International Perspectives

A ‘formidable force’ in nursing worldwide wins ICN's top award

Kirsten Stallknecht, former President of the International Council of Nurses (ICN), has been awarded the 2013 Christiane Reimann Prize, nursing's most prestigious international award. Stallknecht is a formidable force in nursing in her native Denmark, throughout Europe and internationally. She has dedicated more than 50 years to improving working conditions for nurses, particularly those affected by war, financial difficulties and catastrophes, and those in countries with fewer resources.

ICN awards the prize every four years in recognition of outstanding vision, leadership and commitment to the advancement of nursing knowledge.

‘Kirsten Stallknecht is an inspiration to many nurses around the world’, stated Rosemary Bryant, ICN President. ‘Throughout her career she has led a crusade for the socio-economic welfare of nurses, particularly those working in extremely difficult circumstances. Her enthusiasm and passion for her work has encouraged nurses around the world to strive for excellence in nursing’.


Kirsten Stallknecht

Photo credit: Danish Nurses Organisation

The Danish Nurses Organization accepted the award on behalf of Stallknecht during the opening ceremony of the ICN 25th Quadrennial Congress in Melbourne, Australia in May. Expressing her surprise and delight at being selected for the prize, Stallknecht said: ‘All of the nurses I have known, met and admired during my work in ICN, and then one day a message arrives in the middle of the dark winter in Denmark, that the ICN Board has chosen me. It is difficult to describe all of my feelings at that moment: thankful, honoured, happy and not quite believing it to be true’.

As ICN President from 1997–2001, Stallknecht chose ‘humanity’ as her the watchword, because ‘nursing is about humanity’. During her tenure, she led nurses' condemnation of lethal injections and torture, advocating that health professions join together to move governments to stop such practices. At ICN she also served as a member of the Board of Directors (1981–1985), Vice President (1985–1989), Chair of ICN's Socio-economic Welfare Committee and on advisory groups and task forces.

Stallknecht believes passionately that nurses have to ‘fight for their right to salaries comparable with those of other professions with the same responsibilities … and to fight for the right to pension schemes, payment for inconvenient hours, and most of all, to create a career structure that enables nurses to continue in their profession when they have chosen a family life’. In her opinion, nurses can only deliver quality nursing care if they have satisfactory work conditions.

She is a former president of the Danish Nurses Organisation (1968–1996) and the Northern Nurses Federation (1989–1995). In 2001 she was named Commander of Donnebrog by Queen Margrethe II of Denmark, and in 2004 she received the CGPN International Distinguished Leadership Award.

The prize is named for ICN's first full-time Executive Secretary, Christiane Reimann, and is funded by a trust reserve established through her will. The list of past recipients represents a wealth of achievement in nursing science and practice. Previous winners include Virginia Henderson, often referred to as the world's most beloved nurse; Dame Nita Barrow, an expert in public health and health education; Dame Sheila Quinn, a leader in establishing the position of nursing within Europe and improving nursing education throughout Europe; Dr Mo-Im Kim, for enhancing the nursing profession at national and international levels; and Dr Hildegard Peplau, for her revolutionary work in patient-nurse relationships which established the groundwork for the speciality of psychiatric nursing; Dr Margretta Madden Styles, a nurse scholar renowned globally as an international leader in nursing education, regulation and credentialing; and most recently, Máximo A. González Jurado who made an enormous contribution to the development of nursing in Spain, and whose enthusiastic and charismatic leadership has encouraged nurses around the world to strive for health care excellence.

Nurses expand action, evidence and advocacy to fight tuberculosis

In launching the third phase of its highly successful tuberculosis (TB) project, the International Council of Nurses (ICN) committed itself to establishing a strong evidence base to support best practice for quality patient care, to strengthen health systems and to save lives.

Since 2005, the ICN TB Project has focused on strengthening the role of nurses in TB care, prevention and management, and building nursing capacity in countries where TB poses a serious public health threat. A United Way Worldwide grant made possible by the Lilly Foundation on behalf of the Lilly MDR-TB Partnership supports the ICN TB Project.

