Global development opportunities for nursing practice


In developed countries, nursing as a profession is generally held in high esteem and is the profession of choice of many young people who want to care for sick people. In the United Kingdom (UK), the transformation of nursing into an academic discipline has enabled development of advanced practice and clinical-academic roles such as the Consultant Nurse and Nurse Practitioner. Nurse-led clinical care is now common, and care delivered by nurses is consistently found to be equally as effective as care provided by doctors (Laurant et al. 2004). Patients have also reported high levels of satisfaction with nurse-led clinical care.

The World Health Organisation (WHO) is now capitalising on advances in nursing practice as an opportunity to transform access to healthcare in developing countries. The GREAT Project initiative, for example, is focussing on how best to facilitate and utilise the potential of nurses and other health workers by optimising and raising the profile of their clinical roles in developing healthcare contexts (GREAT Project 2010). It is intended that improving access to, and delivery of, clinical care can be achieved by ‘taskshifting’ (or sharing) care from doctors to appropriately prepared nurses and other health workers to attain Millennium Development Goals to reduce child mortality and improve maternal health.

In contrast to the professional status afforded to nursing in developed countries, in developing county contexts nursing is frequently perceived as low-status work, and specifically where there is a negative perception of delivering hands on clinical care. One of the biggest challenges to achieving the ambition of high quality and safe nurse-led clinical care in developing countries will be to address widespread negative attitudinal barriers to delivering ‘nursing care’ in order to maximize opportunities for advancing nursing practice. The low status of clinical nursing in Pakistan and the desire to introduce faculty practice is explored in a timely discussion paper by Premji et al. (2011) in this issue of the Journal of Advanced Nursing. The Pakistani healthcare system has a low nurse to patient ratio, is overcrowded and under resourced and holds the profession of nursing in low regard. As a result Premji et al. report that nurses are reluctant to give direct patient care. Premji et al. (2011) present a fascinating case study of one private institution and describe their efforts to develop academic nursing practice locally with evidence-based principles of practice development and innovation. The case study institution is the only institution in Pakistan approved to deliver a Masters of Science in Nursing course. Because of a scarcity of Masters and Doctorally prepared faculty, Premji et al. report that the priority has been for new graduates to act as professional educators and not to care for patients.

The authors used an evidence-based approach to searching the literature and engaging local stakeholders in the practice development process. Having found a dissonance between different conceptual definitions in the literature and locally held beliefs, they developed their own shared conceptual clarity and definition of faculty practice with local stakeholders, from which shared opportunities for faculty practice could be developed and nurtured in a local context. Premji et al. (2011) are realistic in their assessment of the challenges to keep momentum going to build sustainable attitudinal change towards faculty practice and nursing care. Nonetheless, the case study institution has created a unique opportunity to lead the development of nursing as a profession in Pakistan, and will be in a unique position to fulfil the ambitions of initiatives such as the WHO GREAT ‘knowledge into action’ Project.

If implementation of nursing practice developments as envisaged by the GREAT project follows the UK experience, patients will value the care and services they receive from nurses, and the status of clinical hands on nursing will improve.