R e t u r n   t o   t a b l e   o f   c o n t e n t s

Nursing leaders around the world are doing their part to stem the shortage of nurses and improve the delivery of health care.

A historic gathering unites nursing leaders
from Albania to Zimbabwe in the global effort
to lessen the workforce shortage and
improve delivery of health care

by Pam Auchmutey and Holly Korschun



In troubled times such as these, the most important thing we can do is stay true to our values and make the world a better place.

—Dr. Michael Johns,
executive vice president for
health affairs and director,
Woodruff Health Sciences Center

Even in the wake of September 11, nursing and health leaders from 60 countries traveled to Atlanta to build new nursing workforce strategies together. In Dean Marla Salmon’s view, “Their commitment and work during the five days was truly inspiring and unforgettable.

Dorothy Chikampa (center) of the Zambia Nurses’ Association accepts the award for Leadership in Improving the Health of Vulnerable People. She is pictured with Marla Salmon (left) and Judith Oulton of the International Council of Nurses.

You who are health providers must also be agents of forgiveness, of reconciliation, of ubuntu (the essence of being human). For you see, we are created for togetherness, we are created for harmony, we are created for family.

—Desmond Tutu, archbishop of
South Africa and Nobel laureate

Desmond Tutu, known worldwide for his efforts to reconcile differences among people, received the award for Enhancing Human Health Through Humanitarianism.

Dr. Naeema Al-Gasseer, senior scientist for nursing and midwifery with the World Health Organization, was one of many key conference planners.

My mother, who I’m sure is in heaven, would be surprised and pleased that I’m a nurse.

—Jimmy Carter, former US president
and the first honorary nurse
fellow of the Lillian Carter Center
for International Nursing

Dean Marla Salmon and former US President Jimmy Carter unveil a plaque to commemorate the dedication of the Lillian Carter Center for International Nursing. During her lifetime, Miss Lillian served as a community nurse in Georgia and a Peace Corps volunteer in India. She also was an adviser to the School of Nursing on its international programs.





Make no mistake about it. Nursing leaders around the world are doing their part to stem the shortage of nurses and improve the delivery of health care. Many of their respective tasks will take months or years to complete, whether it’s standardizing and strengthening the curriculum for nursing students, making the workplace safer for nurses in hospitals and clinics, or providing new incentives to attract new professionals and retain experienced veterans. In some nations, emerging diseases threaten the very lives of nurses who care for patients. While resolving any one of these problems is challenging in its own right, it is that much harder for nurses in countries where financial resources are scarce and progress is hampered by unstable government, a poor economy, a weak infrastructure, or even civil war.

Whatever their situation, nursing leaders today are more united in their endeavors because of the Nell Hodgson Woodruff School of Nursing. Last fall, the school brought nursing professionals and health care experts from more than 60 countries together in Atlanta to find better ways of working together to improve the quality of health care and attack the critical shortage of nurses worldwide. The Global Nursing Partnerships conference was the first major initiative of the Lillian Carter Center for International Nursing (LCCIN), established last year by the School of Nursing to address nursing workforce issues and provide education, research, and leadership development opportunities for nursing students and practicing nurses in and outside of the United States.

By the time the conference ended, it had set a precedent. It was the first time that government chief nursing officers (CNOs), international and national nursing association (NNA) leaders, and human resource planners had come together on so large a scale. “They helped build a common strategy to improve health that underscores the importance of outreach and alliance-building at all levels—local, regional, and national,” said Naeema Al-Gasseer, senior scientist for nursing and midwifery with the World Health Organization (WHO).

The gathering also marked a professional milestone for the nursing school and its dean, Marla Salmon, who was asked by the International Council of Nurses (ICN) to host a global forum in conjunction with international nursing work under way at Emory. During the forum, government CNOs asked that the School of Nursing serve as the secretariat for their global network, continuing to host similar events and providing an ongoing focal point for leadership development for nurses worldwide. As secretariat, the School of Nursing will put forth strategies to address the global nursing shortage, formally recognized in a proclamation issued by WHO last year.

