Rejoining the International Council of Nurses – Heart, head or a little of both? - Liam Williams

I was asked how I feel about the RCN re-joining as a member of the ICN. Instinctively I responded positively and said ‘yes, of course’. And why wouldn’t I? I was on RCN Council when we were members before, and as Chair of the RCN Association of Nursing Students I was privileged to be elected Chair of the European Association of Nursing Students. I got to travel to Slovenia for a weekend to represent the RCN at the European Association of Nursing, but I wasn’t one of the fortunate ones who took a long haul flight to ICN Congress, as it was held in London when my turn came around! I’m a proud European and have recently gained dual nationality through my Irish parentage - I can’t abide nationalism. So why wouldn’t I want the RCN to be a part of the ICN?

I remember some of the debate about leaving; ICN and RCN governance, money, officers’ and elected members’ privilege, general bad will to a lot of things professional in the College.

I looked at the current position compared to the point at which the RCN decided to leave to check what had changed - not a lot. I thought about the debate among the RCN membership on recent policies and the key priority of nurses’ pay. I considered the political environment in the UK where nationalism appears to have particular sway. What’s the point of standing for membership of the ICN in this environment? I couldn’t really articulate it, but then I was asked to write a blog that meant my belief needed more than emotion.

This could be a pseudo-intellectual piece, but I don’t think that is what drives my thinking, so I’ll avoid those arguments and share a brain download starting with the easy bit! The Covid-19 vaccine, likely to be the first approved vaccine for use in Europe, is the product of European collaboration across governments, organisations and personal relationships. Sharing clinical evidence and learning across Europe at the beginning of the Covid pandemic was strong, but clinical relationships enabled effective information sharing across countries using government agencies, professional bodies, social media and informal clinical networks. Formal governance processes ensured that research was undertaken at pace, with the New York Times highlighting the respective benefits of the NHS approach compared to the US. The NHS relied on clinicians from across the globe to fill rosters and social care organisations found the effect of stricter immigration rules caused significant workforce issues.

All of that is good, but why go back to the ICN? It costs over £400k and that’s a lot of money, isn’t it? Of course it is, until you consider the benefits of the RCN sitting as a serious player in the ICN, supporting global collaboration that genuinely focuses on clinical and population outcomes enhanced by nurses. Consider that the UK’s role in taking nurses from other countries to backfill a lack of investment in our own workforce programmes – does the money ‘sent back home’ mitigate the loss of a productive domicile professional workforce that keeps the local population fit and well? I think about the threat to nursing as a graduate profession – a significant contribution to the move into higher education for nurse education was the requirements in EU law.

Then I listened to a webinar by Professor Christy Watson and felt the power of nurses talking with one voice at a national level, and how that should translate internationally. Suddenly half a million pounds didn’t seem like such a huge sum of money in the scheme of things. But then there was the governance. Could we trust the RCN machine to make effective use of the opportunity?

This was the hardest question as the current situation is volatile with many voices shouting about how the College should be configured. We are no longer all together in our understanding of what the College is about across the UK and international boundaries. Personally, I am with Robert Francis QC – we cannot be both a Royal College and a Trade Union. We have proved that we are unable to sustain both functions effectively and I therefore support a stronger delineation of roles. It could be argued that ICN membership is a professional issue, but then you consider the exploitation of countries which lose highly qualified staff to our NHS; is that a professional consideration or is it political and in the spirit of the internationalist labour movement? Younger generations will increasingly work remotely from different countries supporting the NHS. Is that lifestyle professional or employment terms and conditions? When our international standing is outside of the EU, the US and other significant trade blocks how will we sustain the international investment in academia and healthcare research? And is that professional or employment? I think nurses in academia would say both.

What does the membership fee equate to? I’ve just been party to a national mailing contract and anticipate that ICN membership costs something akin to a single mailshot to every member. When you consider the cost of mailshots and the associated membership participation in elections as an example, to me the cost benefit analysis could not be more obvious.

None of this is easy, but on a planet where the land mass is reducing I would rather throw my lot in with international collaboration and spend some money wisely than sit on the beach on my personal deckchair trying to push back the waves.

Liam Williams

Director of Quality and System Performance

NHS South, Central and West CSU