Tuesday, 12 May 2015

Nurses: a force for change

Hester C. Klopper
President: Sigma Theta Tau International

Hester Klopper

In South Africa, my home country, we often say the only constant is change. In looking at the ICN’s theme for International Nurses Day 2015, Nurses a force for change, it seems that the sentiment of constant change is shared across the world. We have seen numerous changes in disease patterns over the past few decades. The non-communicable disease burden is heavier in low and middle income countries, and in several developing countries the quadruple burden of disease adds pressure to the already overloaded health systems. Changes in the healthcare environment seem to be daily with an increased focus on disease prevention and health promotion. Nurses as the largest group of health care professionals, are often the closest and most available to attend to patients, families and communities. Recently on a website I saw such a relevant quote: ‘A nurse is one who opens the eyes of a new-born and gently closes the eyes of a dying man, It is indeed a high blessing to be first and last to witness the beginning and end of life’ (www.nursebuff.com). Nurses are indeed the force for change. With the worldwide notion of providing equitable and accessible health care to all populations, nurses are playing the most critical role. Evidence indicated that the better qualified the nurse, the better the patient outcomes (Aiken et al. 2011). And results of our recent research studies indicate the better the quality of care a nurse provides, the more job satisfaction is experienced (Klopper et al. 2012, Coetzee et al. 2013).

With 19 million nurses globally we can indeed be the force for change. Change agent means the person who helps or facilitates in bringing about positive change. So how can nurses bring the change for the future? There are many ways we can bring about change, but let me focus on what I believe are the three most significant changes to be considered. First and foremost, if we want to bring about change we need to see the bigger picture … bigger in terms of the global and regional context (not just a focus on the local); seeing that nursing is part of the bigger system of healthcare, and therefore not just the focus on nursing, but the role nurses play in the healthcare system. Seeing the bigger picture will enable nurses to play a significant role in policy formulation, such as influencing the Post-2015 UN health agenda. Secondly, a change in the global workforce is needed. If we want to sustain a well-educated nursing workforce for the future, both the health and education systems need to take responsibility and collaborate. Proper workforce planning, in terms of competence, level (degree entry), skill mix and numbers are essential and needs a sound basis for planning. This will furthermore allow for more nurse-led care and advanced nurse roles, both associated with positive changes in the health care delivery system. A further aspect is to get the workforce to being productive. A productive workforce results in lower number of professional needed. This brings us to the third aspect in need of change – the work environment. The utmost importance of a positive work environment can no longer be underestimated. Adding more nurses to a toxic work environment will have no effect, opposed to adding nurses to a positive work environment that result in great benefits for the health care system. Important elements linked to the practice environment are good leadership, managerial support, respectable relationships amongst all members of the healthcare team but especially good relationships with doctors, nurses taking control over their own practice, and adequate resources – both human and equipment (Lake, et al, 2002). ‘ In concrete terms, this refers to adequate staffing and resources necessary to provide safe and timely patient care; and collaboration between nurses and physicians is critical for optimizing patient care’ (Jarrin et al. 2014).

As we celebrate International Nurses Day this month, I salute all the nurses of the world, be the change agents and continue to make a difference!


Aiken, L.H., Sloane, D.M., Clarke, S., Poshosyan, L., Cho, E, You, L., Finlayson, M., Kanai-Pak, M. Aungsuroch, Y. (2011). Importance of work environments on hospital outcomes in 9 countries. International Journal of Quality in Health Care, 23, 357-364.

Coetzee, S.K., Klopper, H.C., Ellis, S.M, Aiken, L.H. (2013). A tale of two systems—Nurse practice environment, wellbeing, perceived quality of care and patient safety in private and public hospitals in South Africa—A questionnaire survey. International Journal of Nursing Studies, 50, 162-173.

Jarrín, O., Flynn, L., Lake, E.T., Aiken, L.H. (2014). Home Health Agency Work Environments and Hospitalizations. Medical Care. 52: 877–883.

Klopper, HC; Coetzee, SK; Pretorius, R and Bester, P. (2012) Practice environment, job satisfaction, intention to leave and burnout of critical care nurses in South Africa. Journal of Nursing Management, 20:5 685-95.

Lake, E.T. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing & Health, 25, 176-188.

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