With an estimated annual incidence of an eight million cases worldwide, TB is a grave public health, social and economic problem. Each year nearly a half million people worldwide are infected by multidrug-resistant TB (MDR-TB), which is difficult to treat. The disease burden is heaviest in developing countries, where 95% of the cases occur. Even in developed countries, TB is re-emerging as a public health concern.

Nurses leaders from South Africa, India and China – all countries with high burdens of MDR-TB – spoke at a press conference held in Geneva, Switzerland to launch the ICN TB Project's third phase.

David C. Benton, ICN Chief Executive Officer, emphasized that nurses are the patient's best allies in recognising TB symptoms, referring them for diagnosis and assuring treatment. ‘Nurses have practical ideas about how care can be improved but they need support to make changes and gather evidence so others can benefit from their experience’, he stated. ‘Along with developments in diagnostics and treatment, we need investment in care, and research into effective care strategies in collaboration with the people who implement those strategies on the ground, which are most often nurses’.

Also participating at the press conference were the managers of the ICN Wellness Centres for Health Care Workers® in Ethiopia, Lesotho, Malawi, Swaziland, Uganda and Zambia. The Wellness Centres, which support the development and delivery of health services for health care workers and their families in countries with high rates of TB and HIV, collaborate with the ICN TB project to strengthen its impact. Like the TB Project, the Wellness Centres operate through the ICN member national nurses association in each country.


Harriet Kapyepye, Manager, ICN Wellness Centre for Health Care Workers®, Malawi, describes the success of the ICN TB Project in her country. Seated next to her are Yayeneabeba Tadesses Garedew, Wellness Centre Manager, Ethiopia and (far left) Doreen Chaoana Mapetja

Wellness Centre Manager, Lesotho. Photo credit: Lorenzo Chiriatti, ICN.

The ICN TB Project builds the capacity of nurses and other health workers to provide safe, quality care to people affected by all forms of TB, from the moment they seek help to the completion of treatment. The project uses a Training of Trainers (TOT) methodology, designed specifically to encourage practice development. Experienced nurses working mainly in the TB and HIV field are trained to pass information to nursing colleagues and other health workers in order to improve patient care delivery. The ICN TB Project's impact on nursing attitudes and practice has exceeded all expectations. Results have demonstrated the significant value of investing in the nursing workforce at every level.

With funding from the Lilly Foundation, ICN will be able to gather and publish the evidence to demonstrate how patient outcomes can be improved through investment in nursing interventions.

‘ICN's innovative model of training nurses to pass knowledge on to their colleagues is a powerful way to ensure messages reach beyond the training venue and can be adapted to a variety of settings’, said Dr Evan Lee, head of the Lilly Multi-Drug Resistant-TB Partnership. ‘Nurses are a critical part of the complex health system needed for TB treatment. We want to help empower nurses and enable them to do treatment adherence and patient management. We are proud to continue our relationship with ICN on this project’.

The Lilly MDR-TB Partnership is a public-private initiative wholly funded by the Eli Lilly and Company Foundation to address the expanding crisis of MDR-TB. The Partnership is pursuing a comprehensive strategy to fight MDR-TB by providing access to medicines, transferring manufacturing technology, training healthcare workers, raising awareness of the disease and providing resources for prevention, diagnosis and treatment of people living with MDR-TB. Further information is available at:

Comments from the ICN TB Project Team

In the 20 years of my experience working with TB, first as a TB nurse and now as a project leader, I've never been more alarmed. It is a scandal that people still die from this curable disease. Obviously it's good to be able to diagnose the disease quickly and to have effective treatment strategies, however, the glue that adheres the patient to the treatment regimen is the nurse. Nurses have a critical part to play in ensuring that patients have access to the best available treatment and good quality support. MDR-TB is a serious diagnosis for a person, involving a long and involved treatment plan. It is almost equivalent to a diagnosis of HIV before treatment was available. We've proven the fantastic amount that nurses can accomplish with only a small investment and a boost in confidence. Behind every statistic there is a human being, each of whom requires the best possible care to recover from this potentially fatal disease. Our plan for Phase 3 is to build the evidence base for effective care strategies that will save lives.

