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Guest Editorial

Thirty Million Strong

Mancuso, Leslie PhD, RN, FAAN; Davidson, Patricia M. PhD, MEd, RN, FAAN

Author Information
AJN, American Journal of Nursing: May 2020 - Volume 120 - Issue 5 - p 11
doi: 10.1097/01.NAJ.0000662720.40824.48
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Abstract

Figure
Figure:
Leslie Mancuso
Figure
Figure:
Patricia M. Davidson

Nurses are the largest single contributors to the global health workforce, delivering almost 80% of the hands-on health care. From Baltimore to Bangalore, nurses are key to achieving the United Nations' Sustainable Development Goals (SDGs) because of their knowledge and commitment to person-centered, outcome-focused models of care.

You might think that, at 27.9 million strong, our sheer number—not to mention our transformative potential—should confer authority and influence, situating us squarely at the nexus of power and health. But the nagging reality is that nurses today occupy relatively few positions of leadership. Far too many lack fair wages and a safe workplace free from harassment, discrimination, and violence.

The first-ever report on the State of the World's Nursing (SoWN), published in April, brings this reality into stark focus with analyses of comprehensive data and contemporary evidence from over 190 countries. Developed by the World Health Organization with the International Council of Nurses and the global Nursing Now campaign, and with governments' support, this real-time snapshot of nursing across the globe challenges all of us to envision what our profession needs to look like in the upcoming decade, and to identify opportunities to shape it for the better.

Among the many overlapping issues that warrant urgent attention and energy are those about promoting a realistic and contemporaneous image of nursing, addressing gender bias, achieving scope of practice, focusing on workforce shortages and distribution, and increasing the voices of nursing and midwifery in charting the future of health care.

Image. SoWN reveals a vast variety of nursing titles—171 distinct nursing roles. Still, public perception may remain rooted in the stereotypical nurse assisting physicians, as opposed to autonomous and highly skilled professionals and collaborative members of the health care team. When nurses are seen as alongside and integrated into science, technology, engineering, and mathematics, the perception of nursing's value improves.

Gender bias. Approximately 90% of the global nursing workforce is female, but women earn less than men. An analysis of leadership barriers and facilitators in nursing commissioned by the Nursing Now campaign describes not only a glass ceiling for women, but also a glass elevator for men, who hold a disproportionately high number of senior nursing roles. We can start to rectify this by being our own best advocates and negotiating our value. Policies to prevent and address sexual harassment need enforcement of zero tolerance. And we need to destigmatize men's role in the profession and engage more male applicants to schools.

Scope of practice. Nurses all over the world serve in specialty and advanced practice roles, both by design and by necessity. For instance, in remote regions and rural communities nurse autonomy may be a result of inequitable physician distribution. Sadly, though, nurses are viewed as good enough, instead of good, period. We need a global commitment to build the role of advanced practice nurses who confidently and legally provide specialty care and run their own primary care practices—because they are competent experts. Let's promote the robust evidence that shows we provide cost-effective quality care, and scale-up what works.

Shortages/equitable distribution. Projections indicate that both demand-based and SDG-needs-based nursing shortages will persist through to 2030 without additional investment in education and employment. One of the main causes of the supply-side bottleneck is the lack of a skilled and robust nurse faculty. We suggest awarding scholarships to PhD candidates who commit to teaching. Insufficient staffing impacts nurses' stress level and job satisfaction, driving many to leave the profession and creating a vicious cycle of shortage that restricts equitable access to health care by all.

Leadership. Achievement of the SDGs by 2030 depends on nursing leaders making decisions and exerting influence in communities, facilities, and health care systems worldwide. SoWN data and evidence are intended to spur pro-nurse policies and government investments. Still, data gaps in the SoWN report reveal what hasn't been measured—and so can't yet be properly managed. A deeper understanding of our workforce requires strengthening the support systems that underpin the collection, analysis, and use of evidence to attract the best and brightest, reduce attrition, and improve quality of care.

Simply, the health of the world hinges on it.

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