The Role of Nursing Leaders in Global Health Issues and Global Health Policy

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One can turn on any news program these days and see video clips of heart-wrenching scenes of poverty and starvation out of Darfur, AIDS orphans in sub-Saharan Africa, children warehoused in Romania, and thousands displaced by war or natural disasters to live in makeshift refugee camps for months or even years. I find myself asking: Are these unpleasant global health issues something with which nurse leaders in the US should become involved?

I also reflected on that same question as I read the articles published by our international nursing colleagues in this issue of Nursing Outlook. Although the authors are primarily from developed countries and the articles do not address the headline-grabbing issues we see in the news, they are another piece of evidence that globalization is not only affecting our economy but our profession. I believe it begs the question: Should US nursing leaders become more involved in the health of our global neighborhood? I believe the answer to that question is a resounding yes, but with a caveat.

First, what are we already doing and is it enough? As a profession, we can point to Sigma Theta Tau International’s efforts, our membership in the International Council of Nurses, and the work of our School’s WHO Collaborating Centers as evidence of involvement in global health issues. But is this involvement enough? Do we have a responsibility to do more?

Over the past few months, I have traveled to the urban slums and isolated rural villages of sub-Saharan Africa to work with nurses and physicians as they learn to provide HIV care and treatment. During these travels I have learned much and gained a profound respect for the dedication and ingenuity of our African nurse colleagues as they struggle to provide HIV/AIDS care and treatment with scarce resources and in situations few of us can imagine. However, as I returned to the US a few weeks ago from my third trip to Africa this year, I kept asking myself: Am I doing enough? If not, what else can I do? I decided I should go to the literature to arm myself with the following questions:

In the literature, I read about policy issues such as the global nursing shortage, nurse migration and ethical nurse recruitment from resource-poor countries. I read about supplying vaccines and medicines for the poorest countries; HIV, malaria and TB, emerging infections such as bird flu, and drug resistant pandemics. I also read about the ethics of clinical research in developing countries and working to identify compelling research questions within individual countries.

Once I had identified some possible targets for intervention, I asked myself what can be done by the Academy and what can be done by individual nurse leaders?

To my surprise, I found the beginnings of an answer in an earlier issue of Nursing Outlook. Rosenkoetter and Nardi (2006) presented a brief of the White Paper on Global Nursing and Health written by members of the Expert Panel on Global Health and Nursing of the American Academy of Nursing. This brief offered some concrete recommendations for action that could serve as a “Road Map” for action by the Academy and/or its members, including but not limited to such things as: creating an inventory of exchanges that already occur, consultations and services needed by countries, gathering models of global nurse recruitment that are ethical, linking international data bases to the AAN website, encouraging re-focusing of nursing curriculum to include global health, supporting technology, distance-learning initiatives that are affordable and usable in developing countries, and actively pursuing legislation in support of global healthcare research funding (italics are mine).

My conclusion was that, at the very least, the Academy needs to examine the White Paper of its expert panel on Global Nursing and Health and outline a plan of action based on their recommendations. Individual nurse leaders also need to read the White Paper and exert pressure not only on Academy leaders to act but on their elected officials to commit to doing something more.

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Dr Smith’s work is funded in part by a grant to the Institute for Human Virology, University of Maryland, Baltimore, from PEPFAR, President’s Emergency Plan for AIDS Relief.