“The nursing school was privileged to be the lead force in the most remarkable gathering of key leaders I have ever experienced,” said Salmon, who directs the LCCIN. “Because we were able to provide scholarship support, in part through the generosity of donors, we were able to bring all country partners who applied from the least developed parts of the world. Their commitment and work during the five days was truly inspiring.”

Two years in the making, the conference provided an opportunity for the nursing school and the Woodruff Health Sciences Center to take the lead in addressing global nursing issues with input from WHO; the ICN; the governments of the United Kingdom, Canada, and the United States; and The Carter Center, where much of the conference was held. It also showcased the strong working relationship between The Carter Center and Emory, which share similar goals. “Both partners are committed to improving the health of people worldwide, and nurses play an important role in that effort,” said John Hardman, executive director of The Carter Center. “They also work closely with the World Health Organization to provide better health care for all, which includes building and maintaining the nursing workforce.”

Just as important, more than 250 nursing and health leaders from Albania to Zimbabwe opted to attend the gathering after terrorists attacked the United States in September. Some participants traveled several days to reach Atlanta.

“In troubled times such as these, the most important thing we can do is stay true to our values and make the world a better place,” said Michael Johns, Emory’s executive vice president for health affairs, during the October conference.

Jeffrey Koplan, director of the Centers for Disease Control and Prevention at the time, could not attend because of September 11 but was with the participants in spirit. “Nurses are vital to improving the health care of people in a world where social and economic disparities greatly impact access to and quality of care,” said Koplan, now vice president for academic health affairs at Emory. “It’s imperative that we build and maintain a strong nursing workforce. Otherwise, the health of people will be at greater risk.”

Learning and sharing together
Those comments seemed all the more poignant as nursing leaders, some of whom had never worked together before, sat down with each other to learn new skills and create joint plans of action for tackling the most pressing problems facing their countries in nursing and health care. Through this process, nurses from developed and developing countries alike shared ideas and learned from each other.

“The conference was important because we could observe and listen to colleagues who have gone through similar experiences,” Elizabeth Solis Archilla, director of nursing at San Juan de Dios General Hospital, and Irma Yolanda Chávez, director of nursing at Rafael Landivar University, wrote recently from Guatemala. Both are grappling with losing the country’s chief nursing officer position as a result of national health care reform. “By the end of the conference, we concluded that we need to fight to have this position recreated,” they said. “Countries that have this position lack the difficulties we are facing with communication and unification of interests among trade associations, education, and service.”

Although CNOs and NNA leaders have met regionally for several years, the Global Nursing Partnerships conference was the largest international gathering of its kind and the first to focus on building partnerships. As Judith Oulton, ICN chief executive officer pointed out, “The global nursing shortage, acute in so many regions, can only be solved through serious and strategic partnerships between national nursing associations, government representatives, and human resource planners.”

To forge those partnerships, the event began with three days of separate and then joint working meetings that included networking forums for government CNOs and NNA leaders and sessions on problem solving, strategic planning, and developing partnerships. “Nurses need to work together,” noted US Division of Nursing Director Denise Geolot, who led a strategic planning session for CNOs. “We need to collaborate if we are going to move the agenda to improve health care and make sure there is access through nursing. When you share common experiences and interests, it facilitates working together by breaking down barriers.”

During the final two days, national human resource directors and health planners joined CNOs and NNA leaders to address nursing workforce issues around the world. In the process, they heard from an impressive group of experts, including Bobby Jindal, assistant secretary of the US Department of Health and Human Services; James Buchan, a professor specializing in nursing workforce planning at Queen Margaret University College in Scotland; Andrew Green, a health economics and planning expert at the University of Leeds in the United Kingdom; and Pedro Brito, human resources development coordinator with the Pan American Health Organization.

Based on the action plans that participants developed during their last day together, it’s clear that many are striving for the same goals—ensuring that nurses are represented on health policy committees, standardizing nursing education (basic as well as continuing education), developing new programs to meet the health care needs of their nations (especially in rural areas), and defining what elements are needed to create national databases on the nursing workforce.

