International Perspectives

Five global healthcare organisations commit to putting patients first

To support high quality patient care, five global healthcare organisations have signed a Consensus Framework for Ethical Collaboration between patients' organisations, healthcare professionals and the pharmaceutical industry. The framework is based on four overarching principles: put patients first; support ethical research and innovation; ensure independence and ethical conduct; and promote transparency and accountability.

The five supporting organisations are the International Council of Nurses (ICN), the International Alliance of Patients' Organizations (IAPO), the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the International Pharmaceutical Federation (FIP), and the World Medical Association (WMA). The framework is derived from the individual codes of ethical practice and health policy positions of the five organisations.

‘Core to the Consensus Framework is the transparency and accountability of our work’, said David Benton, ICN Chief Executive Officer. ‘By signing this document, each organisation commits to open, transparent and informed decision-making and action, resulting in clear accountability in our actions’.

As developed and developing economies strive to address pressing health challenges in a complex and fast-evolving healthcare environment, collaboration and trust between all partners is essential. The framework confirms the shared ethical principles of the organisations to the broader healthcare community.

‘More than ever, healthcare delivery requires multiple interactions between patients, healthcare professionals, industry and other stakeholders’, said Luc Besançon, FIP General Secretary and CEO. ‘All organisations signing this consensus framework have reaffirmed that putting patients first is of prime importance’.

Advancing medical knowledge and improving health depend on regular information-sharing interactions between all partners. While individual codes of practice govern the activities of the five supporting organisations, this broad-based consensus framework includes interactions involving patients, nurses, pharmacists, doctors, and the healthcare industry.

‘Because navigating the healthcare system can be very challenging for patients, they need to trust that the care they receive is based on accurate information’, said Joanna Groves, IAPO Chief Executive Officer. ‘Following the principles outlined in this framework will help ensure high quality patient care’.

‘Heath care requires trust and confidence in what health professionals do for their patients. Providing care is a team effort nowadays and our cooperation has to be transparent, accountable and professional,’ said Otmar Kloiber, WMA Secretary General. ‘However caring and ethics are not enough: medicine needs scientific research to develop and to provide honest defensible answers to many open questions in healing diseases and protecting our health. Making the cooperation possible for ethical research and innovation is one of the aims of the consensus framework’.

The Consensus Framework for Ethical Collaboration between Patients' Organizations, Healthcare Professionals and the Pharmaceutical Industry is accessible at The codes of practice for each supporting organisation are available on their respective websites.

Degree educated nurses reduce hospital deaths

A better-educated nursing workforce reduces unnecessary deaths, according to a European study published in Lancet. With data from more than 420 000 patients in 300 hospitals across nine European countries, the study found that a 10% increase in the proportion of nurses holding a bachelor degree is associated with a seven percent decrease in the risk of death.

The study, led by Professor Linda Aiken from the University of Pennsylvania School of Nursing, USA, also revealed that every extra patient added to a nurse's workload increases by seven percent the chance of surgical patients dying within 30 days of admission.

‘This study consolidates the growing quantity of proof from different regions of the world and confirms what nurses already know: quality nursing education and safe staffing levels have a direct impact on patient survival’, stated Judith Shamian, President of the International Council of Nurses (ICN). ‘While this study was carried out in Europe, the lessons learned are similar to findings from other countries and applicable in all countries and all settings. ICN calls on all nursing associations to use this study to gain the support of their citizens and to collectively lobby their governments to ensure that well-qualified, well-cared for nursing staff are available in sufficient numbers’.

Patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients, had almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients.

‘Our evidence demonstrates that it is not only quantity but the quality of the workforce that counts’, said Professor Anne Marie Rafferty from the Florence Nightingale School of Nursing and Midwifery, King's College London, and the lead investigator for England. ‘Hospitals should take notice because when budgets are tight, cutting back nurses is often the first step, but the study has shown that this can have disastrous consequences for patients’.

