1. Kennedy, Maureen Shawn MA, RN


Nurses seem to be disappearing from the World Health Organization.


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In 1948, Lucile Petry, the chief nurse of the U.S. Public Health Service, attended the first World Health Assembly of the newly created World Health Organization (WHO) as a member of the U.S. delegation. Writing in AJN about the role nurses would have at the WHO, she noted, "The principle was accepted that a nurse be appointed to any of the expert committees which advised on programs in which nurses would be expected to play an active part," adding, "Everywhere there seemed to be recognition of the importance of nurses in the health activities which are recommended by the WHO."

Figure. Maureen Shaw... - Click to enlarge in new windowFigure. Maureen Shawn Kennedy

But despite that auspicious beginning, today nurses seem to be hard to find at the WHO. The latest blow to nursing's presence there is the organization's failure to replace the position of chief nurse scientist, who headed up the Office of Nursing and Midwifery. That office coordinates the work of the WHO's Global Advisory Group on Nursing and Midwifery (GAGNM), which advises the Office of the Director-General, regional offices, and member countries on programs aimed at improving access to nursing and midwifery services. (According to David Benton, chief executive officer of the International Council of Nurses [ICN], GAGNM has also lost most of its funding.) The position of chief nurse scientist has been vacant since 2009. At the ICN's May meeting in Malta, ICN president Rosemary Bryant indicated that the position is among those frozen again this year. Manuel Dayrit, director of the WHO's Department of Human Resources for Health (HRH), confirmed this by e-mail, stating that the position, "has been put on hold until the HRH Department acquires enough resources to support its salary."


This comes at a time when other important entities are finally acknowledging the evidence that nursing is crucial to improving health care systems. Both the Institute of Medicine's 2010 report, The Future of Nursing: Leading Change, Advancing Health, and a similar British report, Front Line Care: Report by the Prime Minister's Commission on the Future of Nursing and Midwifery in England, call for a greater role for nurses in health care planning and leadership positions. Apparently, the WHO's executive board agrees, at least on paper. In January, the board drafted a resolution recommending that the World Health Assembly, the WHO's governing body, request that the director-general "strengthen . . . nursing and midwifery policies [and] programmes through continued investment and appointment of professional nurses and midwives to specialist posts in the WHO Secretariat" and throughout the WHO.


The ICN is campaigning to restore a greater nursing presence within the WHO. In Malta, the ICN passed a resolution urging that the WHO "immediately recruit suitably qualified expert nurses and appoint them to the vacant positions at WHO headquarters" and regional and national offices. And ICN president Bryant sent an open letter to WHO director-general Margaret Chan, demanding that she "empower and finance nursing leadership positions throughout the organization" and urging the reestablishment of the position of WHO chief nurse scientist. Not requesting-demanding.


Strong words, to be sure, but strong words are needed. Are resources an issue? Definitely; the WHO depends on member nations to support its infrastructure. But nursing can't continue to be the target of budget cuts, whether in hospitals or global entities. Nurses and midwives provide 80% of health care services worldwide, according to 2008 figures from GAGNM; more than any other group of providers, we witness the effects of health care policies at the point of care. Nurses know more about coordinating and delivering care than do any other health care professionals, yet we're still often excluded from planning policies and programs. And when problems arise that might have been avoided if nurses had been consulted earlier, we're often the ones who improvise work-arounds and find creative solutions. Nurses must be included in policymaking-and not as an afterthought. The United States and other member nations should support the ICN in demanding more nurses at the WHO.