“In my lifetime, I have not seen the profession go through such a challenging and difficult period,” says International Council of Nurses (ICN) CEO Howard Catton when asked to reflect on navigating the unprecedented and turbulent global COVID-19 pandemic.

“For this generation of nurses, whether at the beginning or the end of their careers, we’ve not experienced anything like it before. When you break that down, the toll that the pandemic has taken on the profession and nurses has been huge.”

Catton’s insights mirror mounting evidence showing nursing around the world is facing numerous challenges.

In March, ICN released another alarming report, Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, which revealed 40-80% of nurses have reported experiencing symptoms of psychological distress, while nurses’ intention to leave the profession has risen by 20%. Amid looming nurse shortages, the report highlighted increased levels of burnout, absence, and underlying concerns about poor working conditions and unsafe staffing. It labelled the situation a “global health emergency” that can only be addressed with sufficient investment in the workforce.

“Based on the evidence, the nursing shortage needs to be considered a global health emergency. It’s of that magnitude,” warns Catton, speaking to the ANMJ from Europe.

Yet, while the pandemic has challenged nursing and health systems like never before, Catton acknowledges it also put the profession in the spotlight and afforded it the opportunity to display its unique skills and far-reaching impact.

“The public have seen nursing in a different way,” he explains.

“I think they have seen the courage, as well as the compassion, and the complexity and technical skills that are required in nursing. And I think a lot of policymakers have seen the potential for nursing [to have an impact]. As the world’s efforts around universal health coverage, and sustainable development goals have been set back because of the pandemic, people are thinking ‘how do we get back on track?’ and absolutely see nurses as part of the solution.”

It’s a strong position to be in as ICN gears up for its first face-to-face Congress for four years in Montreal, Canada, this July. Hosted by the Canadian Nurses Association (CNA), the 2023 Congress’ theme is – Nurses together: a force for global health.

While international nursing leaders arguably remained even more connected throughout the pandemic thanks to online tools like Zoom and resources such as webinars, Catton says coming together physically remains equally important.

“There’s an excitement, an energy, a buzz, and a real sense of people wanting to come together,” he says.

“Lots of people made new contacts and professional relationships over the last few years. There’s a very strong desire to come together, not only to take stock of what we’ve been through and to reflect on experiences, but to take from that, as we have been throughout, extracting the learnings and putting that into the policy, actions, advocacy, the steps that we need to now take, not just as a profession but as countries and health systems, to invest and prepare for the future.”

Eight sub-themes were selected for the 2023 Congress. They include topics such as nursing leadership, the critical role of nurses in emergency and disaster management, driving professional practice through increased regulation and education, addressing global health priorities, and growing and sustaining the nursing workforce.

Catton says the diverse set of sub-themes overarchingly reflect the contribution that the profession can make to improving global health. From ageing populations to rising noncommunicable diseases (NCDs) and mental and physical health challenges, he says many countries are facing similar public health challenges.

“When you look at those future health needs, and you couple that with the ambition the world has to improve access to universal healthcare, it’s nursing work, together with a multidisciplinary effort, but overwhelmingly nursing work,” he argues.

Nevertheless, and despite nursing’s newfound prominence, Catton still has questions:  “But does the world really recognise that?” he poses.

It’s why he says ICN, and other nursing leaders around the world, continue to work hard to highlight the influential work nurses can, and are already doing, to improve healthcare and outcomes.

Other key focus areas for the Congress will include growing the workforce and nursing leadership.

Catton claims he hasn’t seen evidence as concerning as the recent Recover to Rebuild report and that workforce retention is most critical.

“All of our efforts to grow the nursing workforce, to increase supply to deal with the global shortage, that is going to take time. The thing we can least afford to do is lose the valuable experienced nursing staff that we have at the moment,” he says.

Similarly, nursing leadership and how it can shape the future of healthcare, will be another talking point. So too will be forging partnerships with others, such as policy and political leaders, to ensure nursing’s quest for change isn’t viewed as self-interest.

“We’ve always got this risk of talking in our own echo chamber and talking among the profession about the issues and problems we have and what needs to happen. But to make the sort of change that we’ve talked about, we need to bring along other partners like patient groups and representatives who work in finance and in industry,” Catton explains.

“The Congress program has a lot of key nursing leaders but also leaders from other international organisations, not just in health, but finance, industry and other NGOs. Taking what we need to do in terms of the profession’s leadership, forging partnerships with leaders from other sectors to come together to make this case for change that we need seems like a really important thing.”

Prior to the Congress, ICN leaders will come together to review its strategic priorities and progress made over the past few years, and plan for the future.

“Our efforts are absolutely focused on bringing about the change that will result in tangible improvements to the working likes of individual nurses around that world because the job that they do not only makes a direct change to individual loves every day of the week, the collective effort as we’ve seen around the world, results in more peaceful, more stable, more cohesive, more economic, prosperous societies.”

Nevertheless, Catton suspects the review will reveal a “mixed-bag” when it comes to global implementation.

“There are absolutely countries and places who are running with what the strategic directions are, who are looking at their country’s needs and are then using those strategic directions to help them address their country’s priorities. But there are other areas where I think there is very low awareness of the strategic recommendations and, perhaps, even less action to implement it.”

As the world emerges from the COVID-19 pandemic, Catton says one of the biggest learnings was that without a strong nursing workforce and health systems, everything else collapses.

“The pandemic exposed deep-seated inequalities in our health systems, the fact that our health systems were often fragmented,” he says.

“The overriding [takeaway] is that we simply were not prepared for the pandemic because we had not sufficiently invested in our health systems and, critically, our nursing workforce.”

“It’s been overwhelmingly nursing and women who have then had to suffer the consequences of that failure to properly prepare, invest and support, and I think that gives us a huge legitimacy and power, and, frankly being able to say we will not tolerate this again.”