The full article is available at:

Addressing the crisis of TB and mining in Southern Africa: a conversation with Benedict Xaba, RN

Benedict Xaba, the former Honourable Minister of Health for Swaziland and a nurse by profession, is serving as a Special Envoy for The World Bank on TB and Mining for the Southern African Development Community (SADC) region. He spoke with ICN News Editor Jan Harrington about his work to engage the public and private sectors in innovative partnerships to address the health and socio-economic impact of tuberculosis (TB) in Southern Africa, and why it is critical for nurses to influence global policy.


What is the link between the mining industry and TB?

Mr Xaba:

The Southern African region has the highest rate of TB infection in the world, and people who work in mines have three times the risk of TB infection as the general public. The mining sector also has a high level of HIV infection. For example, in Swaziland, 80% of the people with tuberculosis are also living with HIV. Many of the miners do not receive adequate healthcare.

TB and mining is a regional issue because mine workers cross borders. We need a system to track all miners and ex-miners, and to follow them home since they can infect their wives and families, and communities. We need a coordinated effort to provide good clinical care for those who get sick wherever they are. In 2010, when I was the Minister of Health in Swaziland, I started championing this issue together with the Ministers of Health in South Africa and Lesotho. One country can't solve the challenge alone. All involved countries need to come together in partnership.


What are your responsibilities in your new position as a Special Envoy for The World Bank on TB and Mining for the Southern African Development Community (SADC) region? Have you identified priorities and challenges?

Mr Xaba:

My major responsibility is to build high-level regional political commitment so that this issue receives the crucial attention it needs. A solution won't happen without governments getting involved. I work to engage high-level politicians on the issue of TB and mining in the SADC region, and to ensure that they show strong leadership and country ownership of initiatives. I meet with the Ministers of Health, and also the Ministers responsible for Finance, Labour and Mining. My priority now is the four countries – Lesotho, Mozambique, South Africa and Swaziland – which account for roughly 40 per cent of the mining industry in the region. If we can engage them, we will be able to engage the remaining countries. The World Bank and the Global Fund convened a special summit in South Africa in late March, led by the Vice President of South Africa, so that SADC countries could come together and discuss how to meet the TB challenge jointly.

I work to create political will and momentum, as well as a strong link between the public sector and the private sector including: government officials, mining companies, workers' organizations, civil society and development partners. We must develop an original approach and a joint effort to provide health services to miners and to reduce infection rates.


A worker tends to the healing garden at the ICN Wellness Centre in Manzini, Swaziland. Opened in 2007, the Centre provides health and support services to health care workers and their families. ICN Wellness Centres exist in six Sub-Saharan countries where rates of TB and HIV are a serious problem. The Wellness Centres have proven to be a cost-effective intervention addressing the severe health worker crisis existing in much of Africa.

One of the main challenges for this initiative is that the issue is very complex, involving many stakeholders. The mining sector is of crucial economic importance to SADC and the driver of development in our region. TB has a significant impact on the economic development of countries engaged in the mining industry, including the communities that send workers to the mines. So a health concern is also a pressing economic regional issue. It is a challenge to bring together different countries with different backgrounds and different health systems. The migration of miners is another complicating factor.


As a nurse, what special qualities do you bring to this role?

Mr Xaba:

Nurses have the quality of being hands-on. I bring practical experience to this regional initiative, not just a theoretical perspective. I worked for a long time in the nursing profession, and was in contact with patients with TB and people coming from the mines, and understand first-hand the challenges of delivering care in rural areas. This gives me a special edge and confidence.

I am the son of a mine worker, and I have lost relatives to TB associated with mining. I draw on this background for discussions with high-level politicians and policy-makers.


It has been shown that a strong nursing profession fundamentally enhances a nation's prosperity. What do you see as nursing's unique contribution to health care?

Mr Xaba:

The nursing profession is the cornerstone of the health system. Nurses are fundamental because they assume so many roles, including advocacy and leadership. At same time, nurses are clinicians. They are the first contact and the end contact with the client or patient. Nurses are crucial because they're always there with clients affected by TB.


