Let Nurses Lead—They Hold the Key to Reaching Global Health Goals

By Peter Johnson

Nurse treats a child with severe malaria

Nurse Celestine Rimhiguide treats a child with severe malaria at Doba Hospital in Chad.
Karen Kasmauski

It’s May 12, time to thank those who are the heartbeat of global health care.

Say thank you in Swahili, French, Portuguese, Pashtun, Hindi, Bahasa and all the local languages in countries where nurses and midwives deliver 90 percent of health services. To be grateful on International Nurse’s Day this year is a gesture of appreciation. But we also need to acknowledge and accept the expanding roles of nurses in the health and welfare of families worldwide.

Let me explain.

For too long, the world has seen nurses as helpmates, regarding them as mid-level providers performing routine tasks. That myopic view is widening, ever so slightly. Why? Because there haven’t been enough “high-level” providers (aka doctors) for nurses to help. In the developing world and beyond, physicians aren’t available to tend to all those who need cesarean sections, seek antiretroviral therapy or want voluntary medical male circumcision. These are just a few of the health services that nurses, over time, have shown their ability to perform admirably.

Head nurse Mme Gueririm

Head nurse Mme Gueririm treats patients who have malaria in the village of Gore.
Karen Kasmauski

As one of the few nurse-led international health nonprofits—one that’s 1,000 nurses strong and has dedicated professionals on the ground in more than 40 countries—Jhpiego has long invested in local health care providers, namely nurses and midwives, who are working in specialty areas and remote communities. Others have been slower to recognize nurses as the natural solution to expanded access to care, and that it’s OK for nurses with advanced competencies to step up.

Nurses, being nurses, have indeed stepped up. They’re preventing and treating disease the world over, proving time and again that they aren’t just good enough in a pinch. They are good, period.

And yet, some global, national and local decision-makers seem continually surprised by the ability of skilled nurses to be more than mere fill-ins for doctors. That attitude is reflected in the dearth of nurses in policy-level positions.

My proposal—that we acknowledge and accept the capability of nurses to provide 90 percent of health care worldwide—might appear to be window dressing. Or self-serving. (Full disclosure, I am a nurse as well as a midwife.) But in fact, our achieving the Sustainable Development Goals by 2030 depends on a fully empowered nursing workforce performing to peak capability.

What do I mean by that? Nurses managing the care of people living with HIV, diagnosing and treating people with hypertension and diabetes, caring for and empowering survivors of sexual assault, and overseeing treatment of children with malnutrition—just to cite a few.

It’s critical now to expand global nursing’s scope of practice by matching local needs with emerging areas of advanced practice. That’s why Jhpiego’s urgent mission is to engage nurses in roles and responsibilities traditionally closed to them. How? By providing appropriate education and support for clinical and leadership skills and by developing standards of practice for the advanced nurse practitioner.

Nurse treats a patient for parasites

Nkollo Village nurse Adamou Mahamat of Cameroon treats a patient for parasites.
By Karen Kasmauski

On-the-ground evidence informs our vision: Nurses already serve on the frontlines of carrying out life-enhancing skills to reach the Sustainable Development Goals, including reducing maternal mortality, ending preventable deaths of newborns, tackling chronic disease and, most notably, achieving universal health coverage by partnering with everyone from patients and prominent stakeholders to community health workers.

By supporting nurses to analyze, question and lead, Jhpiego is working toward equality and justice for not only underserved communities but also health workers because we know that nurses are fundamental to saving lives and when we empower them as caregivers, women, men and children benefit tremendously.

What needs to be understood is that each health care provider of an interdisciplinary team works collaboratively to deliver care, and every member is equally important and uniquely contributes to the health of a client.

When we build nurses’ skills and allow them to do what they’re capable of, we move that much closer to ensuring that women don’t die from cervical cancer for lack of screening and treatment or from childbirth for lack of a cesarean section.

On my work travels, whether I’m in Botswana or Burma, I meet with nursing leaders who are working through their professional associations to strengthen the practice and regulation of nursing to assure quality health services for all and a standard of living and status for nurses that will keep them on the job and thriving. I often like to stop at a local health facility to visit with the nurse-in-charge. It’s time that we put some muscle behind that title and let nurses take charge and lead not from behind, but from the front.

Peter Johnson, a midwife and a nurse, directs global learning, nursing and midwifery at Jhpiego.