Category Archives: Nursing

Primary Health Care & Universal Health Coverage 2024

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The International Council of Nurses (ICN) released an important discussion paper in September 2024. Nursing and Primary Health Care: Towards the Realization of Universal Health Coverage authored by David Stewart, Madrean Schober, and Howard Catton.

As I write this blog just after December 12 – Universal Health Coverage Day – it is an opportune time to reflect on the topic of the paper and its recommendations. The paper is well organized  making it easy to work through its main body and appendices. Brief case studies are interspersed showcasing nursing leadership and innovations in different health systems and contexts.

In the introduction, the authors point out many of the current realities that stand in the way of achieving universal health coverage: resource constraints, fragmented care, underutilization of nurses, and lack of teamwork. They trace key developments in the PHC movement referring to the major global conferences and declarations – Alma-Ata (1978) and Astana (2018) – emphasizing foundational principles of primary health care. I was glad to see the sidebar quotation (page 8) on the difference between PHC and primary care, often a source of confusion.

Chapter 1: The case for change reviews the challenges and documented gaps. The value of PHC in improving population health outcomes is highlighted here. The focus on patients and a greater orientation to community control are highlighted throughout the discussion as is the case for funding. The key role of PHC in public health emergencies is illustrated by the COVID-19 pandemic. This chapter ends with a timely reminder about the vital aspect of PHC in delivering vaccination programs. Nurses have a key role in managing and delivering immunizations to all age groups and in a multitude of community settings.

Chapter 2: Reimaging the possibilities of nurses in primary health care. This chapter focuses on roles including advanced practice and documents how countries are promoting team-based models. Details are provided in tables and illustrations as well as in the case studies. The authors note that digital health is becoming more relevant to PHC education and practice and encourage innovation by nurses in design of appropriate digital tools.

Finally, it’s worth reading the conclusion; I find myself in complete agreement with the points offered including this statement: “PHC should be at the highest priority for governments because it is the cornerstone of a sustainable health system.” (page 51).

Appendix 1 offers a summary of ICN’s recent work on PHC highlighting papers, position statements, media initiatives, and ongoing partnerships.

The summary of the authors’ recommendations found in Appendix 2 is a useful tool organized into four groupings:

  1. Care coordination
  2. Integrated and team-based PHC
  3. Advanced practice nurses
  4. PHC nursing workforce

The recommendations encompass ideas for health system change, advocacy, interdisciplinary education, and action by professional associations. One of the many nursing workforce recommendations is to “increase the voice of PHC nurses in policy development and high-level decision making” (page 55).

Reading this rich discussion paper and reflecting on the interesting case studies reminded me of visits to primary health care centres in past travels to Aotearoa/New Zealand, Australia, Nepal, India, and at home in Canada. I wrote about experiences in Japan in my August 2024 blog Public Health Nursing in Japan: Then and Now reflecting on strengths of their system as it has developed. My appreciation of the reality of PHC is rooted also in early career experiences in a community health centre in rural Manitoba and at the Alexandra PHC Clinic in urban South Africa. In my home province of British Columbia, I worked with a coalition that promoted the CHC model and development of a network leading to the establishment of the British Columbia Association of Community Health Centres. Sometimes I wonder why we haven’t made greater progress when so many well-established centres exist as models in many countries including Canada. 

An excellent resource in Canada is the Canadian Association of Community Health Centres with member CHCs across the country. As highlighted on its website CACHC is “the federal voice for Community Health Centres and community-oriented, people-centred primary health care across Canada.” Recent announcements following provincial elections in New Brunswick and British Columbia provide optimism for new centres on the horizon in 2025.

It has been a turbulent year in geopolitics including concerns about the interconnected issues of conflicts, environmental crises, and global health. The positive messages of the 2024 ICN discussion paper do offer us hope for a time when universal health coverage is realized.

