Collegian
Volume 16, Issue 1 , Pages 41-45, January 2009

Scaling up the global nursing health workforce: Contributions of an international organization

  • Ellen E. Rukholm, RN, BScN, MScN, PhD, FCAHS

      Affiliations

    • Canadian Association of Schools of Nursing, Fifth Avenue Court, 99 Fifth Avenue, Suite 15, Ottawa, ON, Canada, K1S 5K4
    • Corresponding Author InformationCorresponding author. Tel.: +1 613 235 3150x26; fax: +1 613 235 4476.
    • ,
  • Lynnette Leeseberg Stamler, RN, PhD

      Affiliations

    • College of Nursing, University of Saskatchewan, Saskatoon, Canada
    • ,
  • Lise R. Talbot, RN, PhD

      Affiliations

    • School of Nursing, Faculty of Medicine & Health Sciences, University of Sherbrooke, Canada
    • ,
  • Geraldine (Polly) Bednash, RN PhD FAAN

      Affiliations

    • American Association of Colleges of Nursing, Washington, DC, USA
    • ,
  • Fay Raines, RN, PhD

      Affiliations

    • College of Nursing, University of Alabama in Huntsville, USA
    • ,
  • Kathleen Potempa, DNSc, RN, FAAN

      Affiliations

    • School of Nursing, University of Michigan, USA
    • ,
  • Pauline Nugent, RN, PhD

      Affiliations

    • Faculty of Health Sciences, Australian Catholic University, Australia
    • ,
  • Dame Jill Macleod Clark, PhD DBE

      Affiliations

    • Faculty of Medicine, Health & Life Sciences, University of Southampton, Southampton, UK
    • ,
  • Sue Bernhauser, RN, MBA, PhD

      Affiliations

    • Council of Deans of Nursing & Health Professions, UK
    • ,
  • Barbara Parfitt, CBE, PhD, RN

      Affiliations

    • Global Health Development, Glasgow Caledonian University, Scotland, UK

Accepted 30 December 2008. published online 24 February 2009.

Article Outline

Summary 

In this paper key highlights of the scholarly work presented at the Toronto 2008 Global Alliance for Nursing Education & Scholarship (GANES) conference are summarized, challenges opportunities and issues facing nursing education globally arising from the conference discourse are outlined and initial steps are suggested as a way forward to a shared global view of baccalaureate and graduate nursing education and scholarship. This shared view arises from beginning understandings of the issues and opportunities we face globally starting with and building upon the lessons learned from the literature and from the experiences of nursing educators and nursing education organization locally, regionally, nationally and internationally. The theme of the groundbreaking GANES Toronto conference was “Educating the future nursing and health workforce: A global challenge”. One hundred seventy delegates from 17 countries attended the event, with over 80 papers presented. A primary focus of GANES is the contribution of a strategic alliance of national nursing education organizations to contribute to nursing education leading practices and policy that address the scaling up of global nursing and health workforce. The founding members of GANES see a clear link between a strong educational infrastructure and strong scholarship activities in nursing and the ability of a society to be healthy and prosperous. Evidence presented at the recent GANES conference supports that belief. Through the strength of partnerships and other capacity-building efforts, member countries can support each other to address the global nursing education and health challenges while respecting the local issues.

Keyword: Global nursing education leading practices policy

 

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Introduction and background 

The global shortage of health care workers has been described extensively in WHO's 2006 World Health Report. Even though there is no common definition of a nursing shortage it has been identified that the supply of nurses in both low-income and high-income countries is not meeting the demand (CNA, 2002; WHO, 2006a, WHO, 2006b). Indeed, as one example, the WHO's 2006 World Health Report states that Sub-Saharan African countries are short in excess of 600,000 nurses. Worldwide nursing shortages exist for varying reasons. In developed countries, mostly those located in the northern hemisphere, we find aging populations and increasingly highly technological health care which intensify the demand for health care workers. In contrast, in developing countries, for the most part located in the southern hemisphere, the AIDS epidemic, tuberculosis, malaria and other devastating illnesses have taken their toll through decimation of the population, including illness and death amongst health workers. One obvious response to the global shortage of health care workers is to increase the number of workers produced – a scaling up of the health workforce (Global Health Workforce Alliance, 2008a, Global Health Workforce Alliance, 2008b; Gostin, 2008, Kuehn, 2007, Shaw, 2007). However, in these discussions, one element that has received little attention but that is common to many countries in the world is an underinvestment in health worker education (Murray, 2008). Basic nursing education as well as continuing professional education is fundamental to the delivery of quality health care and ultimately to the health and security of nations worldwide.

