Mon 10 Jul 2017

ICN Report

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations, representing the more than 16 million nurses worldwide.  New Zealand membership is through the New Zealand Nurses Organisation. The ICN was founded in 1899 and is the world’s first and widest reaching international organisation for health professionals.  Operated by nurses and leading nurses internationally, ICN works to ensure quality nursing care for all, sound health policies globally, the advancement of nursing knowledge, and the presence worldwide of a respected nursing profession and a competent and satisfied nursing workforce. The current Chief Executive of the ICN is Dr Frances Hughes who is from New Zealand.

The ICN works closely with the specialised agencies of the United Nations system, particularly with the World Health Organisation, the International Labour Organisation and the World Bank, as well as working closely with a range of international non-governmental organisations.

ICN Congress:

This bi-annual event saw over 8000 nurses explore nurses’ leading role in the transformation of care, with a particular focus on universal health coverage (in 2015 all nations in the world signed up to everyone in the world having access to healthcare), the Sustainable Development Goals and human resources for health. The three ICN pillars – Professional Practice, Regulation and Socio-Economic Welfare (see table below) framed the scientific programme and the dynamic exchange of experiences and expertise. Of note, a number of attendees and some presentations were made by Bachelor of Nursing Year 3 students.

Professional Nursing Practice

·         eHealth

·         Leadership Development

·         Ethics and Human Rights

·         Communicable Diseases

·         Noncommunicable Diseases

·         Primary Health Care

·         Immunisation/Vaccines

·         Mental Health


Nursing Regulation

  • Regulation and Credentialing
  • Education
  • Counterfeit medicines
  • Women’s and Children’s Health


Socio-economic Welfare for Nurses

·         Occupational health and safety

·         Human resources planning and policy

·         Remuneration

·         Career development

·         International trade in professional services

·         Ageing

The nursing health workforce is the largest in the world and this resource must be harnessed so that its expertise can lead and contribute to global health care being available to all. Nurses are trained locally but must be globally prepared; preparation through degree- level training with competence in leadership, creativity and innovation, collaboration and team work, not just within healthcare but across all relevant agencies. However, nurse’s knowledge and skills hinge on advocacy. Health is political and nurses must speak up. Nursing is no longer just skill (task) based, we must shift to work as knowledge-based mind operators. Some of our work will be replaced by computers and robots. Nurses’ expertise means leadership, having a voice, thinking and acting globally. Dr Mary Wakefield opened with the first plenary session. She was appointed by Barack Obama as the Acting Deputy Secretary of the US Department of Health and Human Services. A nurse was chosen for this role due to the experience Barack had when his own child required hospitalisation. Mary’s focus was on the hidden work of nursing; that we need to communicate our work to the public and media, that without this focus of nurses impact being publicised, the lack of awareness may mean lack of support for us.

A Report by the All-Party Parliamentary Group on Global Health Triple Impact is an all party report chaired by Lord Nigel Chrisp (presenting at the conference) from the UK on how developing nursing will improve global health, promote gender equality and support economic growth. The report outlines how universal health care cannot be achieved without strengthening nursing globally, including enabling them to work to their full potential and contributing to fulfilling the 17 Sustainable Development Goals (WHO). Nurses must therefore be at the table where policies and decisions are made (Jhpiego; An international, non-profit health organization affiliated with The Johns Hopkins University dedicated to improving the health of women and families).

A popular saying at congress was ‘if you don’t have a seat at the table, bring your own chair, or if you don’t have a seat at the table, you are probably on the menu’. Although there is some research to demonstrate the benefits of nurse-led healthcare, adequate staff:patient ratios (for every 1 patient added to workload above 5, there is a 7% increased mortality and adding ‘assistants’ to the skill mix increases mortality by 12%, Aiken et al BMJQS Nov 2016) and the impact on morbidity and mortality (nurses educated to degree – level), much more research is required to demonstrate the impact of nursing on economies. We need to reframe the business case for nursing such as lower costs due to: decreased length of stay, decreased infections, decreased re-admissions, higher patient satisfaction, decreased missed care incidents.

