A Call to Action: 2020 Year of the Nurse and the Midwife

Many of you have heard by now that 2020 is designated as the Year of the Nurse and the Midwife.¹  This is a historical first! The World Health Organization (WHO) took this opportunity to celebrate the importance of nurses in transforming health care around the globe. The timing of this designation is in honor of Florence Nightingale’s 200th birthday, a day we celebrate during Nurses Week, on May 12 of each year.

Many of us recited Nightingale’s pledge, or a modified version of her pledge, during our pinning ceremonies when we graduated from nursing school. The more I read about the founder of modern nursing, the more I recognize the scope of her progressive vision. She was an innovator, a nurse, a statistician, and a tireless advocate for patients and nurses, and these are just a few of her accomplishments.^2,3  Nightingale successfully lobbied to begin the first nursing school in 1860 in London, United Kingdom.³  The training of nurses focused on standards of care for physical and psychological needs to return patients to their former state of health. She helped transform nursing from a job of laborers into a skilled profession, elevating the status of nurses in society.

During the Crimean War, Nightingale took meticulous notes to document her observations of the health care environment while caring for British soldiers. Her analysis of the data, including the Coxcomb diagram for which she is also famous, led to the development of early germ theories and an understanding of the impact of the environment on healing and health. Some of her theories (eg, handwashing before providing patient care) were applied to clinical practice and resulted in improved patient outcomes and reduced mortality. Nightingale’s school taught an early version of germ theory in 1872.³  She is considered by many to be the pioneer of evidence-based practice.

One of Nightingale’s quotes, “How very little can be done under the spirit of fear,”⁴  makes me think of today’s institutional cultures and how important it is to create a healthy non-punitive environment of trust and safety to encourage open communication. Reporting errors and near misses are necessary for learning about adverse events to improve systems, clinical practice, and ultimately patient care. As I learn more about the career of Florence Nightingale, I am surprised to find that some of the problems of her time, such as lack of handwashing and healthy work environments, continue to be barriers to providing safe, effective, and evidence-based care today. I encourage you to reflect on whether we are living up to our professional expectations in the way that we envisioned when we first became nurses.

In other areas, the nursing profession may have exceeded Nightingale’s vision. Around the globe, more than 90% of patient contact with health care workers is with a nurse.²  In the United States, more than two-thirds of anesthesia is now administered by nurse anesthetists.²  Internationally, nurses are performing selected surgeries and emergency cesarean deliveries, with results that are on par with those of their physician colleagues.²  Although there is still work ahead, nurses are increasingly at the table with interdisciplinary teams to develop clinical practice guidelines that promote expected standards of care. I believe that Nightingale, who authored more than 200 publications of her own,²  would be proud of the work performed by nurses to disseminate evidence into practice, generate new knowledge, and promote safe and caring clinical practice for patients and their families.

The Year of the Nurse is also heavily focused on increasing awareness about the nursing profession. We have been aware of actual and projected nursing shortages in the United States for decades, but did you know that this is also a global issue? Eighteen million more health workers are required to provide and sustain universal health coverage worldwide; almost half of the health workers needed are nurses and midwives; the majority of needs are in Southeast Asia and Africa.^1,5  The WHO estimates that another 9 million nurses and midwives will be needed by the year 2030,¹  only 10 years from now. We need to recruit heavily. How can individual nurses help? We can tell people about what nurses do and advocate for nursing as a profession. Over the years, I have frequently heard nurses say, “I am just a nurse.” Just? As an acute or critical care nurse, you save people’s lives. You touch the lives of patients and their families every day. Nurses have a very important role in health care, and we must tell our stories.

For those who need some assistance to articulate what nurses do, I recommend reading work by Suzanne Gordon, a health care journalist who specializes in health care systems, teamwork, patient safety, and nursing.⁶  Gordon was instrumental in shaping the way I speak about my nursing role to others. She gave me confidence to speak openly about how nurses influence the lives of their patients and families; how nurses develop relationships, providing touch or presence at the right time while critically thinking to intervene as needed; and how nurses shape the plan of care and save lives. When you really think about all that nurses do, acute and critical care nurses are a bit like superheroes. We do the right thing at the right time. Do not be shy when sharing your professional accomplishments; we can help others gain a better understanding of the important role nurses fill without breaching confidentiality of our clients. The WHO has provided a nursing advocate toolkit to help us disseminate our important role in health care.⁵ 

How do we help others learn about the nursing profession? We can start by educating friends and family. The WHO suggests using social media, attending public events, building and strengthening partnerships, engaging local leaders, recognizing awards and certificates, and displaying campaign posters.⁷  A variety of frames are available for your Facebook profile picture, such as “Excel, Lead, Innovate: Year of the Nurse 2020.”⁸  You can share your story on Twitter or follow what other leaders are saying about nursing using the search terms #YON2020 and #YearOfTheNurse.

Noteworthy events in the month of April are World Health Day on April 7 and World Immunization Week April 24 to 30. The International Council of Nurses has set the theme for International Nurses Day 2020 as “Nursing the World to Health,” with a focus on the “true value of nurses to the people of the world.”⁹  Campaign materials and key messages are available on a variety of health care and nursing association sites.^5,8,10–12 

During this Year of the Nurse and the Midwife, make time to reflect on what we have accomplished so far and set goals for the future of nursing. Nightingale said that it would take up to 150 years to see the kind of nursing she envisioned.¹³  Visioning and setting goals is important, but as Nightingale projected, action is also necessary to effect change: “I think one’s feelings waste themselves in words, they ought all to be distilled into actions and into actions which bring results.”⁴  This quote makes me think about our American Association of Critical-Care Nurses presidents, both past and present, who encouraged us to be smart, be brave, find our voice, and, most importantly, put our energy into positive action. Who are the nurses who take action? Could you be one of them?

While I was writing this editorial, Americans voted nurses as the most trusted, ethical, and honest profession for the 18th consecutive year.¹⁴  What an honor—this really is our time to celebrate. I hope to see you at the American Association of Critical-Care Nurses National Teaching Institute (NTI) conference in Indianapolis. Attending NTI is a great opportunity to bring acute and critical care nurses together from around the United States and the globe and to celebrate being a nurse. The energy at NTI is palpable. Together, we will network, increase our knowledge, expand our vocabulary, and charge our personal batteries so we can continue to be an advocate for one of the best professions—nursing. Thank you for what you do. Nurses make a difference.