Gini Williams, ICN TB Project Director

So many of our colleagues die each day from HIV and TB. Until several years ago, we'd always assumed that nurses received the best possible care for TB but found out we were wrong. The stigma attached to TB and HIV made it tough for them to access health services. At the Wellness Centre, we provide confidential testing services, and give diagnoses in a private and supportive way. We provide follow-up even at their homes. In 2010, we integrated the ICN TB Project into our Wellness Centre activities. We've conducted training and have provided information to thousands of health care workers. We're reaching out to TB screening facilities in rural areas. The ICN TB project is working wonders for us.

Muzi E. Dlamini, Manager, ICN Wellness Centre for Health Care Workers®, Swaziland

In South Africa we have high prevalence of TB and also face the challenge that many nurses move out of the country or leave the profession. We began the ICN TB Project in 2005 with the objective of training nurses at the national level and then having them train their colleagues in the provinces. We've trained close to 280 nurses and they in turn have trained an additional 4000. In this way, the knowledge has cascaded and we've taken the project to the provincial level. We've built local teams with professional and government networks, and we work in partnership with provincial health services to address the challenges of TB and MDR-TB.

Madithapo Masemola, Deputy General Secretary, Democratic Nursing Organization of South Africa (DENOSA)

In China nurses work with doctors and other health care providers to deliver TB care in hospitals and in communities. Our country has a shortage of nurses, especially TB nurses, and this represents a significant challenge for us. Chinese nurses have taken initiatives to build knowledge about patient care strategies, a neglected area for research. We have worked to increase research capacity among nurses with the goal of improving patient care.

Hong Zhao RN, PhD, ICN TB Project Leader for Chinese Nurses Association

We have a critical shortage of nurses in Malawi, and it's not unusual for one nurse to look after 50–80 patients in one shift. Prior to the ICN TB project, our TB wards didn't have a nurse dedicated to the ward. Instead they borrowed nurses from other wards – the nurse came, administered medicines and then left, meaning that patients were then alone with their questions. The project allowed us to train nurses and build capacity so that now we have two or three nurses located in a TB ward. The project has made our government and others in our country aware that nurses are working with TB. Today the Red Cross is taking advantage of the capacity we built in order to increase capacity in communities.

Harriet Kapyepye, Manager, ICN Wellness Centre for Health Care Workers®, Malawi

We are reaching out to nurses who work in tertiary institutions to sensitize and train them about treatment and infection control and how to counsel patients. This is a challenge because the number of nurses in India is so large. Together with the Central TB Division, we're working to bring nurses up to speed and build nursing capacity to save lives in India.

T. Dileep Kumar, President, Indian Nursing Council


Nurses leaders from countries with high burdens of MDR-TB participated in a press conference to launch the ICN TB Project's third phase. Shown above are (left to right) Madithapo Masemola, Deputy General Secretary, Democratic Nursing Organization of South Africa (DENOSA) and Muzi E. Dlamini, Manager of the ICN Wellness Centre for Health Care Workers®.

Photo credit: Lorenzo Chiriatti, ICN.

Mary Robinson wins 2013 ICN Health and Human Rights Award

Mary Robinson, the first female President of Ireland and former United Nations High Commissioner for Human Rights, has received the 2013 International Council of Nurses (ICN) Health and Human Rights Award. The award expresses the esteem and recognition of the world's 16 million nurses for Robinson's outstanding contributions. It is the only award bestowed by ICN on someone who is not a nurse.

‘We are honoured that Mary Robinson has accepted this award’, said Rosemary Bryant, ICN President. ‘Passionate and inspiring, she is one of the greatest living role models for women everywhere. Throughout her career, she has demonstrated a dedication to defending human rights, and a passion for advocating for gender equality. Her work epitomises the goals and values of ICN in the promotion of health and human rights’.

The award was formally presented during the opening ceremony at the ICN 25th Quadrennial Congress in Melbourne, Australia in May.

