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How Nurses Can Change the Future of Healthcare

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nursing-icn-charter for change-respects-healthcare

The International Council of Nurses (ICN), has launched a Charter for Change to call for protection, respect, and investment in our nurses for a sustainable future for nursing and healthcare.

Dr. Pamela Cipriano

President, International Council of Nurses

“We believe the tenuous state of the nursing workforce is a threat to health knowing that nurses are the key to thriving people and communities.”

We all know the COVID-19 pandemic has taken its toll on nurses across the world. Multiple studies have shown that nurses are exhausted, burned out, underpaid, and undervalued. So why has the ICN, which represents more than 130 national nursing associations across the world, launched a new positive campaign called “Our Nurses.Our Future”?

We believe the tenuous state of the nursing workforce is a threat to health knowing that nurses are the key to thriving people and communities. ICN has published several reports showing that nurses have been pushed to the edge. The most recent one, “Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness,” says the worldwide shortage of nurses should be treated as a global health emergency. We have warned governments that unless they invest in nurses, health systems will not recover.

Furthermore, we have highlighted a study by the Global Burden of Disease, which suggested that the current shortfall could be as high as 30 million nurses and midwives. And we have seen nurses forced to take industrial strike action in order to pressure their governments to pay them their worth.

But despite this doom and gloom, we have also seen the amazing resilience of nurses and the solidarity within the profession and toward their patients. We know that together, with support and investment from governments, nurses can change the future of healthcare!

The new normal

COVID has made the case that we must invest in nursing; we must see spending on healthcare not as a cost but as a cast-iron investment critical to the future viability of health systems and economies.

Nurses do not want to return to the pre-pandemic workforce conditions where they were taken for granted. We need a new approach to compensation, recognition, autonomy, and respect for the nursing workforce in decision-making.

We need a seismic movement away from pre-pandemic healthcare systems toward sustainable, accessible, affordable healthcare for all, delivered by a valued, respected, competent, and satisfied health workforce.

How can we achieve this new normal?

ICN’s new Charter for Change presents 10 policy actions that governments and employers must take to create and sustain healthcare systems that are safe, affordable, accessible, and responsive, and shift nurses from being invisible to invaluable.

  1. Protect and invest in the nursing profession to rebuild health systems that can deliver the Sustainable Development Goals and Universal Health Coverage to improve global health. Recognize and value health and healthcare as investments, not costs. Secure commitments for investment to maintain equitable and people-centered care.
  2. Urgently address and improve support for nurses’ health and well-being by ensuring safe and healthy working conditions and respecting their rights. Put in place systems to ensure safe staffing levels. Ensure protections against violence and hazards in the workplace, and implement and enforce international labor standards on the rights of nurses to work in safe and healthy supportive environments, ensuring physical and mental health protections.
  3. Advance strategies to recruit and retain nurses to address workforce shortages. Improve compensation for nurses to ensure fair and decent pay and benefits, and uphold positive practice environments that listen to nurses and provide them with the resources they need to do their jobs safely, effectively, and efficiently. Fund professional governance, recognition, and development activities across career trajectories.
  1. Develop, implement, and finance national nursing workforce plans with the objective of self-sufficiency in the supply of future nurses. Align resources to support a robust workforce to deliver essential health services, reverse unemployment, and retain talent. When international migration takes place, ensure it is ethical, transparent, monitored, and delivers equal mutual benefits for sending and receiving countries, as well as respecting the rights of individual nurses. Undertake system workforce planning and monitoring across the care continuum. 
  1. Invest in high-quality, accredited nursing education programs to prepare more new nurses and advance career development for existing nurses. Design curricula so nurses graduate with the right skills, competencies, and confidence to respond to the changing and evolving health needs of communities, and support career progression from generalist to specialist and advanced practice.
  1. Enable nurses to work to their full scope of nursing practice bystrengthening and modernizing regulation, and investing in advanced nursing practice and nurse-led models of care. Reorientate and integrate health systems to public health, primary care health promotion and prevention, community, home-based, and patient-centered care.
  2. Recognize and value nurses’ skills, knowledge, attributes, and expertise. Respect and promote nurses’ roles as health professionals, scientists, researchers, educators, and leaders. Involve nurses in decision-making affecting healthcare at all levels. Promote and invest in an equitable culture that respects nurses as leading contributors to high quality health systems.
  3. Actively and meaningfully engage national nursing associations as critical professional partners in all aspects of health and social care policy, delivery, and leadership as the experienced and trusted voice of nursing. Build local, national, and global multilateral partnerships.
  4. Protect vulnerable populations, and uphold and respect human rights, gender equity, and social justice. Place and uphold nursing ethics at the center of health systems’ design and deliveryso all people can access healthcare that is equitable, non-discriminatory, people-centered, and rights based, and without the risk of financial hardship.
  5. Appoint nurse leaders to executive positions of all healthcare organizations and government policy-making. Strengthen nursing leadership throughout health systems, and create and sustain nursing leadership roles where they are most needed.

What underscores these 10 action points is the irrefutable need for investment in the nursing profession.

How can you help?

  • Advocate for nurses using the Charter for Change and other ICN resources to call for protection, respect, and investment in our nurses.
  • Come along to ICN’s Congress in Montreal, July 1-5 to listen to expert speakers on all issues of importance to nurses, and network with other nurses from across the globe!
  • Registered nurses should join the American Nurses Association, ICN’s member in the United States, so your voice is heard at the national and international levels, and nurses around the world should join their national nurses’ associations.


Nurses will no longer tolerate being expected to work tirelessly in poor environments where workloads threaten patient safety and nurses’ physical and mental well-being, and their voices are ignored.

We have seen the devastating results of poor investment in and respect for nurses, and we know that lack of action is leading to more nurses leaving the profession, or migrating to countries where there are better conditions and salaries. We also have several important reports outlining the actions that need to be taken to stop the outflow of nurses and attract more people to the profession.

What is left now is for governments and employers to find the will to act on this knowledge and understand that spending on the healthcare workforce is an investment that will bring huge returns. The new normal for nurses must move them from invisible to invaluable in the eyes of policymakers, the public, and all those who make decisions affecting the delivery and financing of healthcare.

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