced by nurses recovered from COVID-19: A phenomenological study. Journal of Nursing Management, 29(8), 2353-2363. https://doi.org/10.1111/jonm.13394
Ralph, J., Freeman. L.A., Ménard, A.D., & Soucie, K. (2021, Aug. 31 ahead of print). Practical strategies and the need for psychological support: Recommendations from nurses working in hospitals during the COVID-19 pandemic. Journal of Health Organization and Management, 36(2), 240-255. https://doi.org/10.1108/JHOM-02-2021-0051
Raso, R., Fitzpatrick, J. J., & Masick, K. (2021). Nurses' intent to leave their position and the profession during the COVID-19 pandemic. Journal of Nursing Administration, 51(10), 488-494. https://doi.org/10.1097/NNA.0000000000001052
Sharif, S. P., She, L., Liu, L., Naghavi, N., Lola, G. K., Nia, S. S., & Froelicher, E. S. (2022). Retaining nurses via organizational support and pay during COVID-19 pandemic: The moderating effect between intrinsic and extrinsic incentives. Nursing Open, 10(1), 123-134. https://doi.org/10.1002/nop2.1286
Yang, Y. T., & Mason, D. J. (2022, January 28). COVID-19’s impact on nursing shortages: The rise of travel nurses, and price gouging. Health Affairs Forefront. https://doi.org/10.1377/forefront.20220125.695159