By Nora Whyte – December 17, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Nurses in the News

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National Nursing Week in Canada is around the corner (May 6 to 12) and it is fitting to think about nurses in the news and how our vast experiences and perspectives are profiled. We often talk about the need for a much greater presence in the public media in our communities and around the country.

Two nurses who are bringing their expertise to the public discussion about health care in Canada are Amie-Archibald Varley and Sara Fung, co-hosts of The Gritty Nurse Podcast and authors of The Wisdom of Nurses. Since the release of their book, they are in demand for interviews and book signings. As I’m reading their book, I’m thinking about their questions and the multiple issues they raise about the profession. I’m pleased to see the attention the book is getting on social media and to learn that it has become a bestseller already.

Amie and Sara pose the question: “How many famous nurses can you name?” and then go on to share profiles of nurses from the past as well as current nurses who are well-known for their advocacy and contributions to changes in nursing and health care in Canada. They weave in their own personal stories – including their experiences in nursing school – as they describe their career paths in hospitals and, ultimately, the realization that they needed to make changes in their professional lives. They have included chapters by contributing authors to round out diverse voices and experiences.

I have no hesitation in recommending it and hope that readers will discuss it with people in their workplaces, in policy meetings, and in nursing schools across the country. Part of that discussion could explore the collective influence of nurses, thinking beyond one individual “famous nurse” to the groups of courageous nurses who came together to form nursing associations and unions not only in the distant past but also within the last 25 to 50 years. I’m thinking of the Canadian Indigenous Nurses Association, the Canadian Nursing Students’ Association, our national specialty groups, and the newly formed professional associations of the past 5 to 10 years, including the Nurses and Nurse Practitioners of BC in my home province.

Looking beyond our borders, we can celebrate the voice of national and global nursing organizations exerting their collective influence in reforming health systems and leading vital policy work. A great example is found in this recent announcement from the International Council of Nurses (ICN).

Dr. Cipriano, president of ICN will co-chair the global Steering Committee on Universal Health Coverage, known as ‘UHC2030’ with Dr. Magda Robalo:

UHC2030 warmly welcomes new co-chairs Dr Magda Robalo and Dr Pamela Cipriano – UHC2030

I feel fortunate that I have known famous nurses in my nursing lifetime, both in Canada and in countries I have visited for conferences and as a consultant. Memorable individuals and visionary groups of nurse leaders give me hope this Nursing Week.

By Nora Whyte – April 29, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

February Update: ICN and WHO

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This week I received the first newsletter for the 2021 International Council of Nurses (ICN) virtual congress taking place in November. This congress promises to be a highly relevant one for these times with the theme of “Nursing Around the World” using a virtual format that will increase access to the event.

Abstracts are due by March 11, 2021 for e-posters and oral concurrent sessions on eight sub-themes.  Sub-themes include Nursing Workforce, Epidemics & Pandemics, Global Health Challenges, and Digital Health & Innovation. The concurrent sessions will be 10-minute pre-recorded video presentations grouped by sub-theme.

Having attended past ICN congresses – in Barcelona, Durban, Singapore, and Vancouver – I can attest to the value of meeting nurses from around the world, listening to their presentations, and learning about policy advocacy to apply to my own work. Along with colleagues, I have submitted abstracts and been part of presentations. And sometimes an encounter at a congress has led to later collaboration and exchanges.

Global Vaccine Equity

Throughout the pandemic ICN has been vocal on the behalf of nurses and health workers globally and is supporting the current WHO campaign on vaccine equity in the first months of 2021, the Year of the Health and Care Worker.

The WHO Declaration calls on “global, national and local leaders to accelerate the equitable rollout of vaccines in every country, starting with health workers and those at highest risk for COVID-19. This includes scaling up vaccine manufacturing and rejecting vaccine nationalism at every turn.”