Based on your experience as a Minister of Health, what do you believe can be done at the policy level to help assure that countries have the number of nurses needed and that they are able to work at their full capability?

Mr Xaba:

Governments need to develop a key strategic plan that addresses relevant issues for human resources for health and for nurses. Countries need to create an enabling environment and policies that allow nurses to function effectively, and to keep them in our region. Nurses work under difficult conditions. They often contract the diseases of the people they treat. It is critical to motivate them, for example, by providing incentives such as risk and hardship allowances. We need to provide the tools and equipment needed by nurses both in urban hospitals and rural settings. Nurses in our region don't have the tools they need, meaning they can't always apply knowledge learned at school.

We need to engage the Ministers of Finance and of Public Service and help them understand the nursing profession, as well as the contribution it can make. In Africa, I think we need collaboration and cooperation so that we enable nurses to do their best and end the brain drain. It is critical to develop more nurses. Developed countries that benefit from nurses trained in Africa must support African nations in training nurses, for example, with scholarships. Nurses in SADC are struggling and governments are struggling. We need the support of developed countries to produce more nurses.


What impact is the TB crisis in the sub-Saharan region having on healthcare workers?

Mr Xaba:

The TB crisis, and co-infection rates with HIV, has an extremely negative impact. As a consequence, our region will not be able to reach the MDG targets of a 50 per cent decline in TB mortality by next year. This affects staff morale and productivity, and is demotivating for nurses and health workers, and the communities they work in. The economies of Africa need an adequate and healthy workforce if they are to develop. We need to strengthen Southern Africa to achieve our goals and help the global health initiative.


Since 2005, ICN has worked with its member national nurses associations and other partners to develop nursing capacity in countries where TB and MDR-TB represent a high burden of disease. The innovative ICN TB/MDR-TB Project is improving the quality of patient care and helping to reduce the impact of TB and the emergence of drug-resistance. How do you see nursing's role in helping to solve the TB crisis facing the world today?

Mr Xaba:

Nurses are in the forefront of TB management. Nurses provide prevention services and treatment, as well as making sure patients adhere to treatment so they don't progress to MDR-TB. Prevention is critical. Nurses in Africa multi-task and do a lot of work which is supposed to be done by doctors. You can't find a doctor in most rural areas. It is crucial that we have the required numbers of qualified nurses. Much more investment is needed in the nursing profession.


As the Minister of Health for Swaziland, you supported the ICN Wellness Centre for Health Care Workers and their families, which opened in Manzini, the country's largest urban area, in 2007. How do you view the contribution of the Wellness Centre to maintaining a healthy and motivated workforce?

Mr Xaba:

The ICN Wellness Centre in Swaziland has indeed become a model for other countries in Africa. Its focus on the development and delivery of health care services for healthcare workers and their families is unique. Many nurses are infected with TB and HIV, often from helping clients, and suffer from the stigma attached to it. Nurses can get angry, and say, ‘I've been helping a TB patient and now I have TB’. The ICN Wellness Centres – I understand there are now six in Sub-Saharan countries where rates of TB and HIV are a serious problem – give comfort, assurance and motivation. The centres are special facilities where health workers know they and their families will be welcomed and treated with understanding. The ICN Wellness Centres help with morale and encourage nurses to continue working in difficult times and conditions.


You have had an interesting career path. What factors contributed to your involvement in political office and policy leadership?

Mr Xaba:

I started at the grass roots level, first becoming active in policy and leadership during my university days. As a vice president in a student association, I got involved with nursing issues such as poor working conditions. Following graduation, I went to work in rural areas where life and conditions were very difficult, and it was tough for patients to access health services. I began to understand the challenges faced by nurses and other health workers, as well as patients.

As an example, it frustrated me that I'd test rural clients for HIV and realise that my clients couldn't access services because they were centralized in urban areas. So I cofounded a non-governmental organization active with HIV and worked to decentralize services. I'm proud and happy to say that, after five years, we achieved universal coverage in Swaziland for antiviral drugs. The country's rate of mother to child transmission is now less than two per cent.