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The need for high quality nursing education 

High quality nursing education is a crucial element in tackling nursing workforce challenges now and in the future. Furthermore, there is a clear link between high quality nursing education and health outcomes for people receiving health care services in countries around the world (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Aiken, Clarke, Cheung, Sloane, & Siber, 2003; Rafferty et al., 2007, Tourangeau et al., 2006). With this in mind, the Global Alliance for Nursing Education and Scholarship (GANES) was established in December 2005, by four of the world's leading nursing education organizations to improve patient care and ensure a substantive global supply of highly educated nurses. GANES “is a body that will engage leaders in nursing education from around the world. Its core vision is to provide an informed global voice for nursing education in order to improve health and health care through nursing education and scholarship. It will offer a forum for nursing education leaders to collaborate in and share nursing knowledge and best practices, learn from one another, and work as an international group to influence policy and health care in respective countries” (Daly, Macleod Clark, Lancaster, Orchard, & Bednash, 2008, p. 1116). Members share a commitment to enhancing the educational preparation of baccalaureate Registered Nurses, expanding opportunities for nursing education, and addressing student enrollment concerns. GANES members include the American Association of Colleges of Nursing, the Canadian Association of Schools of Nursing, the Council of Deans of Health (United Kingdom), and the Council of Deans of Nursing and Midwifery (Australia and New Zealand).

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The international conference 

As a first international activity, GANES recently held an international conference in Toronto 2008, Ontario Canada hosted by one of the member organizations, the Canadian Association of Schools of Nursing. The idea of holding an international nursing education and scholarship conference emerged as GANES recognized that an opportunity for nursing educators from around the world to begin to dialogue, share with and learn from each other's successes and failures in scaling up the global nursing and health workforce was paramount in being able to meet the challenges ahead. Acknowledging the importance of bringing strong nursing minds together to tackle the challenges, the conference provided a forum for other like minded national nursing education organizations and nurse educators to learn about and discuss the potential role of a global organization such as GANES in addressing the challenges of nursing education and the ‘scaling up’ of the nursing workforce. While other international groups have been formed to address ‘scaling up’ the global health workforce however none of these groups represent nursing education organizations in quite the same manner as GANES (Daly et al., 2008; Global Health Workforce Alliance, 2008a, Global Health Workforce Alliance, 2008b).

In this paper key highlights of the scholarly work presented at the Toronto 2008 GANES conference are summarized, challenges opportunities and issues facing nursing education globally arising from the conference discourse are outlined and initial steps are suggested as a way forward to a shared global view of baccalaureate and graduate nursing education and scholarship. This shared view arises from beginning understandings of the issues and opportunities we face globally starting with and building upon the lessons learned from the literature and from the experiences of nursing educators and nursing education organization locally, regionally, nationally and internationally.

The theme of the groundbreaking GANES Toronto conference was “Educating the future nursing and health workforce: A global challenge”. One hundred seventy delegates from 17 countries attended the event, with over 80 papers presented. A primary focus of GANES is the contribution of a strategic alliance of national nursing education organizations to the scaling up of global nursing and health workforce. Inherent in this focus is the examination and dissemination of leading practices in nursing education. With this in mind, conference topics included:

•preparing students for global mobility,

•developing and educating for evolving nursing and health professional roles,

•developing leadership capacity in nursing and health,

•supporting changing skill mix in health care,

•exploring innovative approaches to support learning,

•developing faculty capacity,

•developing and educating for interprofessional healthcare, and

•preparing for ethical and cross-cultural collaboration.