Later this year, a new campaign will be launched ‘Nursing Now’; a strategy that Lord Chrisp and Dr Frances Hughes worked on in the House of Lords, UK. New models of care are needed. In The Netherlands, a new model of primary health care (Buurtzorg model) has been successful. Nurses work in an expert generalist manner within their community; building relationships not just carrying out tasks. Their work is directed by what the population requires; there are no required outputs or KPIs to meet. Further, they act autonomously with no management structure and have their own professional development budget that meets their self-determined needs. The model is being rolled out in other parts of the country. New models of mental health care, developed as a response to the earthquakes was presented by our colleagues (Heather Casey and Daryle Deering) from Canterbury. Two models from the US, health clinics run by Schools of Nursing and retail-based clinics run by Nurse Practitioners identified opportunities for increased access to healthcare were also presented as examples of new models.

The Sustainable Development Goals (SDGs) call for a rapid transformation of nursing education. GANES, (Global Alliance for Leadership in Nursing Education and Science) is taking a lead in developing global pillars for high quality nursing education. Work is being undertaken on standards for nurse educator competence (our Level 5 teaching and learning certificate would not meet these standards), clinical instructor certification (quality of clinical instruction challenged) and not only simulation standards (are they valid and reliable?) but certification of simulation educators (inter-rater reliability found to be very poor otherwise – supported by another study from Norway).

We were all challenged to consider how our programmes aligned with universal health care, social justice and achieving SDGs; and what our role is with research (there is huge increased demand for Doctor of Nursing programmes as an alternative to PhDs). Examples of BN students studying global healthcare (online programme) transformed their thinking; the focus being on social determinants of health. Global health is increasingly relevant as we now live in a global environment with migration, refugees, and infectious diseases crossing the world in days rather than months or years. The ICN has appointed Dr Jill White from UTS in Sydney to work with a technology company to develop an education platform for education programmes, particularly focussed on leadership and advanced practice.

Technology is and will have an increasing impact not only on health delivery but also education. One symposium described a Bachelor of Nursing programme that was constructed to have 95% of theoretical learning online. Challenges included digital literacy of educators and students, the concept of online presence as a teacher, creating social presence, cognitive presence and teaching presence. Interestingly, the pass rate for the programme was low; the analysis showed this not to be due to the online delivery but due to the selection of the programme by those who had social issues preventing them from attending class.

In line with the SDGs (adopted by the UN in 2015 to replace the millennium development goals, the 17 goals cover a broad range of issues and the 191 UN member states have agreed to achieve these by 2030  the impact of climate change on public health was presented. Dislocation due to sea rises, crop failures due to floods or draught, water shortages, fires, air pollution, longer and wetter climate with increased vectors, increased waterborne diseases mean that we cannot have healthy people on a sick planet. Populations will become less resilient. It was pleasing to see that mental health was also on the agenda at the congress.

I was able to view a number of poster presentations; some of which I photographed as either myself or my colleagues may want to examine further.

Sir Michael Marmot held the final session. He outlined his work with social determinants of health. His curiosity started when he was undertaking his medical training when he became frustrated at providing medical care when it was the social causes of ill-health that needed the help. He was invited to chair the WHO Commission of Social Determinants and the Health Divide (2005-8) and the European Review of Social Determinants and the Health Divide. His recommendations have been adopted by the World Health Assembly as well as many countries. The Marmot Review is a result of the British review of social determinants and health inequalities. His presentation and his book ‘The Health Gap: the challenge of an unequal world’ is humbling, sickening, revealing, shameful, political and evidence-based. Although New Zealand is considered a rich nation in the world, the existing health inequalities are damning on us all.

And so what are the questions that I see for us in the WITT School of Nursing?

1. How are we preparing global nurses with social justice and advocacy as core values and leadership capability?

2. What is our role in reducing and addressing health inequalities?

3. How will our research contribute to universal health care and meeting the SDGs?

This is a short summary of a four day conference where I met with old and new colleagues, where I felt re-grounded and re-focussed, privileged to attend, listen, hear, think and re-energised to champion healthcare. My thanks to WITT for the professional development ward which funded my attendance.