Do you believe it would make a difference to have more nurses at the policy table?

Mr Xaba:

Absolutely. I'd be happy to see more nurses involved in policy-making and politics. Nurses do their best because they don't want to let other nurses down. We think: ‘if I fail, it will be the failure of the whole nursing profession, and if I succeed, it will be not only my success but the success of nurses everywhere’. When I was the Minister of Health in Swaziland, nurses were always supportive. And they still are. I'm an alternate board member for Eastern and Southern Africa for the Global Fund. Nurses admire my leadership and that motivates me to work even harder. It's encouraging to see a nurse involved at the highest levels and at global levels.

I encourage nurses in all countries to get involved in policy work because we have hands-on experience and understand what works. Nurses are advocates and leaders, and we have so many qualities and so much knowledge to share. Our populations need us at the policy table at the country, regional and global levels.

Nurses fight tuberculosis

Mobilising the nursing workforce is critical to the global scale-up of prevention, care and treatment of all forms of tuberculosis. With support from Lilly, ICN has implemented a nurse TB training programme in countries where TB poses a serious public health threat. The programme has facilitated the training of more than 18 000 nurses and allied health workers in TB endemic countries.

Experienced nurses, working mainly in the TB and HIV field, are trained to cascade information to nursing colleagues and other health workers with the goal of improving the delivery of patient care. The practice-oriented nature of the training programme enables nurses to improve the implementation of policies and guidelines relating to TB and MDR-TB using a patient-centred approach.

Now in its third phase, the project also involves gathering and publishing evidence to demonstrate how patient outcomes can be improved through investment in nursing interventions. ICN is committed to establishing a strong evidence base to support best practice for quality patient care, to strengthen health systems and to save lives.

A United Way Worldwide grant made possible by the Lilly Foundation on behalf of the Lilly MDR-TB Partnership supports the ICN TB Project.

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

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'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.

New informatics resource available for nurses

An equivalency table for the International Classification for Nursing Practice (ICNP®) concepts and SNOMED CT concepts has been developed thanks to a partnership between the International Council of Nurses (ICN) and the International Health Terminology Standards Development Organisation (IHTSDO). The table contains ICNP Diagnosis and Outcomes Statements that have semantic equivalencies with SNOMED CT concepts.

‘This equivalency table between ICNP and SNOMED CT is a tangible demonstration of how collaboration among standards development organisations can contribute to improved and standardized documentation of healthcare delivery’, stated David Benton, ICN CEO. ‘Greater standardization supports the larger goal of interoperability of systems as well as better understanding of the contributions that each discipline makes to health outcomes and the effective and efficient use of health resources’.

ICNP is an international standard that enables the description and comparison of nursing practice locally, regionally, nationally and internationally. The ICNP terminology facilitates representation of the domain of nursing practice worldwide to promote evidenced-based quality care. ICNP provides nurses with content solutions for electronic health records (EHRs) at all levels to support data-based information for use in practice, administration, education and research. SNOMED CT, a multidisciplinary international healthcare terminology, is designed to support the entry and retrieval of clinical concepts in EHRs and the safe, accurate, and effective exchange of health information.

Jane Millar, Head of Collaboration at IHTSDO, commented that: ‘The IHTSDO is pleased to see this work being made available to users internationally and hopes that there will be feedback on its usage over time in supporting the care of individuals on a multidisciplinary basis. Continued collaboration with ICN is important to the IHTSDO going forward, providing a key link to the nursing profession internationally’.

This new product advances the collaboration on terminology development agreed between ICN and IHTSDO in their 2010 harmonization agreement. It allows ICN to make the equivalency table available through its website at the ICNP Download page ( Although this table is not formally endorsed by IHTSDO, persons interested in using it should review the terms of the SNOMED CT Affiliate License before downloading (

The product can be a useful resource to nurses and healthcare facilities interested in using SNOMED CT for documentation in EHRs, and using ICNP to help identify clinically relevant content for use in documentation of nursing care.

