Professional Documents
Culture Documents
In 1996, global health came onto the agenda of the G8 where nurses can have a significant effect both from
and we began to see a relationship between health and a prevention and a treatment perspective
foreign policy; that is, health and wealth are related. : New and re-emerging diseases
However, it has also become obvious that, to effect - 34 million people are living with HIV or AIDS
change, we as nurses need to act in concert with other (WHO, 2013)
organizations and create lobby groups, such as the Health - 8.7 million new cases of tuberculosis (13%
Action Lobby in Canada. co-infected with HIV) and 1.4 million deaths
Increasingly, aid is tied to trade, and the health (WHO, 2012).
workforce is viewed as a ‘commodity’. Developed : Health security—counterfeits and corruption
nations are driving their healthcare systems on an : Patient acuity
economic basis only and not investing enough in nurses, : Underinvestment in technology
so staff are recruited from developing nations, where the : Underutilization of nurses
healthcare systems are already stressed. But worldwide, : Unmet health targets
healthcare systems are stressed and stretched from : Innovation deficits, especially in pharmaceuticals
serious, chronic underfunding and investment, and the : Diverse lobby interests
underdevelopment of community/home care, resulting in : Priorities aligned with election cycles
rising costs to both the system and users. Other stressors : Consumer expectations
on healthcare systems are: : Maternal and child health
: Climate change (floods, drought, food, water) : Human Resources crisis: in 2006, 57 countries
: Unemployment (mental health, violence, unrest) experienced acute shortages of health care personnel
: Poverty, which mainly affects women and leaves1.2. : Weak management
billion people living in extreme poverty; i.e., on : New power groups and ways of working.
US$1.25 a day (World Bank, 2013) In 1990, health policy was mainly dictated by the UN
: Population growth with a rise to 9.5 billion and national governments, but now, multiple partners—
predicted by 2050 governments and nongovernmental organizations—come
: Migration: in 2013 there were 232 million interna- together to address major global problems such as HIV,
tional migrants, nearly half of them women (UN, TB, and malaria. Today we see many other players
2013a). including Global Health Initiatives (GHI). These are
: Growing gap between rich and poor: 20% of the alliances of public and private organizations which have
world’s population have 75% of the income a major impact on decision-making. As a result global
: Aging populations in the West, declining life spans health policy making and leadership are marked by
in Africa competition and confusion, with increasing skepticism
: Clean water/sanitation: nearly 1 billion people have about aid.
no access to clean water and 2.5 billion people live
without even basic sanitation (UN, 2013b) Global Nursing Leadership
: Access to health care: 1 billion people lack access to Global leadership requires a bridging of the divides of
services (UN, 2013b). race, class, gender, culture and country, which happens to
In addition, there is the as yet unquantifiable effect of be part of the nursing ethic. Beechler and Javidan define
communications (e-commerce/social networks/privacy/ it in terms of influence:
cybercrime and bullying/identity theft). “Of influencing individuals, groups, and organizations
that represent diversity again, cultural, political and
Natural disasters institutional systems, but always toward a goal.”
In 2012, there were fewer disasters than on average (394 (Beechler and Javidan, 2007, p. 140)
vs. 400; Fig. 1), but five countries bore the brunt during Global leaders are different from other leaders (e.g.,
the past decade: China, the USA, the Philippines, India, corporations) because they share three common charac-
and Indonesia (Table 2) (Prevention Web, 2013). teristics: they have a global mindset, they are driven to
Not all challenges to the global health system are create new solutions and to seize new opportunities, and
natural disasters. Others are: they are global citizensGlobal leaders have a natural
: Obesity and malnutrition curiosity about the world; they are interested in people
: Noncommunicable diseases, which are the 2nd most different from themselves and they recognize the impact
severe threat to the global economy, but are an area of their actions on others. They are highly flexible and
: Strategic: knows the system, understands the whole Strategic and systems skills comprise having a vision
system and being able to articulate it so that it is accessible to all;
: Culturally competent being able to operate in resource-limited political
: Visionary systems; responding effectively to public policy and
: Able to work alone as well as collaboratively. having the ability to explain policy to both the nursing
Such a person is also a critical thinker—one who is and non-nursing communities; and strategic planning and
disciplined and thinks rationally with an open mind and tactical abilities.
informed by evidence. He or she has good interpersonal A global nursing leader deeply knows and appreciates
skills, is caring and is both mentored and mentoring. global health and health workforce challenges, so is able
Global leaders are accountable risk takers and inspiring to anticipate, recognize, and manage the health needs of
change agents. They are also results oriented. diverse and different populations. As a leader, coaching,
Good leadership depends in part on the leader, the mentoring and teaching are used to facilitate learning by
situation and the followers. Good leadership traits and others, and to foster the creation, collection, analysis,
practices need to be shared across professions, industries, interpretation, management, dissemination and use of
and countries. Unfortunately, women leaders continue to knowledge/data, making creative use of new technolo-
endure discrimination, so ongoing global leadership gies. Expert knowledge ensures skilled questioning and
development, research and advocacy are essential. evidence-based decision making that is effectively
communicated.
Global nursing leadership competency framework Patient safety is paramount to the efficacy of a
An example of a competency framework is the Global healthcare system. A global nursing leader ensures staff
Nursing Leadership Competency Framework developed are clinically competent and trained in their role in patient
by a consortium of 4 universities—two in America and safety, as well as supporting organization-wide patient
two in Europe—as part of the Atlantis Project. It safety programs and designing safe clinical systems,
comprises 7 areas of competency and serves as a basis processes, policies, and procedures. Clinical activities are
for creating individual frameworks from an analysis of monitored to identify both expected and unexpected risks
the strengths and weaknesses as they apply to specific and a non-punitive reporting environment and a reward
situations. The competencies are: system for reporting unsafe practices are instituted.
: Moral & ethical agency Ongoing workforce development involves participation
: Interpersonal qualities in workforce planning and employment decisions,
: Strategic & systems skills corrective discipline to mitigate workplace behavior
: Knowledge management & decision making skills problems and opportunities for employees to be involved
: Patient safety in decision-making. Aspiring clinicians and leaders are
: Workforce development provide with mentorship and career counseling so they
: Quality improvement may develop required skill sets (succession planning) and
Moral and ethical agency is leadership underpinned by the leader continually identifies future skill sets needed to
moral/ethical agency that comprise key metrics associ- remain competitive.
ated with accountability, responsibility, authority, hon- Finally, a global nursing leader works to ensure quality
esty, justice, and fairness, valuing and upholding the improvement through customer satisfaction principles and
caring nature of professional practice, advocacy for, and tools, data collection, measurement and analysis tools and
valuing, the needs and concerns of patients/families/ techniques, medical staff peer review and disciplinary
communities, and accurate and honest self appraisal. processes, national quality initiatives (including patient
The interpersonal qualities required by a global safety) and quality planning and management (Atlantis
nursing leader are inspirational, motivational, and change Project, 2013).
leadership; an ability to create conditions in which others Another application of nursing competencies can be
can lead and be empowered to act; emotional intelligence found in the ICN/WHO Disaster Nursing Competency
and political astuteness; collaboration with other partners Framework (Fig. 2). This was created by ICN and the
and stakeholders; ability to prevent, reduce, and manage WHO Western Pacific Regional Office. (ICN, 2009)
conflict; and the ability to build strategic alliances and
networks within organizations, among national and Future challenges: overcoming weaknesses
international, public and private institutions, and across When we are leading, we are trying to improve things, we
relevant professional and sectors. are trying to move the profession forward, we are trying
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