By Susan Duncan and Nora Whyte

Beyond Healthcare to Health was the theme of the International Council of Nurses (ICN) Congress held in Singapore from June 27 to July 1, 2019. We were pleased to be among the diverse group of over 5,300 nurses from 120 countries to gain inspiration from plenary speakers and to share knowledge and ideas through oral and poster sessions and interactive policy & advocacy cafés. We offer highlights, reflections and questions for Canadian colleagues arising from our recent experience. We were pleased to see leaders of our national organizations (CNA, CASN & CFNU) at the Congress with Canadian nursing students also in attendance.

We take this opportunity to share our experiences and links to noteworthy sessions and resources.

Our Questions in the lead up to the Congress:

  • How is ICN leading and partnering with WHO?
  • What global policy issues are profiled?
  • How is the Nursing Now campaign developing?
  • How was the Congress theme – Beyond Healthcare to Health – expressed throughout the conference?
  • What are takeaways and reflections for Canadian nursing?

ICN Leadership Themes and Initiatives

ICN President Annette Kennedy and CEO Howard Catton were a dynamic presence at the Congress creating a positive mood from start to finish. ICN Board members including Canadian Lisa Little moderated the plenary and main sessions and engaged with participants.

Annette Kennedy referred to the central and pervasive issue of gender inequity in nursing, health and global leadership (Nurses are 70% of the health workforce yet only 20% of health leadership). The G20 Summit was occurring in Japan during the ICN Congress and Annette referred to “the suits” representing global leadership with only three women present.

On behalf of the Board, Annette and Howard provided an excellent overview of ICN’s recent initiatives and the Strategic Plan for 2019-2023. Their presentation on ICN – Being the Global Voice of Nursing highlighted strategic health priorities and the increasing opportunities for collaboration with WHO and other bodies. ICN’s three foundational program pillars – professional nursing practice, nursing regulation and socio-economic welfare for nurses – were affirmed in the new plan. See figure below for details and refer to the full Strategic Plan posted on the ICN Site.

Strategic plan

ICN is an active partner in the Nursing Now campaign. A plenary session on Nursing Now delivered by co-chairs Professor Sheila Tlou and Lord Nigel Crisp generated great enthusiasm as they announced the launch of the Nightingale Challenge to coincide with the Year of the Nurse and the Midwife in 2020. The Nightingale Challenge asks employers around the world to provide leadership development opportunities for nurses and midwives under the age of 35 to prepare the next generation of leaders in the profession. We are following this movement with interest and will write about the Canadian response as organizations take up the challenge.

Throughout the Congress we heard the growing call and challenge to support early career nurses and a prevalent focus on students. We were particularly impressed to hear presentations by early career Canadian nurses, Patrick Chiu and Sarah Walji, who shared their leadership journeys and ideas for future support programs and by Geneviève McCready on her doctoral research in health equity.

There was a commitment to interactive sessions around key policy issues through policy cafés including: the future of Advanced Practice Nursing; Disaster Management, Technology and Digital Health; the meaning of Codes of Ethics in a digitalized world; and achieving “health for all” amidst global health challenges. Echoed throughout the Congress was the message that nurses are crucial to the success of the Sustainable Development Goals (all of them) and to achieving universal health coverage for all.

We enjoyed an impressive interactive historical display commemorating ICN’s 120th Anniversary. We noted pervasive themes across the decades of leadership, nursing contributions during wartime, policy development and collective work on the three ICN program pillars.

World Health Organization Presence and Messages

WHO also had a strong presence at the Congress with Dr. Tedros Adhanom Ghebreyesus, Director-General and Elizabeth Iro, Chief Nursing Officer delivering dynamic presentations on how nurses are the essential global resource for primary health care and universal access to essential health care – achieving health equity and the achievement of the Sustainable Development Goals (SDGs).

WHO has identified the triple billion target – 3 billion people enjoying health, protected from large scale events and outbreaks, and with Universal Health Coverage (UHC).

In his speech, Dr. Tedros highlighted three WHO priorities:

  • Achieving Universal Health Coverage
  • Achieving Population Health as indicated in the United Nations SDGs
  • Addressing emergencies

Both Iro and Tedros referred to 2020 Year of the Nurse & the Midwife as a time for momentum in strengthening nurses’ participation in global health leadership. 2020 will see the release of the first State of the World’s Nurses Workforce Report to be presented at the World Health Assembly. Elizabeth Iro posed the question: “Where do you want to see Nursing beyond 2020?” She focused on a key policy message – “Nurses Save Lives”. She identified the importance of global partnerships in moving forward and the critical role of ICN.

Also from WHO, Dr. Jeremy Lauer, health economist, presented compelling and growing evidence on how investments in the health workforce not only strengthens health systems but also contributes significantly to a country’s GDP and economic well being. His main message – “the health system is an engine of growth – contributing to the growth of GDPs in lower, middle and upper income countries”. This news was striking in its contradiction to the usual economic projections that health workforce spending must be contained. Dr. Lauer contends that business economic models do not inform the impact and outcomes of health system economics. This work resonates with the goals of Nursing Now to strengthen contributions of nurses and midwives to the SDGs by investing in nurse and midwife led community health clinics and also points to how investing in the health workforce improves women’s capacity to contribute to a country’s GDP and the SDG outcomes. For further details see his presentation slides – Investment in health in the global arena.