In addition to the conference proceedings, an opportunity for GANES members and representatives from other countries’ nursing organizations to share information was arranged. Through dialogue within this session and the conference itself it became clear that the conference intent of enabling the sharing of leading education practices, promotion of leadership development, sharing of international education research, and creation of opportunities for education research partnerships were contributions to articulating a commonly held vision of the contribution of nursing education to global health. Furthermore, the nursing education issues in many countries (whether they are developed or developing) are similar – challenges in infrastructure to support education and scholarship activities and faculty capacity to educate. Indeed, it is the magnitude of these challenges that vary considerably. The vast extent and complexity of the problem suggests that solid collaborative efforts between national nursing education organizations globally are warranted.

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Dialogue and discourse 

Discourse amongst conference attendees that began during the speaker and panel presentations percolated and moved on into informal conversations in the conference corridors at breaks and at lunch. From these formal and informal dialogues it became clear that these collaborative efforts must respect the unique cultural circumstances of individual countries yet recognize and address common global concerns. Solutions generated in one part of the world may or may not be useful or meaningful in another. Even more apparent than potential differences was the common commitment to the urgent need for nursing education to work globally with governments and key non-governmental organizations to assist in scaling up the global health workforce and to develop enabling nursing education practices and policies. There were discussions about global standards for nursing education and exploration of policies to support culturally respectful processes such as accreditation to enable excellence in nursing education. Through recognition of the accomplishments of the nursing workforce, the prestige of the nursing would be elevated, enhancing recruitment and retention efforts, and contributing to the ability to further influence global health.

Researchers and leaders have begun to realize the need for policies and strategies to address nursing and health workforce education capacity (Crisp, Gawanas, & Sharp, 2008; Joynt & Kimball, 2008). These leaders recognize that ‘scaling up the health workforce’ cannot happen without a comprehensive quality education plan in place that is grounded in universal standards for the education of registered nurses and other health workers. Standards for nursing education and related quality assurance or accreditation processes need to be based on core concepts of relevance, accountability, uniqueness and relatedness of the local, regional and national health circumstances and culture (CASN, 1995, 2005).

Crisp et al. (2008) outlined a list of ‘critical success factors’ specifically for ramping up the education of health workers. These include: sustained government involvement (10 years and more); a national plan; funding; both short- and long-term goals; assurance of an ‘appropriate mix of health workers’; preparatory programs to enable advanced learning; technologically enabled information systems to track and monitor education and health work force; leadership; and appropriate work and payment for health care workers (p. 689). These authors further describe strategies for advancing education including: recruitment and retention of faculty and students; a continuum of education that prepares students for success in the formal education program and that is embedded in the local clinical experience; common foundation for shared learning for various kinds of health workers; increase access by providing education programs within the local context and using appropriate technology to deliver and enhance education; and build faculty capacity through partnerships (p. 690).

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Challenges with building capacity in undergraduate nursing education 

There are significant barriers to increasing the capacity of registered nursing programs globally. One of the most noteworthy is an ever-increasing shortage of qualified faculty. This shortage blocks the ability for programs to be maintained, when in reality expansion is required (Joynt & Kimball, 2008). There are many reasons for limited faculty resources including – in the northern hemisphere an aging faculty, a time lapse between completion of undergraduate education and entry into graduate education, length of time to complete master's and doctoral education, heavy academic workloads, and lack of succession planning. In the southern hemisphere lack of resources and access to graduate nursing education is a primary deterrent. A second significant barrier is limited access to appropriate clinical placements combined with a dearth of clinical teachers with the expertise to teach. Thirdly, the explosion of knowledge has resulted in considerable pressures to include more and more content in curriculum – integrating a multitude of ‘competencies’ for palliative care, public health care, pain care, patient safety, etc. These new expectations of graduates require continual revamping and revising curricula to take into account technological advances and to be relevant in the context of regional, national and global health security.