‘I am honoured and deeply touched that the International Council of Nurses has selected me as the 2013 recipient of its prestigious Health and Human Rights Award’, stated Robinson. ‘I have a very high regard for the nursing profession, both within Ireland and internationally. I convey my very deep appreciation to the nursing associations in the 134 member countries of ICN, and my best wishes for continuing the invaluable work you do’.

Robinson has spent most of her life as a human rights advocate. While President of Ireland, she was the first head of state to travel to Somalia, bringing worldwide attention to the famine and war there. This was followed, in 1997, by her visit to Rwanda after its civil war and genocide. Her continued trips to Africa shone a much-needed light on the long-standing problems of famine and genocide.


Mary Robinson

In 1997, Robinson was appointed the United Nations (UN) High Commissioner for Human Rights. During her tenure, she ensured the integration of human rights into the other activities of the UN; strengthened human rights monitoring in conflict areas; and highlighted the areas of climate change, human rights and gender.

In 2002, Robinson founded Realizing Rights: The Ethical Globalization Initiative. From 2002 to 2010, Realizing Rights worked with a range of partners on diverse projects and initiatives to fulfil its mission of making ‘human rights the compass which charts a course for globalization that is fair, just and benefits all’.

She has served as Chancellor of Trinity College, Dublin; Honorary President of Oxfam International; Chair of the International Institute for Environment and Development (IIED); Chair of the Council of Women World Leaders; a member of the Elders Group of World Peacemakers; and Head of the International Commission of Jurists.

ICN has long believed that health is a right of all individuals, regardless of financial, political, geographic, racial or religious considerations. The link between health and human rights is a fundamental building block in creating just and healthy societies.

Revised ICN Code of Ethics reflects realities of nursing and health care today

A new and revised version of the ICN Code of Ethics for Nurses is now available. A guide for action based on social values and needs, the Code has served as the standard for nurses worldwide since it was first adopted in 1953.

The International Council of Nurses (ICN) regularly reviews and revises the Code in response to the realities of nursing and health care in a changing society. The latest version highlights the importance of positive practice environments and evidence-based practice.

‘This is a critically timed publication’, stated David Benton, ICN Chief Executive Officer. ‘Today, more than ever before, nurses are facing major ethical dilemmas as governments struggle to contain costs. This publication provides an essential tool – a compass – to help navigate the challenges ahead’.

The 2012 revised edition presents the nurse's role in developing and sustaining a core of professional values; creating a positive practice environment; maintaining safe, equitable social and economic working conditions; sustaining and protecting the natural environment; and contributing to an ethical organisational environment.

The publication provides a framework for the standards of conduct, and assists nurses in translating the standards into action in their practice. It confirms that inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect. Used as a guide by nurses in everyday choices, it supports their refusal to participate in activities that conflict with caring and healing.

In a handy pocket size, the 2012 Code may be downloaded free of charge in English, French and Spanish from the ICN website: Hard copies can be ordered from

To be effective the Code must be familiar to nurses. ICN encourages nurses to help disseminate the Code to schools of nursing, practising nurses, other health professions, the general public, consumer and policy-making groups, human rights organisations and employers of nurses.

We need to equalize roles, responsibilities and pay: a conversation with Lesley Bell

Early in 2013, Lesley Bell RN, MBA joined the International Council of Nurses (ICN) as a Nurse Consultant, focusing primarily on socio-economic issues (SEW). Previously she served as the Chief Executive Officer of the Ontario Nurses' Association for twenty years. Bell has a wide range of experience in lobbying on behalf of nurses for fair and equitable compensation, quality workplaces and safe staffing. Jan Harrington, INR News Editor, spoke with her about SEW.


How did you become interested in socio-economic issues (SEW) as an area of nursing on which to focus?


My interest goes back to watching my mother in the workforce and observing that women didn't have the same pay, working conditions or ability to be promoted. Years later, I became a member of a central negotiating team for nurses in the hospital sector where I worked in Ontario. I've always been passionate about fairness and recognizing people's value, so the union movement and pursuing the collective good seemed a natural path for me. Over the years, I worked to convince employers of the value of nursing, and to demonstrate the link between a healthy workplace and quality of care.


