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Opinion: For a healthier world, empower nurses

Health care workers at Thailand's Bamrasnaradura Infectious Disease Institute. During the pandemic, nurses and midwives around the world have had to sacrifice and work around the clock and with limited personal protective equipment. Photo by: Pathumporn Thongking / UN Women / CC BY-NC-ND


At this stage in the COVID-19 pandemic, many of us have grown numb to the grim statistics.

But we cannot let ourselves look away. Here are three numbers that demand our focus: Estimates suggest that more than 100,000 health care workers have died from COVID-19; fewer than 10% of health and care workers across Africa are fully vaccinated against the disease; and worldwide, we need nearly 6 million new nurses to enter the workforce to offset shortages that have likely worsened during the pandemic.

These statistics from the World Health Organization should break your heart — and set off alarm bells.


Nurses deliver 80% of hands-on health care worldwide; their on-the-ground efforts are intrinsically linked to a nation’s ability to protect its people. To put it more bluntly: no nurses, no health system, no country. Yet the pandemic has devastated our nursing workforce. Unless we can rebuild it — and quickly — the consequences will be bleak.

Rebuilding will require a multipronged effort. We must accelerate delivery of vaccines to lower-income countries to protect both health care workers and populations at large. We must boost efforts to recruit and educate nurses and midwives. And, critically, we must expand strategic investment in training nurses for leadership positions and elevating them to those roles.

This is not just a sound public health strategy; it is an economic imperative.

The overlooked yet pivotal nursing workforce is at a crossroads. Nurses and midwives are on the front lines in all the crucial campaigns of public health, from epidemiological surveillance and infection control to maternal health, nutrition, and preventive care. Their responsibilities have steadily expanded for years. Yet far too often, they are shut out of policy discussions at the highest levels.


From our perspective as leaders in public health, a vital reckoning is overdue. A survey in WHO’s “State of the World’s Nursing 2020” report found that only 53% of responding countries had a nursing leadership development program, and nearly 30% lacked a national nursing leadership position designed to give nurses — who are overwhelmingly women — a voice in shaping health policy and priorities.

We must remedy this failing. Nurses come to the table with insights and experience that can help shape smart public health policies — policies that, as we have seen during this pandemic, can be enormously consequential not just for personal well-being but also for economic health and national security.

The G-20 group of nations and the World Bank have both sounded the alarm on the need to invest in expanding our health workforce so we’re ready for future pandemics. Strengthening nurse leadership will also help rebuild the global pipeline for health care workers, as bright young people will see a promising future for themselves in the profession.

And this is not just an issue for lower-income nations. The pandemic showed how closely our fates are linked. By strengthening the world’s nursing workforce, we will enable a more effective global response to emerging threats. And just as importantly, empowered nurses can lead crucial efforts to address global health issues such as malaria, tuberculosis, immunization, and noncommunicable disease. With enough stature, tools, and training, they can and will bring forth transformational improvements in global health security.

Also, 80% to 90% of the drivers of our health and wellness are determined outside of the traditional health care system — in the places we live, work, learn, and play. In navigating issues such as substance abuse, mental and behavioral health, and poverty, nurses again play a lead role. They help close the gap in health equity, and only by doing that on a global scale can we fully reap the return on investments made in public health.

So how can health systems empower nurses?

First, we must boost educational opportunities for nursing leaders. We must take cues from visionary entities such as The Burdett Trust for Nursing, a charitable group that has poured resources into this pivotal workforce since 2002. It has helped fuel powerful leadership training initiatives like the Nursing Now Challenge, the Global Nursing Leadership Institute, the Edinburgh Global Nursing Initiative, and the new Harvard Global Nursing Leadership Program, which will focus first on elevating nurses in Africa.

These trainings are designed to give nurses the skills and savvy to advance big-ticket items, such as universal health coverage and the Global Health Security Agenda’s objectives.

Nurses represent the highest leverage point within our global health system; they exist at and embody the heart of it. By developing and scaling more nursing leadership programs, we can better meet the public health challenges of this perilous era. Elevating their voices and experiences can and will inspire strategies that strengthen health systems, emergency preparedness, population health management, health financing, strategic communications, and public health law and policy.

Second, we must boost leadership possibilities for nurses. We must continue to work with partners around the world to give nurses prominent seats in cabinets and ministries. In a promising move, health ministers from around the world have agreed to include chief nursing and midwifery officers in their governments and to focus on several priorities to strategically strengthen this workforce.

We need more nursing leaders in high-stature government roles like that of Rear Admiral Aisha K. Mix of the U.S. Public Health Service, who leads 4,500 other nurses. As the country’s chief nurse officer, she advises the U.S. surgeon general’s office and the Department of Health and Human Services on both COVID-19 and the “recruitment, assignment, deployment, retention, and career development of nurse professionals.”


Health care institutions must provide nurses with more leadership opportunities, too. “Nursing remains a highly gendered profession with associated biases in the workplace,” according to the “State of the World’s Nursing 2020” report. It notes that few leadership positions in health are held by nurses — perhaps because about 90% of the nursing workforce is female. A paradigm shift is required.

Finally, we must boost the size of the nursing workforce strategically. We must work with nations to accurately forecast nursing and midwifery needs and ensure the trainee pipeline matches the demands of an expanded global health labor market, as WHO outlined in a recent global strategic plan for nursing. We must compile and optimize data to create nursing jobs where they are most needed to serve the population, to ethically manage international migration, and to effectively recruit and retain nurses.

Empowering nurses does not take enormous resources. But it does take a willingness to dig in, step up, and recognize that our heroic nurses and midwives deserve more than applause at the end of a shift.

If these efforts succeed, the global public health system will be stronger, more resilient, and better equipped for the next pandemic, with nurses leading the way.