Yesterday I represented NZNO at the ICN Congress in Barcelona, in a panel debate on “Globalisation: Its Impact on Nurses and our Associations”. I spoke alongside nurses from Malawi, Denmark, Rwanda and Canada.
Dealing with the impact of globalisation requires international coordination, as it’s too big for any one country to tackle on its own. Opening remarks by Howard Catton, Director of Nursing & Health Policy at ICN, take up the first seven minutes and are also well worth a watch.
Unfortunately, the video did not capture the Canadian speaker, or the wide-ranging questions and discussion from the conference floor. My speech notes are posted below.
Globalisation: Its Impact on Nurses and our Associations
ICN Congress Panel Debate, 29 May 2017
Kia ora, greetings. I am Grant Brookes, Co-president of the New Zealand Nurses Organisation.
I would like to thank Howard Catton and ICN for inviting to participate in this panel discussion on Globalisation. I would also like to greet my fellow panelists: Dorothy, Vibeke, Barbara and Andre.
Our organisation is a professional association and union which represents 48,000 nurses, midwives, students, kaimahi hauora and health workers on professional and employment related matters. NZNO is affiliated to ICN, the South Pacific Nurses Forum, Global Nurses United and the New Zealand Council of Trade Unions. NZNO embraces biculturalism, the partnership between the indigenous Māori peoples and the more recent settlers of European and other ancestries who have arriv
ed in the last two centuries.
In the words of the whakataukī, or ancient Māori proverb, we all in the canoe together.
Our association believes that globalisation will be felt by nurses and NNAs in seven main areas.
Workforce mobility- Immigration/migration/ recruitment practices
- Technology/telehealth
- Population displacement and climate change
- Workforce development and regulation
- Trade and investment agreements such as the Trans-Pacific Partnership Agreement
- Influence of ICN and member NNAs
Regarding workforce mobility:
- Health workforce shortages globally are predicted to continue
- Workforce mobility is set to continue
- Reliance in some countries on internationally qualified nurses (or IQNs) is likely to continue
If allowed to persist, health workforce shortages will increase inequities in access to healthcare, causing preventable illness, disability and death, and threatening public health, economic growth and development. These key points were highlighted by the High-Level Commission on Health Employment and Economic Growth in 2016.
For our association, our publication on Internationally Qualified Nurses and Immigration released this year notes that: “New Zealand has the highest dependence on migrant health professionals of any OECD country (Zurn & Dumont, 2008), and… very low retention of health professionals (Hawthorne, 2012; Ministry of Health, 2016a). [There is a] high percentage of churn among IQNs, both leaving the country and leaving the sector they were recruited for (Walker & Clendon, 2015).”
The next slide illustrates our association’s response.
Long-term planning for a sustainable nursing workforce should include a commitment to employment of new nurse graduates. In 2016, only 57 per cent of new graduates from New Zealand education institutes found work through the Advanced Choice of Employment scheme, according to the Ministry of Health.
Meaningful IQN retention strategies could include:
- Accessible and affordable competence assessment programmes
- Security of working visas (for example, freedom from revolving renewals)
- Supportive work environments (including safe clinical environments, equitable remuneration and freedom from xenophobia and racism)
Technology is the fastest growing enabler of health care delivery. Technology transcends borders and thus its impact on nurses, on nursing practice, and on associations is inevitable.
Technology allows for remote care (telehealth) and interdisciplinary clinical support, as well as knowledge transfer. It has been shown to enhance people’s access to health services.
The way in which consumers/patients use technology as an enabler for their own self care will also impact on nursing and influence future models of care.
Technology and telehealth will change the notion of place and presence. Consequently, nursing care may not be provided in the traditional way (face-to-face). It may be provided across national boundaries, which raises regulatory concerns.
To influence direction in New Zealand we have developed a Position statement: Nursing, Technology and Telehealth, published in 2016.
According to the High Level Commission on Health Employment and Economic Growth, the number of political conflicts globally has doubled over the last decade. The number of people displaced due to conflict has increased from 37 million to 60 million, mainly in middle income countries. Between 2008 and 2014, natural disasters displaced 184 million people.
Within conflict zones, healthcare workers and nurses might become deliberate targets.
Nurses and our associations will need to be more prepared, educated and trained to work with displaced populations and refugees, including providing nursing care in conflicts.
Regarding climate change, our association published a position statement in 2016. We have since divested our funds from fossil fuel companies. The communiqué of the 2016 South Pacific Nurses Forum, which we attended, identified population displacement as a result of climate change – along with migration, education and regulation – as key areas for attention. Our members frequently respond to disasters in the Pacific caused by extreme weather events.
The health crises caused by SARs, Ebola virus, MERS, Zika virus and yellow fever demonstrate the interconnectedness of global health and the inescapable impact on nurses and our associations.
To succeed in implementing the agenda for sustainable development through SDGs in poverty reduction, quality education, decent work inclusive economic growth and gender equality, we potentially will see a shift in workforce development away from narrow specialisation to broader and lifelong building of competencies.
Nursing workforce development, education and training will likely have a strong emphasis on early intervention, community based care, primary care, population health, public health promotion. This will be complemented by improvements in advanced nursing practice to improve access to health services.
Likewise, our associations are likely to change their focus to support a broader approach to workforce development but will continue to ensure that this results in decent jobs, working conditions and pay for health workers.
Globalisation requires NNAs to engage more in political commentary.
Some governments respond to globalisation by entering into trade and investment agreements like the Trans-Pacific Partnership Agreement (TPPA). These have a potential negative impact on economic inequality and other determinants of health and illness, on health policy, health funding and access to medicines. Nurses and our NNAs will need to promote inter-sectoral collaboration at local, regional, national, and international levels.
We have an election in New Zealand this year. Our political commentary will be based on our Election year manifesto (2017), which identifies 7 priorities for nursing and public health:
- Sustainable nursing workforce used to its full extent
- Investment in public health
- Primary care approach to improving population health
- Best start for children
- Safe clinical environments
- Fair employment
- Social & health equity in Aotearoa/NZ, Asia-Pacific region & globally
I will conclude by saying globalisation will require multi-level engagement to address the seven areas highlighted in this talk:
- Workforce mobility
- Immigration/migration/ recruitment practices
- Technology/telehealth
- Population displacement and climate changes
- Workforce development and regulation
- Trade and investment agreements such as the Trans-Pacific Partnership Agreement
Nurses and our associations will need to be adept at managing the impact of globalisation.
As the High-Level Commission on Health Employment and Economic Growth stated: “No single agency and no single sector can implement the changes required to achieve a fit for purpose health workforce in the context of persistently high unemployment and underemployment in many countries, and amid the major demographic, technological and socioeconomic changes occurring across all countries. Political will, leadership, inter-sectoral action and international partnerships will be critical to success”
Thank you
Your Choice. Your Voice | Grant Brookes for NZNO President 