Your position at ICN allows you to work on SEW issues with many countries and on the global level. During your short time here, have you noticed similarities and differences?


It is hugely interesting and enlightening for me to be exposed to SEW at the international level. I didn't think that, at this point in my career, I'd be moving halfway around the world, but the opportunity to work with ICN was too good to pass up. My new position represents a chance to build upon what I learned in Canada and to influence our profession globally.


Lesley M. Bell RN, MBA

In the international arena, SEW issues are more complex and certainly much broader, involving more organizations and players, as well as more political nuances and policy issues. At the global level, ICN places even greater emphasis on policy, and on the research and evidence-based component. Working with countries whose cultural norms and economic resources are quite different from North America represents a learning curve for me. However, the SEW fundamentals remain the same – fairness and value for work, and recognizing the role nurses play in helping to create a healthy world.


How would you describe the ICN SEW agenda? What are the priorities for 2013?


ICN works to help nurses obtain the remuneration and respect they deserve. The SEW agenda encompasses a broad range of areas such as migration, education, leadership development and technical support to member national nurses associations (NNAs). Significant overlap exists among ICN's three pillars so I collaborate closely with the Nurse Consultants for professional practice and regulation.

Our priorities in 2013 focus on workplace conditions, including pay and hours of work, as well as health and safety. Nurses who have a good working environment provide higher quality care. A healthy, positive workplace is better for everyone so I'd like to push forward the positive practice environment (PPE) project ICN launched several years ago.


What do you see as the most important challenges today in obtaining fair and equitable compensation for nurses, as well as quality workplaces and safe levels of staffing?


The economic downturn continues to have an impact. Scarce resources always have implications for nursing because of the number of people required to provide quality care. From the institutional viewpoint, nursing is often seen as a cost factor rather than a resource. We need to use evidence to show that adequate staffing produces better patient outcomes, less morbidity and mortality, and fewer readmissions – all costs to the system in the long-run. A number of ICN member organisations are experiencing a strong attack on public services resulting in wage rollbacks, as well as changes in hours and staff. One approach to cutting expenditures is to pay new nurses lower wages, even though they have the same qualifications as nurses working beside them. Such an approach aggravates the problem we already have of nurses leaving the profession within three years of graduation.

Another issue is the increasing demand for health care workers and the decreasing supply, and the global shortage of nurses in particular. Normally in an economic system, increased demand and short supply would bode well in terms of remuneration. In my experience, it hasn't played out that way. It's true of course that employers can't pay nurses with money they don't have. However, we need to look at the system and analyse how funds are spent. In Ontario, we found that some hospital CEOs earned five times as much as the Premier of the province. Medical staff often receives salaries that are many multiples of nurses' pay. While I don't undervalue the work of CEOs and physicians, I'm not sure that the pay differential can be justified. You can't run a hospital without nurses to provide patient care. We need more equalized roles, responsibilities and pay scales.


What do you most want to achieve in your new position?


I will continue the work ICN has done in achieving recognition and advancement of nurses' roles in health care systems, and in collaborating with professional, regulatory and union bodies. I'm looking forward to becoming involved with Leadership in Negotiation (LIN). Soon I'll travel to South Africa to do a needs assessment with six African countries and we hope to conduct LIN workshops with them in the future. I plan to strengthen the workshops and look for funding from other organisations to support them. Negotiation skills aren't limited to trade union activities. Nurses benefit from these skills in every role and wherever they work.

I will urge all nurses I meet in my travels for ICN to recognize the inherent value of the work they do and to acknowledge the leader within them. Every nurse is a leader. Sometimes they just need support to stand up and be recognized as such. When you get nurses together, regardless of the country, and they start talking about their issues and concerns, you could close your eyes, and aside from the language, be anywhere in the world. My work is to make their lives better.

