ICN: NZ voice at International Council of Nurses

1 December 2012

FIONA CASSIE catches up with International Council of Nurses director Marion Guy about her role on the 113-year-old federation of nursing organisation’s board and efforts to make ICN more sustainable.

With membership varying from 50 to 500,000, it is clear not all national nursing organisations are the same.

“The membership of ICN is so varied and so vast,” says International Council of Nurses board member Marion Guy. And so are the issues faced by nurses in sub-Saharan Africa – with one nurse or less per 1000 people compared to nations with nurse per capita ratios of ten times that and more.

Guy, a former president of the New Zealand Nurses Organisation, which is New Zealand’s member of ICN, was elected as Western Pacific representative on the board in 2009 – the fifth New Zealand board member ever in ICN’s century plus history (see sidebar for ICN background).

She says one of the issues facing the 15-member board, whose members are drawn from Sweden to Kenya and Canada to Colombia, is that the federation is not sustainable to carry on as it is. At present, the large national nursing associations (NNAs) in affluent nations like Japan and the United Kingdom are paying “huge fees” to ICN and Guy has been part of a teleconference group looking at developing a new “transformation, sustainability, and increased impact” model for ICN.

“One of the things we are looking at is introducing a contribution ceiling so no national organisation pays more than ten per cent of ICN’s total dues income,” says Guy. Another issue being looked at is whether dues for the Swiss-based ICN should continue to be collected in Swiss Francs.

Membership fees are currently roughly the equivalent of a cup of coffee per member (about NZ$3.50). “Which is not huge per member,” says Guy. But when an organisation has members in the hundreds of thousands it is a sizable sum on an organisation’s books.

Along with looking at fee costs, ICN was considering shrinking the number of board members from the current 15 that mostly meet by teleconference but do meet once a year face-to-face. She says ICN is already run on a shoestring staff but was looking at reducing costs by no longer translating all ICN documents into French and Spanish.

Guy is also a member of the ICN membership committee, which considers new countries’ applications to join ICN. The latest nation to join is India, bringing countries covered up to 134. However, China is still not a member.

As part of the sustainability discussion. ICN is considering allowing more than one association per country to join but that raises issues over voting rights for sometimes rival organisations. The final proposals on the new transformation and sustainability model will go to the national representative council at the ICN congress in Melbourne in 2013 (see sidebar).

ICN leading or supporting?

Guy believes ICN remains relevant to New Zealand nurses. “From New Zealand’s point of view, we’re one of the developed country members of ICN, yet I’ve heard many staff of NZNO and nurses themselves use ICN policies quite a lot in their work or for references.”

Personally, she is disappointed that New Zealand isn’t making the most of her time on the board and believes she could be used more as a conduit for sharing some of the good work that NZNO has done with the rest of the world and to be one of the leading nursing organisations globally.

“I think it’s been a lost opportunity … it’s a direct link to ICN. I just think globally, as nurses, we should be pulling together. ICN is there for the exchange of nursing information and to support NNAs to lead nursing in their country. It’s not there to do the leading but to support.”

NZNO last year wrote a critical submission on ICN’s 2011–14 strategic plan, expressing concern that ICN was wanting to do just that: lead rather than support NNAs.

Guy believes ICN, with its leadership and other programmes in developing nations, is supporting not directing NNAs, and that “on the whole”, NZNO were supportive of “most” of the strategic plan that emerged prior to the current review of ICN’s long-term financial sustainability. Apathy can also be an issue for organisations like ICN, with Guy’s attempts to get feedback on the sustainability process from her Western Pacific constituency initially only getting responses from Thailand, Japan, Australia, and Malaysia.

Global links

Hearing first-hand tales of relatives caring for family members in Taiwan hospitals because of nursing shortages and a Botswana hospital with one nurse for 70 patients has given Guy a new perspective on nursing issues.

“Wherever you go, nurses are struggling – that continual fight to get enough nurses to do the caring. Like us, they are training nurses but not using all their new grads. Nurses globally are going through similar situations and circumstances.”

ICN alone can’t fix the situation, says Guy, but can help lobby governments to increase the lot of nursing, support nursing organisations and nurses being unfairly treated, and be an agency for sharing what solutions have worked in other nations.

And Guy, now used to be in contact with nurses from Barbados to Ireland and Togo to Russia, will seek another four-year term on the ICN board next year in Melbourne.

About ICN

• The International Council of Nurses is a federation of more than 130 national nurses associations representing more than 13 million nurses worldwide.

•It was founded in 1899 and its physical base is in Geneva, Switzerland.

• ICN says its mission is to represent nursing internationally, advance the profession, and influence health policy worldwide.

• Its three main nursing and health focus areas are professional practice, regulation, and socio-economic welfare of nurses, and it runs related projects in developing countries.

• It has 58 position statements on issues from the protection of the title “nurse” and ethical nurse recruitment to shift work and the participation of nurses in executions.

• The New Zealand Nurses Organisation is a member of ICN and reported last year that its annual membership fee is approximately $120,000 a year.

NZNO concerns

NZNO made a critical submission last year on ICN’s draft strategic plan.

It expressed concern that the plan signalled a shift in direction from ICN supporting national nursing associations (NNA) to lead nursing in their home nations to ICN seeing itself as leading the very diverse international nursing community.

NZNO said ICN cannot be the “voice of nursing internationally” or ‘dictate’ what nursing is or should be in each country. Instead, it should ‘facilitate’, and ‘nurture’ the efforts of NNA in their own countries.

Melbourne ICN Congress 2013

The 25th Quadrennial Congress of ICN is being held in Melbourne 18-23 May 2013 with a theme of equity and access to health care and speakers drawn from across Asia, Europe, Africa, North America, and the Pacific. Presentation topics range from nurse migration, disasters, HIV/AIDs and tuberculosis through to changes in scopes of practice, eHealth, nursing history and ageing.