International Nurses Day: resilience in the health system

April 2016 Vol 16 (2)

To be a force for change nurses need to be part of a resilient health system. The sub-theme for this year’s International Nurses Day (IND) on 12 May is ‘Improving health systems’ resilience’. Nursing Review looks at the IND kit* on the theme and the tragic consequences when systems fail.


The Ebola outbreak in West Africa in 2014 is a tragic illustration of what can go wrong when a health system is not strong enough to respond rapidly and effectively in an epidemic.

The World Health Organization (WHO) reports that when the outbreak hit, the most affected countries had a fragile health system with insufficient numbers of healthcare workers, many of whom died.

“In fact, a May 2015 preliminary report by WHO (2015c) on health workers infected with Ebola, stated that of the 815 healthcare workers who had been infected by the Ebola virus since the onset of the epidemic, more than 50 per cent were nurses and nurse aides,” reports the International Council of Nurses (ICN) in its International Nurses Day (IND) kit for 2016. It also adds the grim statistic that two-thirds of the health workers infected with Ebola died.

In an article for the British Medical Journal last year, James Campbell, the executive director of the Global Health Workforce Alliance, and colleagues gave the following definition of resilience:

“The resilience of a health system is its capacity to respond, adapt, and strengthen when exposed to a shock, such as a disease outbreak, natural disaster, or conflict.”

In the opening letter of the IND kit, the ICN president Judith Shamian and chief executive Frances Hughes acknowledge that nurses “may wonder” how they can help strengthen health systems around the world.

“As members of the single largest group of health professionals, with a presence in all settings, nurses can make an enormous impact on the resilience of health systems,” they say. “Every decision that you make in your practice can make a significant difference in the efficiency and effectiveness of the entire system.” They go on to add that it is imperative that nurses identify opportunities in their organisations, and themselves, to strengthen and develop resilience.

Shamian, in an article published last year, listed nine ways that nurses can make an essential contribution to discussions on health systems and health workforce strengthening:

  • Lead and support interprofessional education (IPE) and interprofessional collaborative practice (IPCP)
  • Advocate for a paradigm and operational shift in health care that balances illness-focused care with population health
  • Identify and champion global and national strategies to address health workforce maldistribution and migration
  • Strengthen and diversify primary health care
  • Ensure a strong nursing voice in all health and social system policy development and planning dialogues
  • Consider the influence of regulation and legislation on the health system and health worker resource planning issues
  • Design and improve information infrastructures and data collection to support health system redesign and planning 
  • Participate in research related to health worker resources and in health systems research and evaluation 
  • Consider the influence of complex, ubiquitous social and gender issues, such as the determinants of health, and inequality and inequity.

The IND kit concludes by saying that providing quality health care services to all people in need is the ethical and professional responsibility of nurses. “As committed, innovative and solution-oriented professionals, nurses continue to provide care with resilience and versatility, even with little or no resources or organisational support,” it says.

However, improving health systems’ resilience requires a collaborative effort for all involved in healthcare services and ICN calls for nurses to play an integral role in leading change.

“With redesigned health systems and full participation of nurses in policy, we will be better equipped to provide quality care for all, even in times of difficulties.” ✚

*Source: IND 2016 kit, International Council of Nurses:


Resilience in action

A nurse in El Salvador, distressed by how many patients she was seeing with Dengue fever in her remote and rural clinic, took action. Knowing she needed evidence to get the support of her local manager, she went to books and the internet and used her records to create a map of cases that identified the locations and magnitude of the problem and highlighted the worsening problem.
She presented the information and suggested the clinic should develop targeted health information sessions for the most affected local groups. Progress in fighting Dengue fever was dramatic and the nurse became part of the local management team supporting the development of similar programmes. (Source: IND Kit 2016)


Fast facts: International Nurses Day

The marking of Florence Nightingale’s birthday on 12 May as International Nurses Day (IND) was initiated in 1965 by the International Council of Nurses (ICN).
Geneva-based ICN was founded in 1899 and is a federation of more than 130 national nurses associations, including the New Zealand Nurses Organisation, representing more than 16 million nurses. The ICN is now led by a New Zealander – former New Zealand and Queensland chief nurse Dr Frances Hughes – who took up the chief executive post in February.

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