Nurse as Leader: Is it time to change our strategy?

Every May 6th-12th is International Nurses Week, a time where we celebrate nurses and shine a spotlight on a profession that is rarely glamorous. It is a wonderful tradition steeped in history that culminates in the birthday of Florence Nightingale, the founder of modern day nursing. This year, for the first time since becoming a nurse, I have struggled with how to acknowledge and celebrate the event. I have been a nurse for 28 years, 19 of which as an Adult Nurse Practitioner, and I pride myself on being an outspoken advocate for nursing. I aim to highlight the role of nurses globally and am, at my core, a nurse advocate. However I also know, that in spite of the overwhelming data demonstrating the foundational role of nurses and the sheer volume of nursing presence as the largest cadre of health providers globally, we are still only making small gains on promoting nurses to leadership positions. The rate of change in advancing nursing leadership has been almost imperceptible to date. Our attempts at increasing nurse visibility and illuminating our numbers and our self-advocacy are simply not enough. Our strategy is not working. We can no longer insist nurses are leaders just because we are nurses---but rather we must show that we are leaders because of what we can do, because of our unique skills and because of the vital role we play in a team. Why is this important? This is vital because we need a radial and cataclysmic change in global health care delivery.

Ebola rocked the world globally. We all had front row seats watching the worst fast-moving epidemic of our lifetime devastate three vulnerable countries in West Africa. As the media attention of Ebola dimmed, these countries continued to struggle with a vast array of health system challenges. Prior to the Ebola epidemic, Sierra Leone had one of the highest maternal mortality rates in the world and now it is assumed to be much worse.

In 2012 the gap for the health system strengthening in West Africa was estimated to be $1.58 billion--this is a third less than the $4.3 billion that international community pledged to fight Ebola.The nature of emergency funding strategies currently widely practiced is too narrow and neglects the need for comprehensive efforts that simultaneously address the acute crisis at hand but also focuses on overall health system strengthening.

While there have been improvements in surveillance and infection control of Ebola in all three countries, access to primary health care and basic life-saving services like routine surgery remain elusive. We need to change the emergency aid paradigm and invest in health systems to prevent global threats like Ebola from emerging in the first place. Ebola acted as a litmus test for societies and health systems--- it illuminated the abysmal state of health care in West Africa and the resulting isolationist behavior that the US exhibited by focusing on closing our borders, rather than turning resources to fighting the real enemy on the frontlines in West Africa; the enemy being a weak health system.

Now that Ebola has faded into the distance for those of us here in America, we have the Zika virus bombarding the media waves. Meanwhile chronic emergencies such as TB, HIV and cancer bubble under the surface, often not warranting a front page headline. What will be our next Ebola? What will kill thousands needlessly? Who will take up arms in defense of those suffering? Nurses.

The portrait of the nurse at the bedside with a cool hand on the brow of the sick child, although compelling, presents a one dimensional caregiver. Of course we provide comfort, serve with compassion and value our connection with our patients. In my role as the Chief Nursing Officer at Partners In Health (PIH) during our Ebola response I saw nurses in Sierra Leone efficiently running Ebola treatment units, juggling complex and dangerous working conditions with minimal staff and supplies. Today I see nurses in Boston managing large hospital systems, individuals responsible for multi-million dollar budgets. I see nurses in rural Haiti, Rwanda, and Malawi running massive community health programs that pioneer models of comprehensive treatment capacity for malnutrition and HIV/AIDS. I see midwives in Lesotho working to address maternal mortality with the Ministry of Health and scale up their program to a national scale. I see nurses in rural Liberia, hours away from the nearest paved road, fighting to build a health system from scratch. I see nurses in Russia addressing the rising HIV crisis amongst pregnant women by providing expert clinical care at patient's homes. I see nurses in Peru who have fought for decades to keep MDR-TB treatment affordable and accessible for all. And I see nurses in Mexico and the Navajo Nation who, as deeply embedded members of their community, serve as advocates for their patients and fight to break down barriers that prevent them from accessing care.

How do we do all of these things? We build, assess, evaluate and adapt systems. We are experts in logistics and operations. We get things from point A to point B via complex supply chains-- and when such a system is not available, we innovate and get the stuff where we need to get it. We manage money, squeeze the last dime out of every dollar, and make difficult life and death choices every day. When we don't have a tool we need to get the job done, we invent equipment to improve care delivery or we leverage technology to improve health systems in any setting. We build excellent teams and value communication as a key element of success. We measure, evaluate and research key areas to assess impact of our interventions. We are adaptable, flexible and innate problem-solvers.

Although I am a strong nurse leader, I am advocating for a decision algorithm that chooses the right provider, right place, right time and right tools. We need to focus on who is best to provide quality and accessible care and advocate for a fully integrated inter-professional and trans-disciplinary team. There is so much to do to address health inequities globally. Our fight for universal health care and coverage has to remain front and center at international, national and local policy tables. We cannot let the distracting political landscape in the US allow us to stray from our resolve to make this issue a resounding, loud and unrelenting priority.

This is no longer purely a pride, equality or advocacy issue for me. We need nurses in decision making positions because we have the leadership skills, tangible tools, flexibility and drive to get things done. Happy International Nurses Week-- let us be the catalysts for change, the future of global health depends on it.