WHO urges world leaders to increase contributions to the COVAX facility and also calls on Ministries of Health “to work with WHO and others to invest in and prepare their primary health care systems for distribution of COVID-19 vaccines to their health workers.” Further, as is expressed often these days, distribution of vaccines quickly and equitably will be key to ending the pandemic. Individuals and organizations can lend their support by signing the declaration and by getting messages out through social media. #VaccinEquity

By Nora Whyte – February 18, 2021

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

The Privilege of Membership

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This is the time of year when membership fees are due and the reminders start rolling in. It is a time when I consider whether or not to renew my membership in various organizations and what commitments I’ll make in the year ahead. In particular at the start of 2021, I have been thinking about the privilege of membership in the Canadian Nurses Association.

As noted on its website, the Canadian Nurses Association (CNA) is “the national and global voice of Canadian nursing, working with nurses in all 13 jurisdictions across Canada to bring essential and meaningful change to health care and nursing in the country.” Membership is open to all regulated nurses who may join as individuals or through their membership in provincial and territorial associations in jurisdictions that are CNA members. Major changes in jurisdictional nursing organizations across Canada will continue to have an impact on national membership. For the first time, I will be taking out an individual membership because the annual membership fee in my provincial association, the Nurses and Nurse Practitioners of British Columbia (NNPBC), no longer includes CNA membership. I remain supportive of NNPBC and CNA and hope that we’ll see new membership models and fee structures in the coming years. Membership in CNA is a vital link to our dynamic global nursing body, the International Council of Nurses.

During the summer and fall of 2020, CNA conducted a member survey to build on dialogue and engagement sessions conducted in 2019 & 2020. For a good overview of survey results, see Your Voice, Your Association.  

Survey respondents viewed CNA in a favourable way with 81% noting that a national professional association is essential.  Communication is key to engagement and three preferred methods are: direct email, social media & webinars. Ideas for building a strong and effective association include:

  • Engage with membership on a grassroots level
  • Offer more mental health resources
  • Offer more continuing education opportunities
  • Forge strong partnerships with provincial and territorial associations

Highlights of the past year – shaped so dramatically and sadly by the pandemic – were linked to my longtime interest in professional associations and their role in policy advocacy clearly in evidence during 2020. It was satisfying to be a co-author with stellar colleagues, Patrick Chiu and Susan Duncan, on an article published in the Canadian Journal of Nursing Research:  

Charting a Research Agenda for the Advancement of Nursing Organizations’ Influence on Health Systems and Policy – Patrick Chiu, Susan Duncan, Nora Whyte, 2020 (sagepub.com)

In our abstract we indicate how we drew on “recent key national and global events including our systematic inquiry into Canada’s 2019 federal election, the Year of the Nurse and Midwife, and the Coronavirus pandemic to examine how Canadian nursing organizations respond in highly complex and evolving contexts.” Further, we used our observations to offer a vision and chart a research agenda for the advancement of nursing organizations’ influence on health systems and policy.

Another highlight that took place at the end of 2020 was receiving a Lifetime Achievement Award from NNPBC at a wonderful virtual 2020 Nursing Awards of Excellence Ceremony featuring music, dance, videos, and special messages from CNA and others. It was an emotional and proud moment to be among the group of BC nurses recognized for contributions to the profession in our province.  

Award from NNPBC – December 2020

I look forward to staying connected to nursing’s collective presence and voice provincially, nationally, and globally in 2021.

By Nora Whyte – January 19, 2021

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Postscript: February 21, 2021

For nurses from BC, the process of membership renewal in CNA was delayed at the start of this year. I was unable to renew in January as planned. Glad to see that the membership portal is working now and that we can renew or rejoin as BC registrants or retired members. Annual membership gives us access to the Canadian Nurse and opportunities to participate in our national association and the ICN. In fact, to submit an abstract (as first author) for the ICN Congress in November, one must belong to a National Nursing Association. I’m thankful that CNA is a member of ICN and that’s one of my primary reasons for renewing my CNA membership.

Nursing the World to Health

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I am writing this post as National Nursing Week in Canada draws to a close. It has been a strange time of celebration mixed with sadness at the losses experienced globally and the ongoing concern about the health of populations and the long road to recovery.

