ICN holds Western Pacific Region webinar to discuss region’s challenges and achievements

The International Council of Nurses (ICN) held a webinar on 26 January 2023 to discuss nursing in the Western Pacific region.

With 79 participants joining from 21 countries, the webinar was introduced by ICN President Dr Pamela Cipriano and chaired by ICN Chief Executive Officer (CEO) Howard Catton.

Dr Cipriano opened the webinar by introducing the ICN Board members who were in attendance, 3rd Vice President Lian-Hua Huang from the Taiwan Nurses Association, Megumi Teshima from the Japanese Nursing Association, and Alisi Talatoka Vudiniabola from the Fiji Nursing Association. Dr Cipriano went on to speak about the focus of ICN’s work during 2022, which had been another challenging year that saw health systems struggling to recover from the shock of the pandemic and its ongoing aftermath.

Among the topics Dr Cipriano mentioned were:

• The 9th Triad Meeting of the World Health Organization (WHO), ICN and the International Confederation of Midwives • The implementation of the WHO Global Strategic Directions for Nursing and Midwifery (2021-2025) with investments needed in the four areas of jobs, education, leadership, service delivery
• The working conditions of nurses; mental health; decent pay; gender equality; rights; diversity, equity, inclusion and belonging
• ICN’s humanitarian work in Ukraine and around natural disasters, nurses’ impact on global health, strengthening the nursing workforce and influencing healthcare policy.

Dr Cipriano said she will be continuing her work as a member of the United Nations Universal Health Coverage (UHC 2030) task force. It is due to report to a special United Nations high level meeting in September 2023. She said the task force’s draft action agenda includes eight action areas that countries should focus on to drive progress towards UHC, including political leadership, leaving no one behind, strengthening the health and care workforce, embracing innovation and new models of care, gender equality and connecting UHC to health security.

She spoke about the need for a new, ‘post-pandemic normal’ based on the hard lessons learned over the past three years, including that nurses are not properly valued by the societies they serve. What is now required is a new situation with appreciation and respect for nurses, adequate resources, protection from harm, and fair and equitable pay.

Dr Cipriano said two highlights of this year for the nursing profession will be ICN’s International Nurses Day celebrations and resources, which will include a manifesto to value, protect and invest in the world’s nurses, and ICN’s Congress, which will take place in July in Montreal, Canada.

Mr Catton introduced ICN Associate Director for Nursing and Health Policy David Stewart, who is ICN’s representative for the WPRO region, and Eriko Anzai who is the WHO’s nurse lead for the WPRO region.

Mr Catton gave an overview of shortages in the global nursing workforce, including figures from the 2020 State of The World's Nursing report, which showed a deficit of six million nurses, ICN’s Ageing Well publication, which spoke of up to five million nurses retiring by 2030, and ICN’s 2022 Sustain and Retain report, which showed that two to three million nurses could leave the profession because of the ‘COVID Effect’. He also mentioned the recent findings of the Institute for Health Metrics, which estimated a nursing shortage of 30 million. He said the fact that nurses around the world are demonstrating and taking part in industrial action shows there is a critical need to invest in, and recruit and retain nurses.

Mr Catton said all of the above suggest that workforce shortages are now the greatest threat to health global health and patient safety, and that the short-term fix of international migration is resulting in negative impacts low income ‘donor’ countries.

He recommended the ICN/BBC Storyworks Caring with Courage films, which show the impact of nurses all over the world and how nurses are leading innovations, improving access to care and raising the quality of services.

Mr Catton said the WHO Director General Dr Tedros has been clear about his support for nurses and the new WHO Chief Nursing Officer is on her way to Geneva to start her job.

He ended by saying that investment in nursing is absolutely critical, but any improvements would be against a challenging background in which world economies are struggling, there is war in Europe, people everywhere are facing a cost of living crisis, and there is a huge need to rebuild our health systems.

Dr Cipriano introduced speakers from the region. Australian College of Nursing (ACN) CEO Kylie Ward spoke about the reduced number of applications for nursing schools in Australia and said some nurses are leaving full-time work to go part-time. She said the Australian government had passed legislation that requires a registered nurse to be present on every shift for ageing care, which has taken nurses away from other areas. ACN is also looking at the ethics of international migration and is keen to improve retention of current staff. The associatoin is asking for nurses to have access to Medicare funding for primary healthcare, which is a big political topic. She said the vastness of Australia means there is inequity in healthcare services in rural and remote areas, which should be addressed.

General secretary of the Fiji Nursing Association (FNA) Filomena Talawadua said Fiji has more than 300 islands and 4,000 nurses, but they have started leaving ‘in droves’. There is a new government with whom FNA is in discussions about the lack of payment of allowances and the lack of nursing leadership. She said nurses make up 62% of the health services workforce but there is a ‘brain drain’ because of migration. “We are losing our middle managers and experienced nurses who are going to Australia for better pay and working environment”. The FNA has been obliged to take nurses’ concerns to the media as the previous government did not reply to their request for discussions. The new government, however, has invited the FNA to meet to discuss nursing shortages.

