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Listen to Nurses: Applause Is Not Enough

“Applause is nice but not enough,” says Karen Elouise Gijan Piga, a nurse supervisor in the Philippines. “What I need is legislation that umbrellas the safety, protection, and adequate compensation for all nurses.” 

When the global health community observed World Health Worker Week last month, the theme was “Listen to Health Workers.” And listen we did, through a month-long video testimonial campaign launched by Frontline Health Workers Coalition and Human Resources for Health in 2030 (HRH2030), in partnership with IntraHealth International, Chemonics, and Women in Global Health.

Throughout the campaign, the voices of nurses dominated—with nurses from around the world contributing their perspectives on what nurses really need to be safer, healthier, and better prepared to do their jobs.  

Ms. Piga, along with other nurses from seven countries and a variety of roles, frames her perspective with the words “applause is nice, but not enough,” a reference to when people clapped for health workers during their shift changes even before COVID-19 was declared a pandemic. These outbreaks of applause traveled—like the virus—from country to country as people, restricted or quarantined within their own homes, yearned to recognize health workers’ struggles and sacrifices in some tangible way.

Yet nurses—and all health care workers—need more than applause. They need to be supported by their supervisors, facility administrators, and governments. They need to be respected by patients and the communities they serve. They need to be protected and equipped. They need to be fairly compensated, trained, have opportunities to attain their desired career paths and goals, and be given a seat (and voice) at the table and in the venues where policies are discussed and become law.

Listen to Ching-Min Chen, a nursing professor at Taiwan’s National Cheng Kung University and the president of the Taiwanese Nurses Association, explain how governments can support nurses:

Ms. Chen’s argument that governments need to invest in nursing to ensure universal health coverage is backed by last year’s State of the World’s Nursing report, developed by the World Health Organization (WHO) in partnership with the International Council of Nurses and the global Nursing Now campaign, along with other partners such as Frontline Health Workers Coalition member Jhpiego.

The report shows countries need to enact strategies to train and deploy new nurses—and retain nurses and provide them with decent work, leadership opportunities, and fair pay—to address the shortage of 6 million nurses globally. And, as women make up 90% of the nursing workforce, countries should put in place gender-sensitive workforce policies like flexible working hours for nurses who are also in charge of childcare and other responsibilities outside of work. These policies need to be backed by financial resources to implement them, and nurses need to be given leadership roles throughout the policy-making process.  

Ms. Chen’s closing words underscore that nurses’ leadership competencies are clear. “We are degree-educated and highly competent professionals deserving fair pay and respect from society,” she says, and her call for respect and recognition is echoed in others’ testimonials, as seen in this one below. 

From Afghanistan, Head Nurse Shabana Halyen Qudart says she needs “equality, respect, and value. ”  

Mike Calipayan, a head nurse in the Philippines, focuses on the stresses brought upon by the pandemic, and how these challenges have surfaced other needs, including the need for mental health interventions for those who have been struggling to care for themselves, even while caring for others.

We are calling attention to all these needs. CORE Group Executive Director Lisa Hilmi, a nurse in the US, reminds us that this is the Year of Health and Care Workers, and millions of nurses are volunteering to provide COVID-19 care, or providing essential health services on the frontline, for free.

“I’m asking you to advocate to ministries of health, to ministries of finance, to donors, and to global leaders, to ensure that health and care workers are paid… to invest in health and care workers, long term.” As she reminds us, investments like these are investments in communities. They’re also investments in women, as women make up the majority of the nursing workforce and the global health workforce.

One year into the pandemic, a survey by ICN reported increased rates of nurses leaving the profession. Applause is not enough. To keep nurses engaged in their life-saving profession, we need to listen to what they really need. Our Frontline Health Workers Coalition has made policy recommendations to protect and support nurses and other health care providers as they respond to COVID-19, based on what we’ve heard from health workers and from our members who work closely with them. We're also asking the US government to fund a new USAID initative to strengthen health systems in low- and middle-income countries and ensure helath workers are adequately trained, equipped, supported, paid, & involved in decision-making.

As Philippe Kayibanda in Rwanda so elegantly says, we urge all government leaders to hear these voices. And act on them. Together, let’s protect and invest in nurses.