Nursing in the COVID-19 pandemic and beyond: protecting, saving, supporting and honouring nurses.

As the world tackles the largest public health event in more than a century, the COVID-19 pandemic, the true value of nursing is being seen by politicians and the public. But while nurses are being praised for the vital work they do, many are being put into high-risk situations, and some have died, because of a shortage of appropriate, high-quality personal protective equipment. The International Council of Nurses has called for governments to make the provision of such equipment their number one priority to prevent further loss of life among the nurses caring for the world's most vulnerable patients.

Everybody knew that a dangerous pandemic was possible, and the World Health Organization (WHO) and most countries had plans in place to deal with one. But it is now apparent that most countries were not sufficiently prepared. The flu pandemic of 1918 showed just how devastating it could be, but it seems few people actually expected it to happen again.

But over the past four months, we have seen the world rocked by the COVID‐19 pandemic, and all the plans for the celebration of the International Year of the Nurse and Midwife have been put on hold. Nobody could have foreseen the high‐profile nursing has right now, albeit for such a terrible reason.

Countries have gone into lockdown, and healthcare systems have come precariously close to meltdown as the pandemic circles the globe and threatens to overwhelm the capacity and capability of chronically underfunded health and social care systems.

COVID‐19 has revealed that, even in rich countries, long‐term under‐investment since the 2008 financial crash has taken its toll and left healthcare services with too few staff and insufficient resources and reserves. There is no doubt that this has made dealing with the current international public health emergency harder than it need have been.

Nurses have been heroic in their attempts to provide care and save lives. Many have worked long shifts for weeks on end without a day off. Many have faced the real possibility of contracting this dangerous infection themselves because of a lack of suitable personal protective equipment (PPE). And sadly, many have died.

Just as we could not have predicted what has happened in the past four months, nor could we have anticipated the shocking fact that our colleagues would be sick and even dying because of a lack of PPE.

Healthcare workers, many of them nurses, make up a large proportion of the people infected with the COVID‐19 virus, up to 15% in some countries. The serious lack of PPE puts them at risk and increases the risk of cross infection for patients, for health worker’s families and community members.

International Council of Nurses has called on world leaders of the G‐20 nations and others to combine their resources to make increasing the production and easing the distribution of this life‐saving equipment their utmost priority. At the time of writing, the confirmed number of nurses who have died worldwide exceeds 100, which is probably a gross underestimate (ICN 2020). If governments do not act immediately on this issue, it will be too late and, tragically, many more nurses will get sick and die.

It is also problematic that countries are not keeping accurate, up‐to‐date records of how many nurses have been infected nor of how many have died, and ICN has demanded that they start doing so as soon as possible. Having accurate data on this and other aspects of the pandemic will provide vital information that will help to improve infection prevention and control measures, shorten the pandemic’s duration and save nurses’ and patients’ lives.

There will come a time when we will want to honour the nurses who died while trying to save the lives of others: we must make sure that every nurse who succumbed to COVID‐19 is remembered. They must not be forgotten. And their legacy must be increased investment in healthcare systems and better pandemic preparedness so that nurses will never again have to give their lives just because they did their jobs.

Nursing leadership

ICN’s 130‐plus national nursing associations (NNAs) have provided leadership and support for nurses’ need in this time of crisis. They have been the voice of nursing in their countries, and many have had access to the top tables where policy is being made.

Nursing knowledge, experience and advice have been a crucial part of the strategy to contain the pandemic, and nursing practice has been fundamental to the care and survival of patients who have been most seriously affected by COVID‐19.

We must not forget the emotional labour of nursing at this time, nor the cost it can have on the mental well‐being of nurses who are seeing large numbers of their patients becoming desperately ill and dying. This is hard work physically and emotionally. It strikes at the heart of what nursing is, and what nurses and others do on the front line.

People involved in the care of these patients are suffering. It is important to ensure that they are getting enough rest and mental health support to see them through. With the right help, they can avoid the worst effects of the burden they are carrying, but they need that help now, not when this is all over.

And ‘when this is all over’ is something we all need to think and talk about now. Because we do not know when that will be, and we do not know what the world will be like.

Experts suggest that social distancing is likely to be around for a long time, certainly until mass vaccination programmes have been completed, and the ways people live, love, work, travel and socialize are likely to change too.

Whatever the eventual outcome of the COVID‐19 pandemic, nurses will continue to provide intimate care for people who need it, whoever and wherever they are. And nurses will continue to be the most trusted profession. Nurses have earned that trust over decades, and 2020 will cement our approval rating in the eyes of the general public for years to come.

Politicians who have praised nurses for their commitment and valour during the pandemic need to put money on the table to ensure that the world has more nurses that they are better paid, educated and resourced and that their voices are heard above the noise in the clamour for government resources. Nursing is critical to health and well‐being everywhere, but it also contributes to our economic prosperity: health and wealth are two sides of the same coin, something the public is now also aware of.

Politicians should not need reminding of this, but ICN and our NNAs will remind them anyway. WHO’s Director General Tedros Adhanom Ghebreyesus has said that countries that do not have enough nurses – and that is most of them – are trying to deliver health care with one hand tied behind their backs. As this pandemic has shown, that does not work.

The newly released State of the World’s Nursing report (WHO 2020), co‐authored by ICN, WHO and Nursing Now, reveals how many more nurses are needed to provide health care for all. I was privileged to co‐chair this report, and I believe that the strategic directions it sets out must be our roadmap for the future. Now is the time to invest in education, jobs and leadership. We, our world, cannot afford not to.

Governments must start planning now for a future with enough nurses, where every nursing post is filled, and the entire nursing workforce is better paid and truly valued for the vital services it provides.

Because the people will expect nothing less.