During this Nursing Week, I found that our Canadian nursing leaders reflected what many of us have been thinking about our profession during the time of COVID. I greatly appreciated reading CNA President Claire Betker’s editorial in the Canadian Nurse: On the importance of nurses in 2020. Claire highlighted the opportunity to raise the profile of the profession during the International Year of the Nurse and the Midwife and demonstrated the many ways in which Canadian nurses have made an impact.

International Nurses Day was celebrated globally on May 12, the 200th anniversary of Florence Nightingale’s birth. This year’s theme, Nurses: A Voice to Lead – Nursing the World to Health captured both the spirit and the urgency of nursing’s vital global role. The International Council of Nurses provided excellent resources on its International Nurses Day site and was highly visible in media interviews and in generating social media energy. ICN’s CEO Howard Catton tweeted: “Let our celebrations be a clarion call for real commitments to actions and investments to support nurses to do the work that the world desperately needs them to do.” Annette Kennedy, ICN President, expressed her appreciation to the global nursing community and held a great video conversation with Dr. Tedros on May 12. It’s worth viewing and reflecting on their messages!

This week also provided opportunities to profile the State of the World’s Nursing 2020 Report, released in April 2020 and now gaining attention. This landmark publication has highlighted the urgent need for acceleration of nursing education, job creation and leadership. The report’s call to strengthen nursing leadership is “to ensure that nurses have an influential role in health policy formulation and decision-making, and contribute to the effectiveness of health and social care systems” (WHO, 2020).

Nursing Week 2020 has played out in a vastly different way than anticipated; however, there is no doubt that the theme of “Nursing the World to Health” is more important than ever as we face the remainder of 2020 using a professional, powerful and collective voice to lead.

By Nora Whyte – May 15, 2020

Nursing Now: Ready for 2020

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Nursing Now launched in 2018 as a global collaboration among the Burdett Trust for Nursing, the International Council of Nurses (ICN) and the World Health Organization (WHO). I have been following developments and have used this Blog to share highlights and links to updates from time to time.

On the cusp of 2020, Nursing Now is perfectly positioned to play a leadership role during the 2020 Year of the Nurse and the Midwife. Events and celebrations are planned throughout the year. In their most recent update (November 2019), the Nursing Now campaign team stated: “During 2020, we are united in our ambition to propel nursing and midwifery into the spotlight and onto the agenda of governments, with the ultimate goal of improving health globally.”

As Nursing Now has gained momentum, I have been pleased to note the connection to the Sustainable Development Goals (SDGs). There’s increasing recognition that nurses and midwives are contributing to the SDGs and are absolutely vital to delivering Universal Health Coverage by 2030.

A new aspect of Nursing Now announced during the ICN Congress in Singapore in June is the Nightingale Challenge currently being promoted as a key leadership development strategy for 2020 and beyond:

The Challenge is asking every health employer around the world to provide leadership and development training for a group of their young nurses and midwives during 2020, the Year of the Nurse and the Midwife, to support them as practitioners, and enhance their skills as advocates and leaders in health.

Nursing Now Canada launched in 2019 with plans for national initiatives in three ‘pillars’ as outlined in its June 3, 2019 media release:

  • Nursing Leadership pillar – to establish a hub to educate, empower and support regulated nurses to lead, advocate, innovate, influence public policy and create sustainable change in health.
  • Chief Nursing Officer pillar – to establish federal, provincial and territorial chief nursing officers in leadership positions within ministries of health.
  • Indigenous pillar – to support nurses and midwives in providing culturally safe care and to strengthen the power of Indigenous nurses.

The Canadian Nurses Association is the official link for Canadian nurses to the global Nursing Now campaign and is carrying out this three-point action plan in partnership with the Canadian Indigenous Nurses Association and Indigenous Services Canada.

From here at home to events on the world stage, communities of nurses and midwives will be joining their colleagues and supporters in celebrating the Year of the Nurse and the Midwife in 2020.