What also was apparent is that no single blueprint exists for resolving any one of these issues. What works for recruiting nursing students and keeping nurses on the job in Scotland (where more than 35,000 nurses and midwives serve a population of 5.1 million and the nursing workforce has remained stable in recent years) won’t work in Ghana (which has a public health workforce of 29,000 and a population of 18.4 million). In Jamaica, the nursing workforce also is spread thin, with 12 professional nurses for every 100,000 people. That’s in addition to the threat of violence that hospital nurses face traveling to and from work in the capital city of Kingston and the personal health risks of caring for patients with HIV/AIDS.

Despite such overwhelming obstacles, one underlying message rang through loud and clear for participants. As the backbone of health care, nurses must toot their horns more loudly to shape workforce policy and improve patient outcomes. “Nurses don’t do this enough,” said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. “Their ideas are often unknown to government leaders. Nurses must translate their research findings into terms (financial and otherwise) that decision-makers understand.”

Consequently, many who attended the LCCIN’s first conference left with ambitious agendas for propelling their profession and health care delivery forward. Nursing leaders from Namibia aim to reduce their nation’s maternal mortality rate, boost the morale of nurses, revive the nation’s nursing association, and push for legislation to unify and strengthen their profession. Their colleagues in Bangladesh have set out to improve the quality of nursing care, raise the status of their profession, and more clearly define the responsibilities of their CNO and NNA. In Uzbekistan, nursing leaders aspire to reform graduate nursing education and create a national center for nursing training.

Ambassadors of peace through health
Along with their newfound knowledge, nursing leaders took away a renewed sense of hope and inspiration from former US President Jimmy Carter and South African Archbishop Desmond Tutu, both participants in the conference.

Carter happily joined their ranks when Salmon named him as the LCCIN’s first honorary nurse fellow. “My mother, who I’m sure is in heaven, would be surprised and pleased that I’m a nurse,” Carter said.

He was there to dedicate the center named for the late Miss Lillian, who served as a community nurse, Peace Corps volunteer, and adviser on the School of Nursing’s international programs. Her famous son grew up in Plains, Georgia, surrounded by respected nurses like his mother, who often was the only link between life and death for poor black farming families struck by illness.

Tutu formed a special bond with nurses early in life as well. When tuberculosis landed him in the hospital as a teenager, he developed a crush on his nurse. The smitten teen grew up to receive a Nobel Peace Prize for his efforts to end apartheid in South Africa. “You who are health providers must also be agents of forgiveness, of reconciliation, of ubuntu (the essence of being human),” he told participants. “For you see, we are created for togetherness, we are created for harmony, we are created for family.”

The archbishop added another honor to his credit when the LCCIN presented him with an award recognizing his efforts to enhance human health through humanitarianism. Additionally, the LCCIN gave awards to the Zambia Nurses’ Association for improving the health of mothers and children through the Kaloko Safe Motherhood Project and to Richard and Verna Huffman Splane of Canada for their groundbreaking work to document the role of chief nursing officers worldwide.

Just as important, nursing leaders at the Global Nursing Partnerships conference were lauded for their service as ambassadors of peace through health. “There is no entity on earth that knows the suffering of people better than nurses,” President Carter said.

In his view, politicians could learn a thing or two from nurses at the bedside. “That is where love is shown in its purest form,” he added. “I hope you return to your homes with a renewed commitment to let your voices be heard.”





Strong Partners
Sessions from the Global Nursing Partnerships conference are available for viewing on the web archive at www.nursing.emory/LCCIN/. Major funding for the conference was provided by Emory University, the Government of Canada through the Canadian International Development Agency, the Government of the United Kingdom of Great Britain and Northern Ireland, agencies of the US Department of Health and Human Services (the Centers for Disease Control and Prevention, the Food and Drug Administration, the Agency for Healthcare Research and Quality, and the Health Resources and Services Administration–Division of Nursing), the International Council of Nurses, the World Health Organization, the Cerner Corporation, and Sigma Theta Tau International.



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