Though well into her final trimester, Kate Middleton hasn’t let the impending birth of her third child stop her from attending royal engagements. At the very end of February 2018, the Duchess of Cambridge visited the Royal College of Obstetricians and Gynaecologists (RCOG) and St. Thomas’s Hospital in London. While there, Kate Middleton ran into the midwife who helped deliver her daughter Princess Charlotte, Professor Jacqueline Dunkley-Bent, and the two shared a warm embrace.
But Middleton didn’t make the visit just to be reunited with her former midwife: She was there to become the second patron of the Royal College and to officially announce the Nursing Now 2020 campaign, which aims to raise the profile and status of nursing worldwide. As the name suggests, the three-year campaign is scheduled to last until 2020, the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing.
“This campaign means a lot to me personally. My great-grandmother and grandmother were both volunteer nurses,” Middleton said in a speech she gave the campaign launch. “They would have learned first-hand from working with the Voluntary Aid Detachment and the Red Cross about the care and compassion that sometimes only nurses can provide.”
Find out everything you need to know about the Nursing Now 2020 campaign below.
Critical Roles Played by Nurses
Nurses are the heart of most health care teams, caring for patients from their first breaths to their last, helping with everything from checking blood pressure to offering diagnoses to administering shots and painkillers. “Nurses are always there. You care for us from the earliest years. You look after us in our happiest and saddest times. And for many, you look after us and our families at the end of our lives,” Middleton said. “Your dedication and professionalism are awe-inspiring.”
As the Duchess of Cambridge went on to point out in her speech, sometimes nurses may be the only health care provider readily accessible in certain areas of the world, which is why it’s extremely important that enough nurses be trained and placed in the coming years. “In some parts of the world, nurses are perhaps the only qualified health care professionals in their communities, so your work is all the more vital,” she said.
Coming Shortage of Nurses
According to Middleton’s speech, 9 million more nurses will need to be trained by 2030 to meet the rising demands worldwide, which works out to about 2,000 more nurses each day for the next 12 years. Nursing Now 2020 hopes to start filling that gap by increasing the profile of nursing roles and raising awareness about becoming a nurse. Indeed, the nursing shortage has been deemed a global crisis since 2002, but the recruiting and retention of nurses hasn’t been able to keep up with the health care demands of a growing population.
Five Campaign Goals
To help increase the number of nurses, and to support nurses already working in the field, the Nursing Now website lists five main goals that the initiative hopes to achieve by 2020. They are:
- Greater investment in improving education, professional development, standards, regulation and employment conditions for nurses.
- Increased and improved dissemination of effective and innovative practice in nursing.
- Greater influence for nurses and midwives on global and national health policy, as part of broader efforts to ensure health workforces are more involved in decision-making.
- More nurses in leadership positions and more opportunities for development at all levels.
- More evidence for policy and decision makers about: where nursing can have the greatest impact, what is stopping nurses from reaching their full potential and how to address these obstacles.
Basis for the Initiative
The goals and methods of the Nursing Now movement are based on a Triple Impact report, which was released by the All-Party Parliamentary Group on Global Health in October 2016. The report found that empowering nurses would not just improve health globally, but also build strong economies and promote gender equality (as the vast majority of nurses are still women). These three results combine to form the triple impact that nurses could potentially have. “The nursing contribution is unique because of its scale and the range of roles nurses play,” the report said.
Organizations Behind the Movement
Kate Middleton may be the most recognizable public face of the Nursing Now campaign, but two major health organizations are behind the campaigns: the International Council of Nurses and the World Health Organization. The International Council of Nurses represents millions of nurses worldwide, and seeks to represent them, advance the profession, and influence health policy. The World Health Organization is a specialized agency of the United Nations that seeks to address international health policy. The campaign is also supported by the Burdett Trust for Nursing, an independent charitable trust that helps fund nurse-led projects.
A Global Campaign
The Nursing Now Campaign Board includes both nurses and non-nurses from 16 different countries to represent a truly international group. Official launch events were held in London (where Middleton spoke) as well as Geneva. Various international nursing associations also hosted their own launch events, with locations including Canada, China, Jordan, South Africa, Taiwan, and Macao.
Ways to Get Involved
Beyond advocating for nurses and nursing, individuals who wish to support the campaign can sign the Nursing Now pledge and share the social media kit on various platforms. If there is no existing Nursing Now group in their area, nurses and non-nurses may band together to form their own group, though the process is lengthy to ensure participants are committed.
Whether you live in a developing country or an advanced health care economy, the coming nursing shortage will affect the entire globe, and is being felt in some places already. Through its five goals, Nursing Now hopes to help meet that need by recruiting new nurses and empowering existing ones through greater leadership opportunities and better policy decisions. To learn more about Nursing Now 2020, visit the campaign website.