Nurse leader appointed as Ambassador to the Girl Child Education Fund


Dr Sheila Tlou

An international leader in nursing, gender issues and HIV/AIDS will serve as the first Ambassador to the ICN/FNIF Girl Child Education Fund (GCEF). In her new role, Dr Sheila Tlou, a specialist in women's health and a former Member of Parliament and Minister of Health of the Republic of Botswana, will promote the right of girls to education and increase awareness of the GCEF. She will act as a spokesperson in the international spheres of nursing, health, education, gender and development.

Established in 2006, the GCEF supports the primary and secondary schooling of girls under the age of 18 whose nurse parent or parents have died. The GCEF presently supports 155 girls in four countries in sub-Saharan Africa: Kenya, Swaziland, Uganda and Zambia. It is a joint initiative of the International Council of Nurses (ICN) and the Florence Nightingale International Foundation (FNIF).

‘The importance of educating girls cannot be underestimated, nor can the injustice of denying them such an opportunity’, said Dr Tlou. ‘I am delighted to champion the GCEF and proud to be associated with the International Council of Nurses in this noble cause. Opening the doors to education for girls and women leads to better health for them and their communities. It also leads to increased demand and realization of sexual and reproductive health and rights, reduced infant and maternal mortality, and increased economic and social development. It is above all the right thing to do’.

Dr Tlou is Director of the UNAIDS Regional Support Team for Eastern and Southern Africa. She has also served as Professor of Nursing at the University of Botswana and Director of the WHO Collaborating Centre for Nursing and Midwifery Development in Primary Health Care for Anglophone Africa. She has conducted research and taught courses to nursing, pre-medical and social science students on gender issues relating to HIV/AIDS, sexual and reproductive health and rights, and ageing.

Dr Tlou played a key role in the development of national nursing and medical education curricula, working to broaden the scope of health sciences education in her home country of Botswana. In 2001, she addressed the United Nations Commission on the Status of Women on ‘Women, the Girl Child and HIV/AIDS’, and participated at the UN Special General Assembly on AIDS on Women and HIV/AIDS.

‘Dr Tlou is an excellent choice as Ambassador to the GCEF, given her deep commitment to the promotion of gender equity, and her experience with the work of nurses in Southern Africa’, said David Benton, ICN Chief Executive Officer. ‘We are delighted to have her passion and experience to help us raise awareness of this important project’.

Nurses and their associations around the world, individually and collectively, support the GCEF. Each girl is paired with a nurse volunteer who helps to monitor her progress. ICN's member national nurses associations administer the GCEF in their respective countries. Individuals and organizations also donate funds to the GCEF. Contributions can be made via the ICN eshop. Additional information about the project can be found on:

Donations go directly to education costs. A contribution of US$ 200 helps to cover the costs of uniforms, books and fees for the primary education of a girl child for one year, and US$ 600 for secondary education. Approximately US$ 5,000 will secure the education of a girl throughout primary and secondary school.

Additional information about the GCEF can be found at and

ICN releases ICNP® 2013

The 2013 release of the International Classification for Nursing Practice (ICNP®), a terminology for nursing that supports standardized nursing documentation worldwide, is now available.

‘ICNP has a significant role to play in achieving our aim to transform nursing through visionary application of information and communication technology’, stated David Benton, ICN Chief Executive Officer. ‘I give credit to the many people worldwide who have been involved in the development of ICNP since its inception in 1989, sharing a goal to make visible the vital work of nurses’.

The documentation data can be re-used for multiple purposes, including clinical and administrative decision-support, generating evidence for practice, nursing education, and policy development.

The International Council of Nurses (ICN) launched the 2013 ICNP at its 25th Quadrennial Congress in Melbourne, Australia in May. A stable robust terminology and strong maintenance programme enables ICN to release an ICNP update every two years in a format that is easy to implement and use. ICNP is available at:

The formal foundation of ICNP makes it capable of harmonizing other nursing and multi-disciplinary terminologies in order to optimize care documentation and analysis of health interventions related to outcomes for patients, groups or communities.

The 2013 release of ICNP includes 783 pre-coordinated diagnosis and outcome statements (a 15% increase from 2011) and 809 pre-coordinated intervention statements (a 50% increase from 2011).