The Canadian Nurses Association Reception

A special highlight for us was the Canadian Nurses Association hosted reception. CNA President Claire Betker welcomed special guests – the Canadian High Commissioner to Singapore, Lynn McDonald, and WHO leaders, Elizabeth Iro and Dr. Tedros. Dr. Tedros issued a challenge to Canadian nurses and our government to appoint a Chief Nursing Officer for Canada as essential leadership in government by the launch of 2020 as the International Year of the Nurse and the Midwife.

The reception was an ideal opportunity for informal socializing with other Canadians and with some of the ICN Board members who dropped by. Thanks CNA for a great party!

Other Notable Topics

Many other speakers provided inspiration and evidence for action beyond this Congress.

Health Human Resources Main Session – chaired by Lisa Little, ICN Board Member from Canada, included an expert panel reporting on global trends including Jim Buchan, policy analyst.  Data on nurse retention and migration are urgently needed. Dr. Buchan reported the damaging consequences of poor nurse retention worldwide: 1) many nurses have poor working conditions including workload, 2) negative impacts on care quality when nurses turnover, and 3) impact on costs and productivity. A main message is that UHC will not happen without improved nurse retention worldwide. He asked: “Does your National Nursing Organization have a strong relationship with HHR policy in governments?” Other panelists pointed to trends of increasing numbers of nursing assistants and technologists replacing RNs and called for investments in MN and doctoral education. A report on Health Worker Migration was offered as a good reference on this global issue.

Nursing Regulation was discussed in a preconference setting attended largely by regulators and there were concurrent and plenary sessions focused on the changing world of nurse and health professional regulation.  The National Council of State Boards of Nursing (NCSBN) had a strong presence as a main exhibitor and sponsor of the Congress and David Benton, CEO, presented as part of a main session on nurse regulation chaired by Dr. Pamela Cipriani, Vice-President of ICN.

Benton noted how nurse regulation defines what it means to be a nurse and we must redefine the way we are regulated by demonstrating impact. He described regulation under siege due to factors related to demographics, robotics and use of assistive personnel and the changing nature of nurses’ work.

Cipriani noted the importance of regulation as a pillar of the ICN and summarized the panel discussion by emphasizing the critical importance of collaboration between professional associations, unions and regulators and called for a focus on system level determinants of safe practice.

Safe Nurse Staffing was presented by researchers Dr. Linda Aiken and Dr. Matthew McHugh who spoke on safe nurse staffing interventions. They noted the vast body of accumulated evidence over the past two decades on safe staffing. Their  focus is now on interventions to improve safe staffing including mandated patient-nurse ratios in some jurisdictions and voluntary adoption of improved nurse staffing in others. McHugh showcased the benefits of nurse staffing improvements in public hospitals in Queensland, Australia where patient deaths and  readmissions were avoided and cost-savings were realized.  Aiken referred to ICN’s 2018 position statement, Evidence-based safe nurse staffing as a strong policy resource.

Human Trafficking was the topic of the closing plenary by Kevin Hyland, emphasizing the widespread nature of the issue and the vital role of nurses and our nursing organizations in raising awareness and taking steps to combat human trafficking.  

Nurses on Boards Initiative: We took great interest in a poster session by American nurses Kimberly Harper, Chair of the Nurses on Boards Coalition and Cynthia Vlasich, Board Member. The Nurses on Boards Coalition has a target of placing “10K Nurses on Boards by 2020 with the vision that all boards benefit from a nursing perspective in the interests of improved health and efficient and effective health care systems at the local, state and national level”. The coalition has developed a competency model and plan to track impact of nurses on boards.

Critical Inquiry / Reflections

As we return to Canada and our local contexts, we reflect on how the congress themes apply to our organizations and present opportunities for new initiatives:

  • Reflections on global nursing leadership at senior levels of government inspire urgent action to meet the WHO issued challenge to Canada to appoint a Chief Nursing Officer in the federal government in time for the launch of 2020.
  • We observed that current concepts of primary health care are founded in achieving global health equity as expressed in the goal of UHC, improved health human resources capacity and focus on a continuum of care including health promotion.
  • We must consider how Canada upholds the value of universality and expands access to a full continuum of health care (mental health promotion, home care, pharmacare) – with particular attention to the role that nursing and nurses play in ensuring this commitment.
  • We were inspired to bring back key messages of the focus on the energy and contributions of students and young nurses with the promise of the Nightingale Challenge across Canada.
  • Nursing Now is an important social movement gaining global momentum in the lead up to 2020 and we are committed to playing our part in Canada.
  • An initiative similar to the Nurses on Boards Initiative is needed in Canada to strategically place nurses on diverse boards of health and other sectors in order to strengthen nursing’s impact in governance. Education of nurses for governance roles is needed in order to ensure power and capacity to bring a nursing perspective on health and health systems.

Selected Congress presentations, photos and speaker profiles are archived here.

Susan Duncan RN, PhD is Professor and Director, University of Victoria School of Nursing. Nora Whyte RN, MSN is President of Primary Health Care Consulting and Adjunct Professor, School of Nursing, University of British Columbia.

Susan and Nora focus their inquiry and writing on how professional nursing organizations in Canada and internationally are working in the public policy arena, with emphasis on how nursing policy and leadership intersect with the health issues and challenges of the 21st century. In their work, they draw on their extensive experience with governance in nursing and health organizations.