Building education capacity may mean identifying new ways to deliver education (Pruitt & Epping-Jordan, 2005) – and nursing education is responding to new opportunities. For example, the use of technology such as PDA's allows nursing faculty and students to access information in regions such as the Caribbean where access to libraries has been severely limited (University of Saskatchewan, 2008). The possibility of delivering education in modular or electronic forms using technology means that nurses can be educated in their local community, using curricula that are respectful of local knowledge and local health issues. Further, collaborative teaching across universities and even countries can build capacity and at the same time mentor junior faculty in less well resourced regions or countries. Recruitment efforts for both students and faculty can be targeted at non-traditional diverse populations such as incentives to support diversity and men, and the same educational strategies used for undergraduate and continuing education can also be used for faculty capacity building.

Partnerships have been forged in nursing since the beginning of formal nursing education (Joynt & Kimball, 2008). However, these partnerships need to be expanded and enhanced. For example, partnerships between education and health care institutions to build a clinical teaching workforce serves both practice and education sectors. Forging partnerships between education programs in developed and developing countries and between private, government, practice and education sectors has the potential to more effectively and efficiently develop faculty capacity. Support of global scholarship activities was a topic that emerged from dialogue with the Director of the Centre d’innovation en formation infirmière/Center for Innovation in Nursing Education and the Dean of Nursing at the Université de Montréal during the Toronto, GANES conference. CIFI is a newly formed center dedicated to developing, evaluating, and disseminating sound innovations and best nursing education practices (http://www.cifi.umontreal.ca/en/contactus/index.html). The future vision is that centers such as CIFI will be linked or connected to the GANES website and thus enable future global collaborative research efforts to occur. To be successful such partnerships or collaborative undertakings must share common concerns and focus on solutions beneficial to all partners.

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The ongoing need to advocate for nursing 

Communication strategies are also important. Engaging the public in understanding the impact nurses has on patient health outcomes is an area not well developed to date. Advocating that an appropriate mix of skilled health workers includes registered nurses, nurse practitioners, doctors and other health workers is a global concern (Crisp et al., 2008). Also, the economic issue of the cost of educating a registered nurse versus other types of health workers needs to be addressed (Aiken, 2008). Now is the time for regulatory bodies, accreditation agencies, educators and practitioners to work together regionally, nationally and internationally to address nursing shortage issues. Nursing education organizations must be at the policy table to ensure issues unique to our sector are seen as an integral component in addressing ramping up the health workforce to meet the health issues of people around the world. In light of the predictions of prolonged nursing and health worker shortages globally and the evidence indicating the positive impact registered nurses have on patient outcomes efficient, effective, new ways to educate highly qualified registered nurses must be put in place globally (Aiken et al., 2007; Baumann & Blythe, 2008).

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Conclusion 

Collaborative global efforts amongst nursing education organizations are fundamental to the meeting of WHO Millenium Development Goals (2000) and improving the health status of global humanity. Organizations such as GANES, with a unique focus on education and scholarship as the means for improving the health status of citizens of our respective countries and other countries around the globe, are a promising strategy for achieving the goals. A core value of GANES is the conviction that the health security of a nation relies upon a highly educated and appropriately skilled nursing health workforce (Daly et al., 2008). Globally, this belief is grounded in mounting evidence which links education infrastructure and scholarship activities with mortality and morbidity health outcomes (Aiken et al., 2002, Aiken et al., 2003, Rafferty et al., 2007, Tourangeau et al., 2006). The founding members of GANES see a clear link between a strong educational infrastructure and strong scholarship activities in nursing and the ability of a society to be healthy and prosperous. Evidence presented at the recent GANES conference supports that belief.

Through the strength of partnerships and other capacity-building efforts, member countries can support each other to address the global challenges while respecting the local issues. Continuing efforts include a one-day symposium which will be organized in collaboration with the South African Deans of Nursing, to be held in Durban, in June 2009 just prior to the International Council of Nurses Congress. Further, the second GANES conference will be held in Sydney in 2010. GANES welcomes additional partnerships through membership and other activities.

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References 

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PII: S1322-7696(09)00002-X

doi:10.1016/j.colegn.2009.01.001

Collegian
Volume 16, Issue 1 , Pages 41-45, January 2009

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