To date, ICNP has been translated from English into 14 languages. Several of ICN's translation partners used the 2013 pre-release of ICNP (available to translators and vendors) to complete an updated translation for their countries concurrent with the formal release date.

The 2013 release of ICNP reflects the intense focus on development of subsets of the terminology to meet nurses' information needs in hospitals, ambulatory care settings and the community. These subsets, published as ICNP Catalogues, either in print or on the ICN website, are comprised of pre-coordinated statements of nursing diagnoses, nursing interventions and nursing sensitive outcomes for documentation in electronic health records.

Five ICNP Catalogues are currently available:

  • Adherence to Treatment (ICN + Expert Panel)
  • Palliative Care (ICN + Expert Panel)
  • Community Nursing (with National Health Service Scotland)
  • Nursing Sensitive Outcomes (with Canadian Nurses Association)
  • Paediatric Pain Management (with Children's National Medical Center, USA).

Nursing and Interdisciplinary Harmonization Partners include: Saba Care (Clinical Care Classification); International Health Terminology Standards Development Organization (SNOMED-CT); the U.S. National Library of Medicine (NLM); and WHO-Family of International Classifications (ICHI, ICF, ICD).

Further information about ICNP is available at:

NNAs meet in Togo to identify priorities for nursing

Strengthening nursing in Togo, Burkina Faso and Benin was the focus of a weeklong workshop and meetings held in Lomé, Togo in early 2013. The International Council of Nurses (ICN) participated along with representatives from the national nurses associations (NNAs) of the three West African countries, the Swiss NNA and the cantonal university hospitals in Geneva, Switzerland.


Representatives of the NNAs of Togo, Burkina Faso and Benin participated in a workshop and meetings early in 2013. Shown are: (First row, left to right) Dr Alexandre Bischoff, Hôpitaux Universitaires de Genève (HUG); Jean Baptiste Elias, President, l'Association Nationale Béninoise des Infirmiers et Infirmières Diplômés d'Etat (ANBIIDE); Jean Barry, Consultant, Nursing and Health Policy, ICN; Dédamani Sanwogou, Past President, l'Association Nationale des Infirmiers et Infirmières du Togo (ANIIT); Kossi Kove, Secretary General, ANIIT. (Second row, left to right) Mr. Banizon, Secretary General, (ANBIIDE); Rosita Koch, l'Association Suisse des Infirmières (ASI); Napo Dare, President, ANIIT. (Fourth row) Kossi Agbodeka, Vice-President, ANIIT; (Fifth row) Justin Pooda, President, l'Association National des Infirmiers du Burkina Faso (ANIBF).

‘These productive meetings were the beginning of collaborations and work that will be ongoing’, said Jean Barry, Consultant, Nursing and Health Policy, ICN, who manages ICN's projects and initiatives in the area of regulation and education.

The meetings addressed three key objectives: strengthening the national nurses association in Togo; enhancing opportunities for continuing education in the region; and strengthening nursing regulation. These objectives were identified as priorities in a 2011 research project funded by the Swiss NNA, l'Association Suisse des Infirmières (ASI), and conducted by a representative of the university hospitals in Geneva, les Hôpitaux Universitaires de Genève (HUG).

During the first two days, participants discussed key issues such as strengthening national nurses associations and nursing regulation regionally, and shared information on the current situation in their countries. Representatives of the NNAs of Togo, Burkina Faso and Benin explored opportunities for regional collaboration, particularly in the area of continuing education. Participants identified nine common areas as the most important to address in continuing education and agreed to continue dialogue about regional approaches.

For three additional days, representatives of the ASI, HUG and ICN worked intensively with the Togo National Nurses Association, Association Nationale des Infirmiers/ères du Togo (ANIIT), to develop strategies and plans of action related to the three key objectives. Preliminary project outlines were developed regarding ongoing collaboration between ASI and ANIIT; development of continuing education programs; and strengthening nursing regulation in Togo through the formation of a nursing order/regulatory body.

The group also met with representatives from Togo's Ministry of Health and Ministry of Education, as well as with a representative of the French Development Agency, a supporter of work to strengthen health human resources in Togo. Representatives of ANIIT from around Togo also gathered so that meeting participants could share information on plans for future work and respond to questions.