Update November 23, 2019

It was a delight to read an editorial published in The Lancet today (Volume 394) entitled 2020: unleashing the full potential of nursing and drawing attention to Nursing Now and the Nightingale Challenge. The editorial makes the case for enhancing nursing to enhance health and looks to the opportunity of 2020 “to showcase the evidence and impact of what nurses and midwives do, and to ensure that they are enabled, resources and supported to meet the world’s health needs.” Thanks to The Lancet for this timely editorial and the social media interest it is generating.

By Nora Whyte – November 21, 2019


Summer 2019 Reflections

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The highlight of this summer was the opportunity to be part of a global gathering of 5,300 nurses at the International Council of Nurses Congress in Singapore from June 27 to July 1. Hosted by the Singapore Nurses Association, it was truly a banner event: well-organized in every aspect and with a warm welcome from local volunteers as delegates arrived each day.

Welcome from Singapore Nurses Association at Opening Ceremony.
Photo Credit: ICN

Susan Duncan and I have written a summary of our experiences in a post on the University of Victoria School of Nursing Blog: ICN Singapore Congress – Reflections for Canadian Nursing: Onward to 2020.

We describe recent ICN initiatives including the partnership with Nursing Now and the exciting launch of the Nightingale Challenge. We reflect on the dynamic presence of the World Health Organization throughout the Congress and the increasing recognition of the vital role of nurses in achieving the WHO goal of Universal Health Coverage. The designation by WHO of 2020 as the Year of the Nurse and the Midwife presents a great opportunity for participation in decision-making bodies and in events including the World Health Assembly next year.

ICN President Annette Kennedy.
Photo credit: ICN

Other highlights included meeting delegates from many countries during receptions, lunches, poster sessions and policy cafés.  We reconnected with colleagues from our national organizations and enjoyed encounters with Canadian students and early career nurses.

Canadian Nurses Association President Claire Betker

For further details on the 2019 Congress and to view presentation slides, photos and speaker profiles, see the archives here.

Onward to 2020!

Trinidad & Tobago Registered Nurses Association.
Photo credit: ICN

Posted by Nora Whyte – August 25, 2019

International Council of Nurses 2019: Congress and Policy Advocacy

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ICN Congress 2019 Singapore: ‘Beyond Healthcare to Health’

In my October 2018 post, I wrote about plans for the next ICN Congress taking place in Singapore from June 27 to July 1, 2019. The impressive lineup of keynote speakers has been announced this week: presentation topics include primary health care, health economics, nursing workforce, patient perspectives, migration issues and the future of nursing regulation. Also available on the conference website are the preliminary schedule, notice of special events and registration information.

Policy Advocacy

At the start of 2019, ICN continues its global policy advocacy through participation in the World Health Organization’s Executive Board convening in Geneva this month. Policy briefs focus on primary health care as the path to universal health coverage, patient safety and human resources for health. I have appreciated reading the strong statement on universal health coverage calling on “ministries of health, within their national context, to integrate PHC as the foundation of their health systems” (ICN 2019, 5.5:1). The statement on human resources for health highlights the important collaboration of WHO and ICN in the Nursing Now initiative launched in 2018:

“In partnership with ICN and WHO, the launch of Nursing Now has raised the profile of nursing and has highlighted the importance of the need for more well-educated nurses, of investing in recruitment and retention strategies and of removing the barriers to the development of advanced nursing roles that are proving highly effective at expanding healthcare coverage” (ICN 2019, 6.3: 1).

I encourage my Canadian colleagues to follow ICN and Nursing Now as this year promises to be an exciting one for nursing on the global stage.

Update January 31, 2019. During the WHO Executive Board meeting, Director General Dr. Tedros Adhanom Ghebreyesus announced the intention to declare 2020 as the Year of the Nurse and Midwife honouring the 200th birthday of Florence Nightingale and celebrating the contribution of nursing and midwifery to global health. Watch for more details as plans unfold.