Homelessness is a global issue. It is on the rise and it impacts health physically and mentally. According to a recently published article in BMC Public Health, emergency departments are more often used by the homeless population for acute health care versus accessing preventative health care services. A 2018 study published in SAGE Open reported that the homeless population experiences health disparities with multiple chronic health conditions, mental illness, substance abuse, and depression.
The U.S. Department of Housing and Urban Development, Office of Community Planning and Development provides an Annual Homeless Assessment Report (AHAR) to Congress. On a single night in January 2018, there were 552,830 people who experienced homelessness in the United States. Most were sheltered (65%, 358,363) compared to 35% (194,467) who were in unsheltered locations. In the United States, 17 people per 10,000 experienced homelessness in 2018. Some of those who were in shelters (3,864 people) stayed in beds that were funded because the president declared natural disaster after four Hurricanes (Maria, Irma, Harvey, and Nate) and wildfires in the west. Twenty percent (111,592) of the homeless were children, 71% were over 24 years of age, and 9% ranged from ages 18-24. There were more men in unsheltered locations compared to women. Almost half (49%, 270,568) of the homeless people identified themselves as white compared to black/African Americans (40%, 219,807).
In the state of Texas on a given night in 2018 there were 25,310 homeless people. There were 9 homeless people per 10,000 in the general population of the state. Individual estimates of homelessness in Texas was 19,199; 6,111 for people in families with children; 1,379 for unaccompanied homeless youth; 1,935 for veterans; and 3,269 for the chronically homeless individuals, according to the 2018 AHAR report.
Houston is the fourth largest city in the U.S. with over 2.3 million people, according to the U. S. Census Bureau. In January of 2019, there were 3,938 homeless individuals (unsheltered and sheltered) in the cities of Houston and Pasadena and Harris, Fort Bend and Montgomery Counties.
There are various reasons that may cause an individual to experience homelessness. A 2009 study published in Psychiatric Services reported a significant association with childhood adversities and homelessness. The childhood adversities with significant findings include: having a history of running away, being ordered by a parent to leave the home, being neglected by a parent or caregiver, having a biological father incarcerated, being adopted, being in foster care, and the duration of welfare assistance before 18 years of age. Significant findings regarding socioeconomic situations included grade when respondent left school, economic difficulty in the past year, and currently employed. Mental health problems such as being diagnosed with depression and having a psychiatric hospitalization in the past five years were significant predictors of homelessness.
More recently, a 2019 study in the Community Mental Health Journal indicated the individuals with mental illness had high rates of homelessness. Addiction problems such as drugs in the past year was also a significant predictor of homelessness, according to the 2009 Psychiatric Services study. Oftentimes veterans return home after deployments to war zones suffering with invisible wounds such as post-traumatic stress disorder and traumatic brain injury. These individuals are at risk for experiencing homelessness, according to the National Alliance to End Homelessness (NAEH).
Homelessness can also be due to loss of property, family violence, or domestic violence. A 2018 study in the Journal of Community Psychology reported loss of support systems and social networks can also lead to a path of homelessness. Lower incomes often lead to an inability to pay for basics such as food, clothing, shelter, and transportation—and this places individuals at risk.
It is a common sight in Houston to see homeless people living and sleeping on the streets. Whether you walk or drive around the city, you cannot help but see individual men and women panhandling in the streets, standing at corners and intersections. They will routinely walk up to your vehicle with signs, cups, and stretched out hands for money. The homeless can be seen sleeping on the sidewalks and huddled up against buildings and fences. Although shelters for the homeless exist and initiatives have been implemented in attempt to get the homeless off the streets of Houston, the homeless population is huge. Many people who are homeless still live in tent cities under freeways.
One might say, they want to be on the streets. One might say they do not want to follow the rules of the shelters. Therefore, they chose to be out on the streets. All of those sayings might be true. All the same, someone remains homeless.
One night during November 2018, I was driving home and it was very cold outside. The temperature was in the 30s or low 40s. I was overcome with sadness and sorrow to see so many people literally sleeping on the sidewalks without any shelter. I noticed that some did not have blankets. I found myself feeling so blessed and fortunate to not be living on the streets. But then, I wanted to do something. I said they need blankets and warm clothes if they will be sleeping on the streets in this cold weather.
The “BLESSED” sign
Community Outreach Project
As a Christmas project for the Black Nurses Association of Greater Houston (BNAGH), we decided to give out blankets and socks to the homeless people in Houston. One Saturday afternoon (December 8, 2018), nurses from the BNAGH gathered the donated items to be distributed and walked the streets where a group of homeless men and women gathered. We drove to a local fast food place near Midtown, between downtown and The Texas Medical Center, and parked with permission from the manager. While still in the parking lot, a man asked me if we were getting ready to do something with the homeless. He was told we were going to pass out blankets, hats, socks, bottled water, and brown bags with snacks (peanut butter cracker, cuties, and peppermint candy canes). He stated his name and the name of his company and said he was there with his crew to do a film about the homeless in Houston. He asked if he could film us passing out the items and we told him yes. He said he would put us in the credits.
