“The return on investment in nursing for global health is priceless” – ICN calls for nurse-led models of care

Howard Catton, Chief Executive Officer of the International Council of Nurses (ICN), today called for advanced practice roles to be at the heart of nurse-led models of care.

“Nurse-led services should be central to expanding and strengthening health systems around the world,” he said, adding, “Now is the time for countries to introduce, increase and grow nurse-led models of care. Nursing is the golden thread that links healthcare policy and practice. It holds the solution to many of the healthcare problems the world is facing, and that is why we are calling for governments to urgently invest in nursing. The return on investment in nursing for global health is priceless.”

Giving the keynote address on the final day of the 12th ICN Nurse Practitioner/Advanced Practice Nursing Network Conference in Dublin, Ireland, Mr Catton said that nursing had come to the forefront during the pandemic and that the war in Ukraine, climate change, natural disasters and other recent challenges had all shown the centrality of health to the safety and security of the planet and the leading role that nurses play in responding to these threats to health.

However, along with these recent challenges, the world is still facing the same pre-pandemic threats to health, such as access to healthcare, poverty, noncommunicable disease (NCDs), infectious diseases, lack of vaccination coverage, humanitarian crises, ageing populations, and an increase in mental illness.

These increasing threats to health, combined with a severe global nursing shortage, mean that many high-income countries are recruiting nurses from lower-income countries which cannot afford to lose their workforce. In his keynote in Dublin, Mr Catton underlined the point he made in a recent Nursing Times story on the UK government’s plans to recruit nurses from Nepal despite global restrictions. He stressed that the UK has more than four times the number of nurses per head of population than Nepal and that access to healthcare for millions of Nepalese is already a major challenge. He noted that international recruitment, particularly from countries that cannot afford to lose their nurses, will only widen inequalities. Calling for strengthened global regulations and improved national workforce planning, Mr Catton said governments must address their own shortages by increasing the number of home-educated nurses and investing in retaining their current nurse workforce.

Mr Catton also called on APNs to raise their voices on the migration issue, saying, “We have to be vocal on the economics, on the ethics and on the local health implications of what we are seeing. What is the root cause? It comes back to underinvestment in the nursing profession. Why does this matter? It matters for people’s health; it matters for community, country, region and global health. And if people aren’t convinced that health is important just remind them about the pandemic over the last couple of years.”

Recent reports from ICN, the World Health Organization, the WISH Foundation and others provide the evidence that investment in retaining and recruiting domestic supplies of nurses and developing advanced practice nursing (APN) roles can provide the solution to these challenges. The WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 provides the strategy to invest in education, jobs, leadership and service delivery.

Mr Catton said:

“We have the evidence: we see around the world how APN roles and nurse-led services are delivering high quality, accessible, timely, people-centred and cost effective health care. And we have the strategy. Now we need to do more to see nurse-led models of care used in health systems.”

In its International Nurses’ Day reports over the last few years, ICN has provided case studies which show examples of these nurse-led models of care in action. Addressing the audience of APNs, Mr Catton gave an example from Ireland where an APN-led cardiology chest pain service has been implemented. Within the first year of this service, admissions to the ward reduced by 36% and to emergency department trolleys by 60%, contributing to significant savings for the hospital and timely diagnosis and treatment for patients.

A case study from the USA, where 36,000 nurse practitioners graduate each year, showed that APNs are helping to meet demands for the shortfall in general practitioners, thanks to the lessening of restrictions on APNs during the pandemic in order to meet demand.

ICN’s case studies show that nurse-led care is key to improving integrated care including adherence to follow-up, improved diagnosis time, improved self-care management, improved quality of life, reduced mortality, lower readmission, and reduced hospitalization costs.

ICN has now taken these case studies to a whole new audience via its partnership with BBC Storyworks and the Caring with Courage film series. One film looks at how nurses in the USA are addressing the social determinants of health, caring for vulnerable and disadvantaged populations by increasing access to primary health care in the heart of the community. This work has reduced emergency department visits by 42%, inpatient hospital admissions by 55% and length of stay in hospital by 61%.

Another film addresses nurse-led NCD prevention and treatment in India using community nurses armed with screening technology who go out into the community to provide early detection, screening and control. Over 135 million people have been enrolled in the system and more than 94,000 health workers trained.

Mr Catton gave a final example, that of a hospital on a train in South Africa which brings access to health care to reach patients. This is a nurse-led service which provides multiple primary health care services to disadvantaged communities.

“This is what countries and health care systems should be funding, “ said Mr Catton. “And this is what APNs need to get out there and advocate for.”

The 12th ICN NP/APNN Conference was held 21-24 August in Dublin, Ireland. Speakers included The Prime Minister of Ireland, Micheál Martin; Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO); Elizabeth Iro, WHO Chief Nursing Officer; Dr Pamela Cipriano, ICN President; Dr Karen Bjøro, ICN Second Vice President; Dr Michelle Acorn, ICN’s Chief Nursing Officer; Karen McGowan, INMO President; Dr Daniela Lehwaldt, Chair of the ICN NP/APN Network; Christine McDermott, Chairperson, Irish Association of Advanced Nurse Midwife Practitioners (IAANMP); and Steven Pitman, Head of Education and Professional Development at INMO.

To read more about the ICN NP/APN Network Conference, click here.

Download the communique here