By Nora Whyte – January 25, 2019

International Council of Nurses Update: October 2018

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The next congress of the International Council of Nurses (ICN) will take place in Singapore from June 27 to July 1, 2019. Hosted by the Singapore Nurses Association, it will bring together the worldwide nursing community to explore theme Beyond Healthcare to Health through plenary presentations, concurrent sessions and networking opportunities. Details are available at the ICN Congress Site.

Since attending the previous congress in Barcelona last year, I have been following ICN’s impressive policy work and advocacy activities on important global topics including climate change and migrant health. Visit the position statements page to view and download recent statements organized by theme:

  • Nursing Roles in Health Care Services
  • Nursing Profession
  • Socio Economic Welfare of Nurses
  • Health Care Systems
  • Social Issues

ICN’s collaboration with the Nursing Now campaign, recently given a boost by the World Health Organization, points to the profession’s increased visibility and influence on the global stage. The signing of a Memorandum of Understanding at WHO Headquarters in Geneva on October 4, 2018 was an occasion to celebrate and strengthen the partnership. The MOU formalizes a new commitment to support and advance nursing in improving health globally. ICN’s dynamic social media presence and a redesigned website have also contributed to increased visibility in promoting events, new initiatives and global health campaigns.  The ICN 2019 Congress will be a perfect opportunity to engage with the Nursing Now campaign and learn about its impact.

Update October 31: ICN and Nursing Now issued a Joint Statement following the Global Conference on Primary Health Care held in Astana, Kazakhstan (Oct. 25-26). Their statement contains links to the Astana Declaration and to a Civil Society Statement, endorsed by ICN and Nursing Now, calling for strengthening political leadership to uphold the vision of health for all.

By Nora Whyte – October 31, 2018

 

Nursing Now: Campaign for Nursing & Global Health

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Nursing Now is a three-year campaign to raise the profile of nursing globally and to enhance the profession’s contribution to people’s health and health systems. In partnership with the International Council of Nurses (ICN), the Burdett Trust in the UK, World Health Organization and others, Nursing Now has described the campaign goals to be achieved by the end of 2020:

  • Greater investment in improving education professional development, standards, regulation and employment conditions for nurses;
  • Increased and improved dissemination of effective and innovative practice in nursing;
  • Greater influence for nurses and midwives on global and national health policy;
  • More nurses in leadership positions and more opportunities for development at all levels; and
  • More evidence for policy and decision makers about where nursing can have the greatest impact, what is stopping nurses from reaching their full potential and how to address these obstacles.

The campaign launch at the end of February 2018 received an enthusiastic response as events were held in various locations and promoted widely through social media. Having first heard about early ideas for Nursing Now during the ICN Congress in Barcelona (May 2017), I have been following developments with great interest and will continue to do so during the three-year campaign. I was pleased to read an overview of the campaign in the March-April issue of the Canadian Nurse including a profile of Sarah Walji who represents young nurses on the Nursing Now campaign board.

Nursing Now will look for opportunities for policy influence through presenting ideas to special commissions and participating in global health events. An initial opportunity this year is the High-level Commission on Non-Communicable Diseases. The Nursing Now team has been seeking input from nurses in preparing a brief to showcase nursing’s role in promoting health and preventing disease.

What now? Suggestions for involvement include pledging support, joining or setting up a national group, providing case studies and contributing to social media discussions. As a first step, nurses can sign up to receive regular updates.

The campaign has great potential to raise the profile of global and national nursing organizations including the ICN and its member national associations. It will be interesting to track achievements during the next three years to observe its impact and to learn about the most effective strategies for realizing the desired changes. It will be important also to consider any issues or concerns arising from this major initiative. It may be that all the focus on nursing is viewed negatively by other professions and there could be challenges embarking on the campaign in countries where governments have limited interest in a strong health sector. It will be important in all aspects of this initiative to refrain from being inward-looking as the nursing profession increases its collective capacity and policy presence for global health.

Follow on Twitter: @NursingNow2020

Posted by Nora Whyte –  April 29, 2018