Professor Julia Downing

Chief Executive International Children’s Palliative Care Network and Chair of the Policy and Advocacy Committee for the International Society of Nurses in Cancer Care.

As nurses, we are catalysts for change, and as the largest profession within the health service ⁽¹⁾ we should have a strong voice, we are trusted bridge builders, we collaborate with others and we promote good health and well-being for all. However, at times our voice is not heard, we do not have ‘seats at the right tables’, and we are not able to impact policy, health service delivery, education and care. In order to strengthen our voice, and speak as one, we need to be involved in developing and impacting policy, at all levels and in all areas.

As a newly qualified staff nurse, working in a cancer unit , I first got involved in policy decision making. Having completed my undergraduate dissertation on pain assessment and management, I was asked to review the documentation that we used in the cancer unit and to make recommendations for improvement. The review went well, the documentation was utilised throughout the hospital and the training programme was repeated on several occasions. At the time, I didn’t think that I was impacting policy – policy at the ward, unit and hospital levels, but I was.

In talking to nurses around the world, as I work to support the development of children’s palliative care, I have noticed a reticence to get involved in policy, a fear that they do not have the necessary skills, and that they won’t be listened to. I know that feeling, and on several occasions I have had doctors literally turn their backs on me because I was a nurse, despite being the most senior person in the room. Sadly, I have learnt when to state proudly that I am a nurse, and when to ‘hide’ behind the title of Professor, or Doctor. If asked I will always say that I am a nurse, however I have learnt to play ‘politics’, to use my status of a nurse when it is helpful, and not to emphasise it when not. Without realising it, I have developed the advocacy and leadership skills to influence and impact policy.

Recently, I was reminded of the statement by the International Council of Nurses (ICN) “Nursing and Health Policy is at the centre of what we do. Ensuring that nurses have a voice in the development and implementation of health policy is fundamental to ensuring these policies are effective and meet the real needs of patients, families and communities around the world.” ⁽²⁾ We need to make sure that we have a voice. At this present time, regardless of where we live, we are facing a time of inflation and uncertainty. The cost-of-living crisis is hitting us all, the covid pandemic is lingering on, unrest and war exist in too many countries, climate change is upon us, there are a range of humanitarian crisis, and inflation is set to increase. It is against this backdrop that we are trying to provide good nursing care, to strive towards Universal Health Coverage ⁽³⁾, to implementing the Declaration of Astana ⁽⁴⁾ and to achieve the Sustainable Development Goal of Health for All ⁽⁵⁾. Alongside these, for those of us working in palliative care, we are moving forward from the World Health Assembly Resolution in 2014 ⁽⁶⁾, the Lancet Commission Report on Alleviating the Access Abyss to Palliative Care and Pain Control ⁽⁷⁾ amongst others. Whatever field of nursing we are working in, we will be striving to improve the care that we give, yet the funds to do this are decreasing. We must be at the policy table, we must be there to state our cause, to fight our corner, to ensure that not only do we raise the voices of nurses around the world, but also to raise the voices of those that we care for.

I believe that each one of us has a role to play, whether it is influencing policy at the ward or organisational level, or at the national, regional or international levels. It might be contributing to the international policy statements, such as those developed by the Royal College of Nursing (RCN) ⁽⁸⁾ or other national nursing organisation, the ICN ⁽⁹⁾ or specialist organisations such as the International Society of Nurses in Cancer Care (ISNCC) ⁽¹⁰⁾ or the International Children’s Palliative Care Network (ICPCN) ⁽¹¹⁾. It might also be giving an intervention at the World Health Assembly on behalf of nurses – something that I had the privilege of doing recently.

As nurses, if we want to improve care, then we need to influence policy. I believe that each one of us as nurses can make a difference, we can and should have a voice in the development of health policy – policy at the ward, organisational, national, regional and international levels. Each one of us can make a difference and need to take any opportunities given to us to impact policy, to have a strong voice at the table. We might not feel comfortable or equipped, but as nurses, we need to step out of our comfort zone, to take that step, and to use our voice.

References

• World Health Organization. (2020) State of the world’s nursing 2020: Investing in education, jobs and leadership. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO
• International Council of Nurses (ICN). (2022) Nursing Policy, https://www.icn.ch/nursing-policy Accessed: 6^th December 2022.
• World Health Organization. (2021) Universal Health Coverage (UHC). https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc) Accessed: 6^th December 2022.
• World Health Organization and the UNICEF. Declaration of Astana. Geneva: WHO; 2018.
• (2022) What are the Sustainable Development Goals. https://www.undp.org/sustainable-development-goals Accessed: 6^th December 2022.
• World Health Organization. WHA67.19 strengthening of palliative care as a component of com- prehensive care throughout the life course. Geneva: WHO; 2014.
• Knaul FM, Farmer PE, Krakauer EL, De Lima L, Bhadelia A, Kwete XJ, Arreola-Ornelas H, Gómez-Dantés O, Rodriguez NM, Alleyne GAO, Connor SR, Hunter DJ, Lohman L, Radbruch L, del Rocío Sáenz Madrigal M, Atun R, Foley KM, Frenk J, Jamison DT, Rajagopal MR, on behalf of the Lancet Commission on Palliative Care and Pain Relief Study Group. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the lancet commission report. 2017;391(10128):1391–454.
• Royal College of Nurses (RCN). RCN position statements https://www.rcn.org.uk/About-us/Our-Influencing-work/Position-statements Accessed: 6^th December 2022
• International Council of Nurses (ICN). Position Statements, https://www.icn.ch/nursing-policy/position-statements Accessed: 6^th December 2022.
• International Society of Cancer Nurses (ISNCC) Position Statements https://isncc.org/Position-Statement Accessed: 6^th December 2022
• International Children’s Palliative Care Network (ICPCN), ICPCN Position Papers. https://www.icpcn.org/icpcn-policy-documents/ Accessed 6^th December 2022.