1. Pfeifer, Gail M. MA, RN, News Director


Intensifying the campaign to reverse a disturbing downward trend.


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Although nurses constitute much of the global health care workforce, their presence in key decision-making positions at the World Health Organization (WHO) has slipped dramatically over the past decade. From 2001 through 2011 the percentage of nurses at the WHO decreased from 2.6% of professional staff to 0.7%-the lowest percentage ever, according to the International Council of Nurses (ICN). The ICN, a federation of 130 nurses' associations worldwide, wants the WHO to reverse this trend.

Figure. This graph s... - Click to enlarge in new windowFigure. This graph shows the trend in nursing posts at the WHO from 2000 to 2011. The ICN expressed concern that, if the trend continues, there would be no nurses at the WHO by 2016. Image courtesy of the International Council of Nurses. Reprinted with permission.

In a March letter to WHO director-general Margaret Chan, ICN president Rosemary Bryant expressed concern that nursing's absence from the WHO will undermine Millennium Development Goals and specific WHO programs at country and regional levels. Bryant also outlined three other main concerns: a two-year vacancy in the WHO chief nurse scientist position, the imminent retirement of several nurses who hold the title of regional nurse lead, and the lack of activity of the Global Advisory Group on Nursing and Midwifery (GAGNM). Although a number of WHO World Health Assembly (WHA) resolutions support mandates to "strengthen the capacity of [the] nursing and midwifery workforce" at the member-state level, little action has followed.


In 2011 the ICN addressed the dilemma of nurses disappearing from the WHO, passing an emergency resolution urging the WHO to immediately recruit and appoint nurse experts to the vacant positions at WHO headquarters and at regional and national offices.


David Benton, the ICN's chief executive officer, told AJN that the resolution has led to some positive movement over the past year, such as reestablishing meetings of nursing representatives to implement recently updated WHO objectives for strengthening nursing and midwifery and to address the burden of noncommunicable diseases. He said the ICN intends to provide a briefing on these matters to nurse delegates at the WHA and ask member states to join the ICN in calling for these gaps in the WHO's nursing capacity to be addressed.


WHO's response. In May Director-General Chan replied to Bryant's letter, disputing the ICN's tally of nurses at the WHO, explaining that some nurses working at the agency fall into the WHO's "professional" rather than its "nursing" category, implying that there were more nurses at the WHO than the ICN found. The report Chan cited, however, surveyed only 14 staff members and says that only "18 individuals with nursing or midwifery backgrounds were employed by various WHO headquarters' departments." Regarding the GAGNM, Chan said that body hadn't met since 2010 because of "financial constraints."


As to the chief nurse scientist position, Chan assured Bryant that "all activities in support of the WHA resolutions on strengthening nursing and midwifery have been maintained," despite the vacancy in that position. Bryant wrote back, emphasizing that the "WHO's objectives to strengthen nursing and midwifery cannot be met without a nursing presence at the decision-making level" and that nursing's role is "as critical at the policy table as it is at the clinical level."


Joanne Disch, current president of the American Academy of Nursing (AAN), told AJN that the organization is appalled that "the chief nurse scientist position remains vacant" and called on other organizations to join the AAN and the ICN in encouraging the WHO to fill the position immediately.-Gail M. Pfeifer, MA, RN, news director