American Journal of Nursing 2000 January Volume 100, Issue 1

Nursing International

Advances in technology and communication—coupled with dramatic economic, political, societal, and environmental shifts worldwide—have created unprecedented opportunities for international exchange and dialogue. Chief among these topics of discussion is health care. Nurses, who make up the largest group of health care workers internationally, have long been advocates of safe, affordable, high-quality, and universal health care; nurses are the ideal group to advance the international health care dialogue.

Although specific health care concerns vary from country to country, all nations grapple with issues such as access to health services and the safety and quality of care. Consider some of what U.S. nurses face: the increasing use of casual or part-time nurses; obstacles to enhancing the professional nurse’s role so that she is a full member of the health team; and collecting and reporting nursing-sensitive health care data. These same issues confront nurses worldwide, as evidenced by the resolutions considered at the International Council of Nurses’ (ICN) Council of National Representatives meeting in June 1999.

“While cultural differences abound, the basic goal of providing care to the people of one’s country is consistent for nurses throughout the world,” says ANA President Beverly L. Malone, PhD, RN, FAAN, who has represented the ANA at the last two ICN conferences and served on the World Health Assembly at President Clinton’s behest.

The roots of international nursing

The ICN is a prime example of how nurses from around the world have come together to examine issues that are both unique to specific regions and common across international borders. Begun in 1899, under the leadership of Ethel Gordon Fenwick of England, Lavinia Dock of the United States, and Agnes Karll of Germany, the ICN comprised seven founding nations: Canada, Denmark, Finland, Germany, the Netherlands, the United Kingdom, and the United States.

Today, the ICN is a federation of national associations, representing nurses in more than 120 countries. It works to ensure universally high-quality nursing care, sound global health policies, the advancement of nursing knowledge, worldwide respect for the nursing profession, and a competent and satisfied nursing workforce.

“Although much of the best of what is happening in the rest of the world has been seeded by the giving nature of U.S. nurses, our international disciples have often exceeded our expectations,” notes ICN First Vice President Lucille Joel, EdD, RN, FAAN. “The baccalaureate is the educational credential for entry into practice in Thailand and Australia. Graduate education, including doctoral study in nursing, is flourishing worldwide. Primary care and family nursing are the standards for health care services in many developing and industrialized countries. The International Classification for Nursing Practice (ICNP), the universal language for nursing practice, is being networked into 122 countries by the ICN, and the organization is bringing leadership development programs to Africa, Asia, South America, and the southern hemisphere. We long ago reached the point where we can learn from those we tutored.”

The ICN also represents the profession to international organizations such as the United Nations, the World Health Organization, the International Labor Organization, and the World Trade Organization and also works in collaboration with numerous international professional and specialty organizations.

“We no longer live in isolated enclaves,” says Virginia Nurses Association member Rita Carty, DNSc, MSN, FAAN, dean and professor of the College of Nursing and Health Science at George Mason University in Fairfax, Virginia. “Health care crosses national, regional, and local boundaries and cultures. We need to understand how our colleagues in other countries are functioning to learn from one another.”

Nurses and the international agenda

To accomplish its objectives, the ICN has initiated several projects—including the development of ICNP and leadership development programs—designed to bring nursing and nurses to policymaking discussions around the world. For instance, the Leadership for Change project works with current or potential nurse leaders to develop their skills in management, leadership, and policy development. The program also enhances their understanding of health reform and its implications. Leadership for Change projects have been started in the Caribbean and Latin America; the South Pacific; East, Central, and Southern Africa; Singapore; and the francophone areas of Africa.

The ICN is also involved in numerous human rights efforts, such as the elimination of child labor. Worldwide, approximately 250 million children between the ages of five and 14 are exposed daily to labor-related health and safety hazards that can irreversibly damage their physiologic and psychological development. The ICN’s Campaign Against Child Labour focuses on Sialkot, Pakistan, where more than 7,700 children are employed by subcontractors that manufacture steel surgical and dental instruments. The ANA has joined this campaign (along with other American organizations), focusing on U.S. companies that import these instruments.

Common issues spark action

Nurses initially united globally because of deplorable work conditions, the exploitation of nursing students as a cheap source of labor, a lack of nursing education standards, and the need for statutory registration. Today, the national nurses associations that make up the ICN grapple with the next generation of these same issues. Here’s what some are doing:

• The Romanian Nursing Association is working within the profession and with policymakers to establish a university-based school of nursing.

• In April, the Saskatchewan Union of Nurses argued for pay equity and contract provisions wherein nurses can document and attempt to resolve unsafe patient care situations.

• All 28,000 nurses within the Irish Republic recently engaged in industrial action, forcing their government to establish promotional posts that recognize the seniority of nurses and to increase the number of student positions to address the country’s growing nursing shortage.

• The Icelandic Nurses Association is dealing with a significant change in working conditions and the elimination or devaluing of nursing management positions as a result of the merging of the two largest hospitals in Iceland.

• The Democratic Nursing Organization of South Africa is addressing the burgeoning problem of HIV and AIDS within the country’s population.

• The Royal College of Nursing, United Kingdom, has launched a new campaign, “Making Time,” dedicated to advocating employee-friendly policies.

On the home front

There are plenty of opportunities for U.S. nurses to take part in international efforts. For example, Carty heads the WHO Collaborating Center for Nursing and Midwifery at George Mason University, one of 39 such centers around the world. The center has worked on several projects, including one that assessed curriculum development in European countries and another that called for collaboration with South Korea to train community health nurses. In addition, as part of an exchange program, student nurses at George Mason University have traveled to Nicaragua for the past seven years to work with health care providers.

“The local people look for them each year,” Carty says. “The students come back and invariably tell us their lives have changed forever as a result of the experience.”

The ANA monitors nursing and health care issues through its International Nursing Center, established in 1990. Through the center, the ANA has built strong collaborative relationships with national nursing organizations in other countries to address issues common to all nurses, including nurse staffing and the need for data collection on nursing-sensitive indicators, as well as occupational health and safety, economic concerns and workplace rights, patient advocacy, and nursing education and competency.

“The ANA continues to refine and expand its involvement in the international arena,” states Malone. “Although U.S. nurses have much to offer, there is much to be learned from our nursing colleagues around the world.”

Additional information regarding the ANA’s International Nursing Center is available at http://www.nursingworld.org. For more information about the ICN, navigate the ANA’s Web site, or visit http://www.inc.ch.