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March 23, 2020

The International Year of the Nurse and Midwife—More Than Just a Celebration

Author Affiliations
  • 1School of Nursing, University of Pennsylvania, Philadelphia
  • 2Professor Emerita, University of Sydney, Australia
JAMA Health Forum. 2020;1(3):e200250. doi:10.1001/jamahealthforum.2020.0250

Throughout the world, there will be numerous events and celebrations to mark the World Health Assembly (WHA) designation of 2020 as the Year of the Nurse and Midwife. What is it that makes 2020 so special? Why are nurses and midwives the first professional group to receive this designation and recognition by the World Health Organization? The answer to the first question is simple—2020 recognizes the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing, a pioneer in the use of data visualization, and an advocate for social reforms. The recognition of nurses and midwives represents an opportunity to elevate the key role nurses and midwives play in contributing to the United Nations’ Sustainable Development Goals .1 Why is this opportunity so urgent?

  • Imagine an industry in which a key group, constituting over half the workforce, is facing an enormous workforce shortage within a decade.

  • Imagine an industry of key end users who possess critical evidence, expertise, and experience but who are excluded from planning and strategy discussions by policy makers at the institutional, regional, national, and international level.

  • Imagine an industry in which over half the workforce has the education and skill set to address the most perplexing programs in a way that benefits both the economy and the population.

  • Imagine, too, that this well-educated and trusted workforce is prevented from working to the full scope of their education and license in a way that restricts and diminishes practice and innovation.

This is the situation of nursing and midwifery in most countries around the world, whether those countries are resource rich or poor.

Nurses and midwives account for nearly 50% of the health care workforce globally, yet the world is experiencing a shortage of health care workers. Nurses and midwives collectively comprise 50% of that shortage.1 Because this is a global phenomenon, importing workers from other countries to address domestic shortages will not be a viable option.

Despite representing the highest percentage of the health care workforce, the expertise of nurses and midwives is consistently underrepresented in middle- and high-level policy discussions and decision-making at the institutional and governmental levels. Nurses and midwives have the requisite education and skills. They have developed evidence-based and cost-effective programs in health systems and communities that improve social well-being and health and ultimately produce stronger economies and greater gender equality.2 However, because nurses and midwives are often excluded from policy-making discussions, the spread and scale of many of these programs are stymied. These 2 professions, regularly cited by patients, families, and communities as among the most trusted in all of health care, are also the key end users of billions of dollars’ worth of new health care technology. It is hard to imagine any other industry countenancing such an oversight.

Education systems in most countries are now preparing highly skilled nursing and midwifery professionals for key practice positions in multiple settings. Much of the care they deliver is autonomous, and all of it is collaborative with patients, families, communities, and other health care professionals. Nurses and midwives are educated and prepared to work with all population groups and play an essential role in the chronic and complex care needs of individuals, including vulnerable population groups who are currently underserved—particularly those in rural and resource-poor settings. However, institutional and governmental regulatory and policy barriers prevent them from working to the top of their education and license. These barriers result in decreased access to essential, safe, and effective health care services. For example, in response to the opioid epidemic in the United States, nurse practitioners and nurse midwives have federal authority to prescribe buprenorphine or medication-assisted treatment. However, many states, including those most affected by the epidemic, have overriding state legislation that prevents nurse practitioners from prescribing needed treatment. These state policies unfairly restrict practice and do not take into account current evidence, consumer demand, choice, and safety. The cost to these professionals, the people they serve, health care systems, and governments is both financial and social and affects the health and well-being of the population.

Globally, more effective utilization of nurses and midwives at all levels is necessary if there is any chance to meet the Sustainable Development Goals and to achieve universal health coverage, to which all WHA member states have committed. In recognition of this issue, the WHA has committed to 2 important initiatives: (1) declaring 2020 the International Year of the Nurse and Midwife to raise governments’ attention to the need to elevate the status and profile of these professions and invest more heavily in their education and practice; and (2) commissioning the first State of the World’s Nursing Report and the State of the World’s Midwifery Report, due in 2020 and 2021, respectively.3 These reports will enable more effective policy development to address predicted shortages and eliminate regulatory barriers.

However, we need not wait for more data and reports to begin to take effective action. There are numerous country-level reports that have shed light on the greater potential contribution of nursing and midwifery. The Institute for Healthcare Improvement has highlighted the role of nurses in quality and safety.4 The Institute of Medicine has provided evidence-based recommendations to ensure nurses have the opportunity to lead needed transformations in health care.5 Furthermore, the All-Party Parliamentary Group on Global Health from the House of Lords in the United Kingdom has documented the need for a greater investment in nursing’s contribution to policy and expanded practice in its Triple Impact report.2

The key message here is that 2020 is more than a celebration of nurses and midwives. This year-long recognition of their crucial roles is about greater access to funding for improved practice models and about inclusion of highly skilled professionals in leadership and dialogue. For patients and communities, it is about greater access to more efficient and effective health care services and improved health for the people of all nations. So please join nurses and midwives—not only in this celebration, but in creating meaningful solutions that fully engage their skills and expertise.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Antonia M. Villarruel PhD, RN, FAAN, Professor and Margaret Bond Simon Dean of Nursing, University of Pennsylvania School of Nursing, Office of the Dean, Claire M. Fagin Hall, 418 Curie Blvd, Room 430, Philadelphia, PA 19104-4217 (amvillar@nursing.upenn.edu)

Conflict of Interest Disclosures: Dr Villarruel is co-chair of the Strategic Advisory Committee of the Campaign for Action, an initiative of the AARP Foundation and the Robert Wood Johnson Foundation. Dr White is a board member for the Nursing Now Campaign (Western Pacific Region).

References
1.
World Health Organization. Nursing and midwifery. Published January 9, 2020. Accessed March 18, 2020. https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery
2.
All-Party Parliamentary Group on Global Health. Triple impact: how developing nursing will improve health, promote gender equality and support economic growth. Published October 2016. Accessed March 18, 2020. https://www.who.int/hrh/com-heeg/digital-APPG_triple-impact.pdf
3.
World Health Organization. Executive Board designates 2020 as the "Year of the Nurse and Midwife". Published January 30, 2019. Accessed March 18, 2020. http://www9.who.int/hrh/news/2019/2020year-of-nurses/en/
4.
Bisognano  M; Institute for Healthcare Improvement.  Nursing’s role in transforming healthcare: nurses are crucial to closing quality-of-care gaps.   Healthc Exec. 2010;25(2):84-87, 86-87.PubMedGoogle Scholar
5.
Institute of Medicine.  The future of nursing: leading change, advancing health. National Academies Press; 2010.
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