Together we can increase the quality of care everywhere: a conversation with Yukiko Kusano

A nurse and programme specialist with international experience, Yukiko Kusano RN, MSc, has joined the staff of the International Council of Nurses (ICN) as a Consultant for Nursing & Health Policy. Her experience includes working in Afghanistan, Indonesia, Liberia, Nepal and Vietnam. Jan Harrington, INR News Editor, spoke with her about her background and new position.


How and why did you choose nursing as a profession and career?


My mother is a nurse and loves her profession. I didn't know what I wanted to do when I finished high school and she advised me to become a nurse. I listened to her and don't regret my decision. I started my career working in several clinical areas at a general hospital in Japan. I found it tough in the beginning and wasn't sure that I liked being a nurse because of the enormous amount of work, night shifts which meant I had trouble sleeping and the physical requirements of patient care. I also felt the weight of responsibility for the life of the patient, and concerns for his or her family. Often the story ended with no happiness. Yet it was fulfilling when I saw a patient smile, or when the family felt satisfied by having done all they could have done.


What led you to work as a nurse internationally, and what countries did you experience?


I had an opportunity to work in Nepal as a volunteer for a philanthropic project that provided cleft palate surgery for children and adults. This experience made my interest in working abroad seem more realistic. In 2002, I went to Afghanistan and worked for UNICEF to help implement a cross-sectoral programme to assist with the immediate recovery of services for children. After a year there, I continued to work in developing countries. I went to Liberia as a nurse with Médecins du Monde (France). Next I served in Indonesia as a Health Delegate and head of a sub-office for the Japanese Red Cross Society. In Vietnam I acted as a Programme Coordinator for Save the Children, Japan.


Yukiko Kusano, RN, MSc

Photo credit: Lorenzo Chiriatti, ICN.

In between my assignments abroad, I went to London and studied at the London School of Hygiene & Tropical Medicine, earning an MSc degree in Public Health in Developing Countries.

Most of my work abroad was as a project manager rather than as a clinical nurse, and after a time, I missed nursing and I wanted to practice again. Returning home to Japan, I accepted a position as a school nurse. This job reconfirmed for me that nursing is a great profession. When you deal with young children, you see the potential for each intervention to have a great influence on them.

Later I came to Geneva to work as a Technical Officer for the World Health Organization (WHO), and eventually this brought me in contact with ICN. Having seen nurses and the need for quality nursing in many different environments during my past assignments, I am happy to join the efforts to advance nursing worldwide. I believe that health is a fundamental human right and with over 16 million of us working together, we can make changes for better health for all.


What are your areas of responsibility at ICN?


My primary responsibilities fall in the area of Professional Practice, one of the three pillars of ICN, along with Regulation and Socio-economic Welfare. So one of my roles is to interact with WHO on professional practice issues. At the moment I'm involved with ICN's preparations for the World Health Assembly (WHA). For example we're preparing documents to brief Chief Nursing Officers so that they will be aware of ICN priorities and can participate knowledgeably in policy discussions.


What are your particular goals in helping ICN to advance nursing worldwide?


I'm new in this position and still learning a great deal. I'm looking for the ways I can best contribute to advancing nurses in their work situation and nursing in health systems. I especially want to support nurses working in the field. I was one of them early in my career and I know how tough it is, even for those working in developed countries.

In order for a nurse to provide the highest possible level of patient care, certain things need to be in place – these include training, education, good working conditions, and policies and health systems that encourage them in achieving their best.

In my opinion, the most significant challenge facing our profession is the variation in the quality of nursing services, including not only patient care but also health promotion and prevention and the variety in practice. Nursing services are affected by education and training, working conditions and health policy, each of which is challenged by the economic crisis. To advance nursing worldwide, we need to work together to increase the level and quality of care everywhere. If nurses feel supported in their work by their NNA and ICN, and encouraged and proud of their profession, as they deserve to be, and if they believe that the everyday nursing services they provide contribute to better health for all, then I will feel satisfied.