ICN also has released an additional product, the ICNP Technical Implementation Guide, to support ICNP users, from vendors to nurses, in care delivery settings. When used alongside documentation available on the IHTSDO website (, the Implementation Guide is of particular use to those who choose to access and use the ICNP-SNOMED CT Equivalency Table. The Guide gives details about applications that use ICNP, approaches to implementation, structure and content of ICNP, and technical overview. The ICNP Implementation Guide is available on the ICN website (

New project helps nurses improve their own wellness


The online health and wellness centre,, now offers new resources to assist nurses in strengthening their own health and wellness, as well as resources to address non-communicable diseases (NCDs) and healthy ageing.

Nurses who invest in their own health act as important role models for their patients and communities. They are also well prepared to respond to the burdens of today's demanding health care environments. The web-based resource centre ( is an initiative to mobilise and equip nurses to help address the global NCD crisis. It is the result of collaboration between the International Council of Nurses (ICN), its member national nursing associations and Pfizer Inc.

‘We encourage nurses worldwide to act as role models, educators and advocates of healthier lifestyles to help maximise wellness and prevent the risk of heart disease, stroke, diabetes and other non-communicable diseases’, stated David Benton, ICN Chief Executive Officer.

NCDs, most notably diabetes, cardiovascular diseases, some cancers and chronic respiratory diseases, are the leading cause of mortality in the world. These diseases represent 63% of deaths annually, 25% of which are premature. Yet NCDs are largely preventable. Effective interventions target the main risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol.

The Grow Your Wellness platform offers wellness tools, such as tips for stress management and how to fit exercise into daily routines, as well as strategies and policies regarding workplace health. It also calls for immunisation for adult and work-related preventable diseases, such as influenza, hepatitis A and B, tetanus and pneumonia. Visitors to the website will discover many ways for nurses to continuously improve their own wellness and lead their communities to better health.

The Grow Your Wellness resource centre provides a variety of practical and easy to use educational, assessment, intervention and advocacy resources to support nurses and their patients in efforts to prevent NCDs.

ICN and its partners welcome nurses' ideas regarding features they would like to see offered at Please send suggestions and questions to

Submit abstracts online for ICN 2015 Conference in Seoul, Republic of Korea


Nurses and other health care professionals are invited to share their ideas, research and expertise by submitting abstracts for the International Council of Nurses (ICN) Conference in Seoul, Republic of Korea. The Conference, to take place from 19–23 June 2015, will focus on the theme, Global Citizen, Global Nursing.

Abstracts can be submitted online at:

As the world's largest international nursing event, this gathering of thousands of nurses will explore the importance of cross-cultural understanding and global cooperation in nursing. It will provide opportunities for nurses to build relationships and to disseminate nursing knowledge and leadership across specialties, cultures and countries. The three ICN pillars – professional practice, regulation and socio-economic welfare – will frame the scientific programme and the dynamic exchange of experiences and expertise.

Abstracts may be submitted for a concurrent session, a symposium or a poster. The working languages of the conference are English, Spanish and French. Factors that will be considered during selection are: interest to an international audience; relevance to both the conference theme and one abstract sub-theme; scientific and/or professional merit; contribution to knowledge, practice, policies or programmes of nursing and/or health; and clarity of the abstract.

The abstract themes are:

  • Care systems, economics and coverage
  • Direct care and patient safety
  • Equity, ethics and human rights
  • Health promotion and disease prevention
  • Information and communication technology supporting global nursing and quality care
  • Leadership and management
  • Nursing education and learning
  • The nursing workforce, workplace and image
  • Disasters, conflicts and pandemics
  • Regulation
  • History.

The deadline for online submission of abstracts is 7 October 2014 (midnight GMT).

More details about the abstracts themes, instructions on abstract submission and key dates are available on the ICN Conference website:

New associate editors join nursing and health policy journal

Two well-known nurse educators and researchers, Dr Valerie Ehlers and Dr Pamela Mitchell, have joined the editorial staff of the International Nursing Review (INR) as Associate Editors. A quarterly, peer-reviewed publication, INR is the official journal of the International Council of Nurses (ICN) and focuses predominantly on nursing and health policy issues.

