Having a seat at the table - Elaine Maxwell
In 1899 three countries (Great Britain, the United States, and Germany) sought to bring nurses across the world together to advance the art and science of nursing for the public good through the establishment of the International Council of Nurses (ICN). The first President, Ethel Gordon Fenwick went on to campaign for a nationally recognised certificate for nursing in Great Britain and she successfully lobbied Parliament to pass a law to limit practice to registered nurses. She was "Nurse No. 1" when the register opened in 1923. In doing so, she was following the example of New Zealand, where Ellen Dougherty became the first registered nurse in the world in January 1902. Gordon Fenwick recognised the importance of what we would now call collective leadership; working across organisational and even country boundaries to improve an interconnected system. As she found from her contact with New Zealand, we have much to share with other countries, but as importantly we have much to learn from them.
Why should we look internationally? The UK is enriched by an increasingly diverse population that both use and provide our health services. Internationally recruited of nurses have been a key part of the workforce since before the NHS was formed, initially coming from Ireland and then the West Indies and now from almost every country in the world. It is therefore in our interests to work closely with health systems in other countries. Internationalism is not colonial paternalism, it is a co-production using all of the talents, however richer nations have more resources to support the bringing together of world nurses to enhance understanding and development of the contribution of nursing practice to health improvement. The ICN provides us with the opportunity to raise our heads above the crushing day to day operational pressures and think strategically about how tomorrow could be better.
In October 2018, World Health Organisation (WHO) Director-General Dr Tedros Adhanom Ghebreyesus made specific commitments to supporting the role of nurses and midwives in achieving the WHO’s 13th General Programme of Work. The WHO is working closely with the International Council of Nurses to achieve this. But the UK is not represented at the ICN. The Royal College of Nursing (RCN), the single largest membership organisation in the world with over 435,000 members, voted to leave the ICN in 2013. Despite the estimated cost per member of £1.80 per year, the RCN Congress decided that this was too high a price to be a member of a global nursing body. In it’s annual report for 2018, the RCN posted a very healthy surplus after tax of £9.9 million and so affordability is not the problem. It is disappointing that the RCN did not feel that a seat at the international table was a priority.
Nursing as a profession has little voice in politics and policy. For the UK to choose not to work with other countries to pull international levers is at best a missed opportunity, at worst it is a dereliction of our responsibilities to seek every avenue to improve care for our population.