Advocating for hospital nurses to be safe from falling bombs is one of New Zealander Dr Frances Hughes's recent duties as Geneva-based leader of the International Council of Nurses.
Hughes, the former chief nurse of both New Zealand and Queensland, took up the chief executive post in February in charge of ICN which represents 16 million nurse members of national nursing associations. She is back home this month to speak to the New Zealand Nurses Organisation's conference and said New Zealand should be proud of "being ahead of the game" internationally in areas like nurse prescribing and advanced practice.
She said in her first six months in the job she has learnt that ICN's role was not only to support the actions of member associations like NZNO but also to speak up on behalf of associations too vulnerable to speak for themselves.
"We can comment on things that aren't right – like the bombing of hospitals, unsafe work environments and poor salaries." Last month Hughes joined the chair of the World Medical Association in condemning the persistent and targeted attacks on doctors, nurses and other health personnel in Syria.
She is also advocating for increased investment in nursing in countries around the world and sharing the evidence on how nursing makes a difference to healthcare provision. "So they can see nursing -rather than as a bottom line cost but instead as an investment strategy to actually reduce healthcare costs and improve quality."
New Zealand was leading in some areas including the extension of prescribing to suitably qualified registered nurses which had prompted letters of congratulations from Geneva to the Minister of Health, Nursing Council and chief nurse Jane O'Malley.
"New Zealand is ahead of the game in many respects and we are way-up with the big western countries in what we are doing (in areas like prescribing and advanced practice) and New Zealand should be really proud of what the policy decisions have been. And the fact that we are utilising nurses to the maximum of their ability."
NZNO has in the past questioned membership of ICN and Hughes said it was right for member associations to hold ICN to account. "I'm incredibly conscious of making sure we are up-to-date, relevant and meaningful to our members," said Hughes
Land of Heidi and cheese
Hughes told Nursing Review that arriving in mid-winter to take up her new job – in a city where French is the lingua franca and English her only language – had had some challenges but overall it was being a great experience.
"It's a bit more than the land of Heidi, chocolate and cheese," laughed Hughes who was also surprised to find that her new home country only got the vote for woman in 1974. She said her French still had some way to go but she could now order green tea and follow gym instructions so had the "basics covered".
Hughes also said she has been loving getting to know and represent an iconic 117–year-old organisation representing 16 million nurses in 142 countries in a city that is also home to the World Health Organisation (WHO) and the International Labour Organisation (ILO). Formed in 1899 by a British suffrage leader the ICN was the first international professional women's organisation, said Hughes.
In her first six months in the job she has been in China to Zambia and Japan to the United Kingdom's House of Lords. She was in China to launch a sponsored Leadership for Change nurse training programme in China with the Chinese Nursing Association that will offer leadership training to 600 Chinese nurses mostly in provincial China.
ICN is a small organisation with about 19 staff in Geneva but Hughes said she was keen to appoint staff outside of Geneva and was looking to appoint regional co-ordinators in areas where it has high number of donor-funded projects. The first post was likely to be in Africa but she was also keen to have one in South America. "And I also desperately want one over here (Asia-Pacific region),said Hughes. "This is a big region and it is where the biggest growth in population and nursing is…we need a greater prescence."
Guns and centenarians
She said she had also learnt there is no such thing as a one-model-fits-all-approach for ICN members because of the diversity of nations represented both economically and culturally. Hughes said just one example was the completely different issues raised when she talked to nurses about the challenges of nursing an ageing population.
"I went to Japan where they have 70,000 to 80,000 people who are over 100 years old. So their challenge for ageing is that people are living way into their hundreds and how to support those people."
"And I go to the US and I'm with a group of nurses and one of the biggest issues they were facing with aged care was people bringing guns into dementia units!" said Hughes. "And in the Pacific it would be about keeping people at home and involving the whole fanau extended network."
"It was a salient lesson – you cannot assume that you can genericise these issues – you must know what each area is facing."
So for example advocating for reducing violence in healthcare can be as diverse as preventing nurses from being assaulted in an emergency department to stopping the bombing of hospital to anti-bullying policies… "The degree is different and the consequences but there is a whole stream of things that come under reducing violence in health care."
These issues will be discussed at a big conference in Ireland later this year at which she will be a keynote speaker which will include discussing global efforts to prevent attacks on hospitals including chief nurses in some countries having to argue for adequate protection for their nurses in hospitals. "This was unheard of in the wars of old – you wouldn't have had this." (see sidebar below)
ICN also had a very strong delegation to the World Health Assembly in May (WHO's decision-making body) with 70 nurses attending and putting up eight interventions to the assembly ranging from domestic violence to antimicrobial resistance (AMR) and human resources to non-communicable diseases.
Being in Geneva means ICN has strong relationships with the ILO, WHO and other UN bodies and is active in responding to UN documents on the behalf of nurses. The ICN president Dr Judith Shamian is also on the UN's Commission on Health Employment and Economic Growth which aims to support the creation of around 40 million new jobs in the health and social sector by 2030 – mostly in the developing world.
Health Care in Danger
The Health Care in Danger project is an International Red Cross and Red Crescent Movement initiative aimed at addressing the issue of violence against patients, health-care workers, facilities and vehicles, and ensuring safe access to and delivery of health care in armed conflict and other emergencies.
Safeguarding Health in Conflict
The Safeguarding Health in Conflict coalition promotes the security of health workers and services threatened by war or civil unrest. The coalition monitors "attacks on and threats to civilian health; strengthen universal norms of respect for the right to health; demand accountability for perpetrators; and empower providers and civil society groups to be champions for their right to health". It is run by a group of international non-governmental organisations (NGOs), including ICN and works to protect health workers, services, and infrastructure.