‘I am delighted to welcome Pamela and Valerie to the INR staff’, said Dr Sue Turale, INR Editor. ‘Coming from different backgrounds and experiences, they will bring fresh new ideas and perspective to the journal. They have significant scholarly and practice qualities, and are passionate about helping nurses and midwives to publish and share knowledge. They are a great addition to the team. Thanks go to our outgoing Associate Editor, Dr Je Kan Adler-Collins from Japan, especially for his work in helping novice writers to become published authors’.

Valerie Ehlers, a nurse educator and academic, has worked in the fields of community health, midwifery, orthopaedics and medical-surgical nursing. She is registered with the South African Nursing Council as a general nurse, midwife, psychiatric nurse and community health nurse. Dr Ehlers retired from the University of South Africa in December 2013.

‘It is a true honour to be part of the INR staff,’ she stated. ‘I look forward to continuing the growth and success of this well-respected journal’.

Dr Ehlers served on the editorial boards of two national and two international journals, and reviewed articles for various journals. From 2009 to 2013 she was the executive editor of the Africa Journal of Nursing & Midwifery (AJNM). She compiled documents that led to the AJNM's accreditation as an academic journal by South Africa's Department of Higher Education and Training.

She has published her work in numerous national and international journals and other publications, and has presented many conference papers and posters. She received the 2012 Women's Research Leadership Award from the University of South Africa. In 2011 the Forum of University Nursing Deans in South Africa appointed her to the Hall of Fame for Research Excellence in Nursing. Her degrees include a B Soc Sc (Nursing), Honours B Soc Sc (Psychology), BA Cur, Honours BA Cur, MA Cur and D Litt et Phil.

Pamela Mitchell is Professor of Bio-behavioral Nursing and Health Systems, and Adjunct Professor, Department of Health Services at the University of Washington in Seattle, Washington, USA. She is also the founding Director of the Center for Health Sciences Interprofessional Education and Research at the same university. A widely published researcher, Dr Mitchell was recently elected to the Washington State Academy of Sciences. Her research and teaching focus on hospital care delivery systems; effective management of clinical care systems; bio-behavioural interventions for patients with acute and chronic cardio-cerebrovascular disease; and outcomes of interprofessional education.

She received a BSN from the University of Washington, an MS with a focus on medical-surgical clinical specialisation from the University of California, San Francisco, and a PhD in Health Care Systems Ecology from the University of Washington.

‘I am pleased and honoured to be joining the INR editorial team’, commented Dr Mitchell. ‘It is a wonderful opportunity to be part of the growing global influence of nursing’.

With readers in in more than 130 countries, INR is a key resource for nurses worldwide and contributes to the ongoing development of nursing internationally. The journal is published both in hard copy and on-line. The editorial team welcomes the submission of original articles that help to forward ICN's global mission by representing nursing, advancing the profession and shaping health policy.

Nurses develop strategies at ICN Workforce Forum for Latin America

Nurse leaders from Central and Latin America discussed how to address socio-economic welfare issues in the region during the second ICN Latin American Workforce Forum convened in Havana, Cuba.

ICN organized the forum with the support of the Sociedad Cubana de Enfermería and in partnership with La Federación Panamericana de Profesionales de Enfermería (FEPPEN). Dr Judith Shamian, ICN President, and Lesley Bell, ICN Nurse Consultant for SEW affairs, participated in the forum.

Held in April, the forum provided a platform for an exchange of ideas and experiences related to the nursing workplace in the region, and a discussion of how to address current and future challenges. The forum is an evolving network of national nursing association (NNA) representatives in Latin America interested in work-life issues affecting nurses.

A panel discussion and a training session, facilitated by FEPPEN, focused on how to work together to develop human resources in nursing in Latin America.

