Nurses have fulfilled the ideals of public service. Now we must listen

Nurses and midwives have never been more important than they are right now. The coronavirus pandemic has made visible the value of nurses in healthcare. Media attention has concentrated on the role of nursing in intensive care but the contribution is much greater.

Nurses provide clinical services in extremely challenging environments in all areas of the hospital and the community to people from birth to death. Nurses as well as being professionals and frontline staff are also public servants, and during this pandemic they have fulfilled the ideals of public service and never reneged on their responsibilities to the public, even when their and their families’ safety is under threat.

In Ireland, approximately 6,000 nurses and midwives have been infected with the disease since the start of the pandemic, and at least two nurses have died

The International Council of Nurses confirmed last October that 1,500 nurses had died from the disease, in 44 of the world’s 195 countries, and this is an underestimate as the council goes on to suggest that about 10 per cent of all deaths globally are among healthcare workers.

In Ireland, approximately 6,000 nurses and midwives have been infected with the disease since the start of the pandemic, and at least two nurses have died. The most recent two-week Health Protection Surveillance Centre (HPSC) report indicates that 1,676 nurses were infected with the disease, representing 24.5 per cent of all infected healthcare workers. The HPSC report further confirms that the healthcare setting accounts for 29 per cent of all infections among healthcare staff. One year into the pandemic, exhaustion and burnout from a highly charged healthcare setting are now visible features of a nursing profession under pressure.

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The true impact of the pandemic on the nursing profession is unknown; however, it has presented new challenges in the road ahead, which must be included in planning for future health services. Given the deleterious impact of the disease on the nursing profession, how difficult will it be to recruit nurses; how attractive will nursing be to potential new entrants compared to other public service roles such as teaching or the civil service?

A recent World Health Organisation (WHO) report, State of the World’s Nursing 2020, estimated a shortage of 5.9 million nurses, and by 2030 there will be a need for 36 million nurses practising across the globe to meet the needs of every individual on the planet. In recent times, the HSE abandoned its latest international recruitment project. Therefore, the logical way forward may be to institute a high-profile nursing national student recruitment and retention project, with an aim to educate more nursing students and retain existing nursing staff in Ireland.

The pandemic has highlighted nursing at its best, but is has come at a personal and professional cost to nursing

The very public debate, which recently occurred about nursing student remuneration, was unfortunately poorly informed and was eventually politicised to the detriment of the nursing profession. In 2002, the introduction of a four-year BSc nursing degree placed Ireland in a flagship position in a European context. Graduate education replaced a system of nurse training which had been in existence for more than 100 years. The notion of moving nursing students away from paid employees and towards the status of university students was debated for many decades and was an integral part of the changes made to nursing education almost 20 years ago.

The inadequate number of intensive care nurses revealed by the pandemic has highlighted our lack of planning for specialist and advanced nursing skills. In order to meet the evolving needs of critical care services, an investment in post-graduate education of specialist nurses is required. The potential for roles in new areas of specialist and advanced nursing practice, aligned with national priorities and emerging global issues, must be an outcome of the expert review body on nursing and midwifery, recently established by Minister for Health Stephen Donnelly.

The WHO nursing report provides a framework to build a strong nursing profession that is adaptable and innovative enough to meet the changing health needs of people and optimise their health. Nurses have not been visible directing and driving actions during the pandemic and all of the public and media commentary has been from medical colleagues. Among WHO recommendations is the need for investment in nursing leadership to ensure nurses have a seat at the table where health policy and practice decisions are made.

The pandemic has created a sense of powerlessness among political and healthcare leaders; many people, including health professionals, have an opinion without specific expertise in coronavirus. Ironically, despite advances in healthcare technologies, coronavirus actions and practices have returned to find answers in what is regarded as the basics of nursing care and infection prevention, which is promoted and practised by nurses.

Since the days of Florence Nightingale, nurses have concentrated on basic actions related to physical distancing, space between beds, handwashing, sanitation, cleanliness, hygiene, light, fresh air and good diet. Relevant to today, Nightingale claimed: “statistics inform us what percentage will die, observation will tell us which one will die”.

The pandemic has highlighted nursing at its best, but is has come at a personal and professional cost to nursing. The profession is at a crossroads without signposts, and failing to plan a pathway into a future that is attractive to new entrants, while also retaining established and experienced nurses, may be a defining moment for the profession.

Seamus Cowman is Professor Emeritus at RCSI University of Medicine and Health Sciences