Taiwan Nurses Association (TWNA) vice president Li-Chi Chung said Taiwan has nursing shortages, which were especially noticeable during the pandemic. She said Taiwan’s nurses need continuing education to improve clinical skills to strengthen the profession. There is a problem with nurse-patient ratios, which the government has a project to address. The TWNA met with the Minister of Health and Welfare who invited nurses to discuss the ratio: nurses want to have a regulated ratio of nurses to patients for each shift in each hospital. TWNA also want regulated ratios in rural areas, and they want offshore islands to have nurse practitioners to improve access to universal healthcare. TWNA is working with the government to increase and retain nurses in clinical practice and increase their level of education to ensure improved patient safety.

The president of Japanese Nurses Association, Toshiko Fukui, said it is vital to retain the current nursing workforce. She said nurses’ starting salaries are higher than all other professions initially, but their remuneration falls behind when they reach their 30s, and by the time they are in their 40s there is big wage gap compared to other industries. Despite an increase in nurses’ salaries during the pandemic and another increase (by ¥12,000 (USD 92) per month) in February 2022, many nurses say their wages are not commensurate with their responsibilities. In December 2022, the health ministry introduced a wage system to raise wages, which JNA believes is a major first step. JNA is committed to nurse education and more nurses are choosing to go to university, which has resulted in university graduates being the largest group of newly registered nurses for the first time.

Vice president of the Malaysian Nurses Association, Abidah Yasin, said Malaysia is forming a nursing council to amend the nursing act so that nurses are included in policy and decision making. She said that at the end of 2022, there was an amendment to Malaysia’s Employment Act for nurses in the private sector, which reduced working hours to 45 per week, extended maternity leave to 98 days and extended of paternity leave to seven days. Ms Yasin said the entry level for nursing in Malaysia is at diploma level, but the Ministry of Health is growing the number of degree-level nurses.

New Zealand Nurses Organisation (NZNO) President (Kaiwhakhaere) Kerri Nuku said that over the past year there has been a transformation in the New Zealand health system, with reforms to eliminate inequities and improve health coverage. The systematic changes have brought the former 20 health authorities under one umbrella organisation to work more effectively as one united system. The Ministry of Health, the Health Authority and the Maori Health Authority now recognise the commitment to New Zealand’s indigenous people, who have experienced shorter life expectancies, less access to services, and disproportionate effects of the COVID-19 virus. This was considered a humanitarian crisis and indigenous nurses took the government to task over the need to create a health system that is responsive to indigenous people’s needs. Nurses collectively challenged government over the importance of representing the indigenous voice of both the population and the nurses. Nurses who choose to work with indigenous people are paid 25% less than others.

Question and answer session

There was a question about Canadian visas for ICN Congress. Mr Catton directed people to the ICN Congress website where there are details about applying for visas and how to get ICN’s letters of support. He urged people to apply for visas as soon as possible.

A second question concerned how ICN members can work together to legislate nurse-patient ratios.

Dr Cipriano said nurses should lobby to have the numbers of nurses that they need to provide safe effective care. She said there will be a discussion about this important issue at the Council of National Nursing Associations Representatives (CNR) in Montreal in June.

Mr Catton pointed to ICN’s Safe Staffing Position Statement, which shows the importance of having systems in place for safe staffing levels. He said as the context of each country varies, ICN cannot put forward one model, but it is important to have mechanisms in place. The White Paper on Safe Staffing shows what different countries have done. He said ICN advocated for a World Patient Safety Day, which now includes healthcare workers safety and safe staffing levels. There is a global patient ministerial meeting later this year which ICN will take part in.

David Stewart said ICN is working closely with WHO’s patient safety director and there will be a dedicated session on the subject at Congress, learning from in country examples. He said the White Paper also shows safe ratios in several sectors, not just acute care.

Alisi Talatoka Vudiniabola from Fiji said she was leaning towards legislation as the only way to guarantee safety, protection of staff and retention of skills. She said most hospitals are relying on new nursing graduates whose skill levels may be poor. She said: “ We need to have that legislated and include skills in that legislation. No amount of advocacy, meetings, literature and discussion will change anything in the Pacific right now.”

Mr Catton said that where nurses are on strike they are ensuring that there are enough nurses on duty to ensure patients are safe. But he said he had heard anecdotally that staffing levels on strike days are close to normal levels, which demonstrates the inadequacy of normal ‘safe’ staffing levels.

Ms Fukui said that in Japan the number of senior patients has increased and there is a shortage of nurses to care for them. She said innovative technological solutions may have some answers to the complicated care needs of older people.

Dr Cipriano said she was in awe of some of the technology in nursing she had seen in Japan and recommended the BBC Storyworks video, which has a great example of technology use in Japan.

Conclusion

Mr Catton said he had been struck by the progress and innovation that colleagues have been making. He said the ICN Asian Workforce Forum in March in Bangkok would be an opportunity to discuss these issues.

Dr Cipriano said she appreciated being in touch with NNAs in the Western Pacific Region and that it would help ICN to understand what is happening on the ground.

Download the communique here