With socio-economic welfare as one of its three pillars, ICN works for fair and equitable compensation and other work benefits for nurses. Over the past 24 years, ICN has organized workforce forums in collaboration with national nursing associations (NNAs). The goal is to stimulate thinking, enhance learning and ultimately assist in developing proactive strategies to address key challenges and issues. These include the impact of the economic downturn, universal health coverage and nurses' working conditions.

New resource assists those developing nursing regulation

A new toolkit to assist the development of effective regulatory frameworks and board governance structures is now available from the International Council of Nurses (ICN). Titled Regulatory Board Governance, it is the latest in ICN's regulation toolkit series.

Since its founding more than 100 years ago, ICN has held the position that regulation protects the public by assuring safe and competent nursing practice.

Regulation is extremely important in terms of the care and services that nurses deliver to the public and the way nurses practise. Because health and social systems are constantly changing, regulation and regulatory practices must evolve as well.

The process of setting up modern, effective, transparent and fair regulatory frameworks for health care professionals is continuous and dynamic. Good governance of the regulatory authority greatly contributes to the process. Effective, transparent and accountable Regulatory Board governance increases the confidence of the public, the nursing profession, employers, government and other stakeholders.

The new toolkit provides information, and promotes discussion and self-assessment for regulatory structures in all stages of development. It identifies and describes effective models of regulation and regulatory board governance, and also explores the core functions of a regulatory authority.

With regulation as one of its three key programme areas, ICN supports nursing regulation globally in numerous ways, for example, by facilitating networking and information sharing among regulators. ICN also organises the annual Credentialing and Regulators Forum, as well as the Observatory on Licensure and Regulation. The latter consists of a small cross-sectional group established to advise ICN on emerging and future trends in regulation, strategic initiatives to be undertaken, and policy stances to consider.

In addition ICN offers regulators the opportunity to participate in the annual Global Nursing Leadership Institute in Geneva and in the Leadership for Change Programme which has been implemented in 60 countries.

A series of ICN publications and other documents related to nursing education and regulation, including fact sheets, position statements, competency lists, and monographs, are available. Information on ICN regulatory publications can be found at ICN also provides toolkits addressing specific aspects of key importance to regulators, including:

  • Model Nursing Act
  • Trade Agreements and Mutual Resonation Agreements (MRAs)
  • Scope of Practice and Decision Making Framework
  • Complaints Management.

The Regulatory Board Governance toolkit can be downloaded free of charge at:

African nurses develop leadership skills at LIN workshop in Zambia

Twenty-four nurses gathered in Lusaka, Zambia to increase their potential to influence policy planning and become a strong voice for nurses in their respective countries. The five-day workshop was part of the Leadership in Negotiation (LIN) project offered by the International Council of Nurses (ICN).

Participating were four nurses from each of ICN's member national nursing associations (NNAs) in Ethiopia, Lesotho, Malawi, Swaziland, Uganda and Zambia. ICN sponsored the workshop, held in April, in conjunction with the Swedish Association of Health Professionals (Vårdförbundet). The International Trade Union Development Cooperation (LO-TCO) provided funding.

‘It is truly a remarkable experience to see these nurses come together and learn as much from each other as they do from the formal educational sessions. They are motivated to strengthen their leadership skills and enhance the functioning of their NNA’, said Lesley Bell, ICN Nurse Consultant for SEW affairs. ‘They recognize the need for negotiating skills in every aspect of their personal and professional lives, whether to improve relationships or positively influence their working conditions’.

The LIN project develops nurses' negotiation, communication, management and marketing skills. It supports their efforts to achieve better pay and working conditions, a safer work environment and greater patient safety, and to influence health and nursing legislation. Participants in the three-year programme attend a six-country workshop each year. In addition a second workshop will be held each year with a focus on two of the six countries in more depth and with more participants. When participants return to their workplaces, they implement a project related to either a professional issue or the growth and development of their NNA.

Nthabiseng Lebaka facilitated the workshop. She is the Director of Nursing Services with the Ministry of Health and Social Services in Lesotho, and a former president of the Lesotho Nurses Association.

More than 35 NNAs worldwide have adopted and implemented the LIN project. With donor support, the LIN project has reached nurses in Africa, Latin America, Asia, the Middle East, and the Caribbean.

Award opens the door to a rewarding career

In 1993 Dorcas Siafwa Phiri, a Zambian nurse, midwife and nurse educator, won the 3M International Fellowship Award given by the International Council of Nursing (ICN).1 Below she recounts her professional journey during the past 20 years and the impact of the award on her career.

I would not be where I am today if it were not for the ICN 3M Fellowship Award. I count myself lucky to have won the award as it has served as a stepping-stone to many of my achievements and has broadened my knowledge and skills, allowing me to perform at my current level of responsibility.

I qualified as a Registered Nurse in 1976 and as a midwife in 1978 at Ndola Central Hospital in Zambia. I then pursued a nurse educator's course at the University of Zambia (UNZA), graduating in 1981 with an advanced diploma. I spent seven years providing didactic and clinical mentoring for students pursuing a Registered Nursing (RN) diploma at Kitwe Nursing School. My next career step was to accept a position with the General Nursing Council (GNC) of Zambia, where I remained for 22 years.

In 1993 the Zambia Nursing Association (now the Zambia Union Nurses Organisation or ZUNO) nominated me for the ICN 3M Fellowship Award. I won in conjunction with a participant from Israel. The award enabled me to pursue an honour's degree in Health Services Management at the Royal College of Nursing in the United Kingdom. I completed the degree with a merit in 1997. Although I was tempted to stay on and work in the UK, I returned to my country because of family obligations.

In 2001, I enrolled in a Masters in Public Health (MPH) programme at UNZA, and graduated in 2003. The GNC promoted me to Training Coordinator and later to Standards and Compliance Manager. In the latter position, I was involved with the accreditation of nursing schools and health facilities; staff development training; curriculum reviews and development of nursing and midwifery programmes. The major curriculum reviews included the inclusion and strengthening of HIV/AIDS components in nursing programmes.

When I left the GNC in 2008, I wanted to find a job in an institution that dealt with HIV/AIDS care. This desire arose from my own experience of losing several immediate family members. Their deaths resulted in my being responsible for 10 orphaned and vulnerable children, most of whom had lost both parents. I also cared for my own four children.

I joined my current employer, the Maryland Global Initiative Cooperation (MGIC) Zambia, an affiliate of the University of Maryland School of Medicine in the USA, in the capacity of Senior Nurse and Community-Based Treatment Services Technical Advisor. MGIC Zambia, a member of a consortium under the AIDS Relief project, assists Zambian health care institutions to provide quality HIV/AIDS prevention, care and support, and treatment services. At MGIC Zambia, I helped develop the HIV Nurse Practitioner programme curriculum. I work with nurse educators as well as Community-Based Treatment Supporters who mentor nurses caring for HIV clients. I also represent MGIC on a number of national technical working groups related to nursing affairs.


Dorcas Siafwa Phiri, RN, MPH teaches community health workers how to give a bed bath at Our Lady's Hospital in Mpika, a rural district in Zambia.

Over my journey of twenty years, I experienced several challenges including: managing my family while I studied overseas; adapting to the European culture with my background of coming from an under-developed country without advanced technology; and balancing my roles as a student, wife and mother whilst pursuing an MPH. I had to cope with the loss of loved ones to HIV/AIDS, and assimilate orphaned children into my home. Financial resources, which had been adequate for my nuclear family, were depleted by the additional burden. Today I still deal with the financial challenge since most of the orphans are now in college.

Thanks to the support of the 3M Fellowship Award, I acquired knowledge and leadership skills, which I have used in each of my positions. I urge nurses who win awards to put the support to good use and to stand out as role models in their countries of origin.


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    The ICN 3M Scholarship Award was offered by ICN and the Minnesota Mining and Manufacturing Company between 1970 and 1995. With assistance from the award, 58 nurses obtained Doctoral, Master's and Baccalaureate/Post Basic Certificate/Diploma degrees. The award is no longer available.