As we gathered all the items in large black plastic bags and started walking with the water, people started coming toward us to get the blankets and socks and other items. We gave away every item that we had. We even had a set of towels and a bar of soap to give out. One man said he wanted the soap. One man and lady were yelling for us to throw a blanket over the fence to them. One lady asked if we had anything girly. She asked for a pink hat. Everyone was so appreciative. Only one person did not want the items. He said he wanted dollars. He walked back into the street, running from car to car begging for money. Overall, it was an awesome experience. We provided items to approximately 60 homeless individuals.
Taking it to the streets takes courage and a compassionate heart. The needs of the homeless are many. One might feel overwhelmed if trying to take on every issue alone. It will take many people and resources. However, everyone can do something to help improve the health and lives of others. That is what the nurses of BNAGH wanted to do and that is why you might see homeless people in Houston with a sign displaying the words “BLESSED.”
Houston nurses handing out supplies
Relevance to Nursing
Homeless Individuals are a vulnerable population and are sometimes considered invisible. However, they are not invisible. They can be seen and counted. They are at risk for health disparities including mental health issues. There were so many obvious needs. One was just basic hygiene. Nurses can advocate for housing because personal hygiene is important. Hand hygiene is the most effective way to prevent and control the spread of infection. Individuals experiencing homelessness face barriers to personal hygiene. For example, personal hygiene and self-care barriers are limited access to facilities for bathing, taking a shower, doing laundry, and washing hands. Such barriers to self-care and personal hygiene can cause one to be at risk for an infectious disease.
Some things that nurses can do to bring about change:
- Contact local coalitions for the homeless for information about their goals and objectives;
- Advocate for jobs and housing for the homeless;
- Contact and lobby local and state congressional and legislative officials regarding policies to help alleviate homelessness in America.
Such efforts will help reduce health disparities among this vulnerable population.
Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. However, if nurses are to make a difference, then we must rise to the calling, step up to the plate, and do something positive to make a change. There are so many things that can be done. What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. Hopefully you will be inspired to do something to help the homeless in your community feel encouraged and strive to be healthier.
Acknowledgements: The author wishes to thank Betty Davis Lewis, EdD, RN, FAAN and the Black Nurses Association of Greater Houston (BNAGH) and Prairie View A&M University College of Nursing faculty members for donations, and the three other nurses from BNAGH (Patricia Boone, RN, BSN; Vivian Dirden, RN, BSN, MS; and Dametria Robinson, BSN, RN-BC) who also walked in the streets of Houston to distribute the items to the homeless and provided photos. In addition, the author wishes to thank Carmen Lewis, MSN, RNC-MNN, IBCLC for providing the “BLESSED” photo.
Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, was recently elected to the National Academy of Medicine, and part of what those who selected her considered was her research on gene-environment interaction and its effects on blood pressure among African Americans.
“African American women have the highest incidence and prevalence of hypertension among any ethnic, racial, and gender group in the United States,” explains Taylor, who works at NYU Rory Meyers College of Nursing as the first Vernice D. Ferguson Endowed Chair. “It is important for me to understand not only the genetic or hereditary underpinnings of this health disparity, but also the psychological and/or environment interaction with genomic risks that may influence development of hypertension.”
In her research, Taylor says that she’s focused for the most part on African American women and children. Most of her studies have drawn on two or three generations of African Americans. While the ages of the children studied have often been wide, in her most recent study, she targeted children from head start programs, who ranged in age from 3-5 years old, along with their biological mothers.
“We have had a lot of discoveries in our research and have disseminated our findings in journals ranging from nursing, medical, public health, genomic, and interdisciplinary. Overall, we have found that gene-environment interactions for certain factors such as parenting stress, perceived racism and discrimination, and others significantly influence increases in blood pressure,” says Taylor.
She admits that she wasn’t shocked by the findings: “The findings were not all that surprising as I expected that social determinants of health were significant factors in health outcomes and looking at the combinatorial effects with genetics and epigenetics only further illuminates that magnitude of interaction on health outcomes such as hypertension,” Taylor says.
Although Taylor says that her research is important because of what she did discover, “One important aspect of the research is that we are able to identify genetic risk for chronic diseases such as hypertension in children as young as three prior to them developing the disorder. Early identification of risk provides an opportunity for nurses and other health professionals to intervene to reduce risk of developing hypertension as in previous generations. Interventions based on the research with this population may require focusing on social determinants of health and lifestyle modification in addition to or rather than conventional pharmacological methods.”
A study from 2017 defined caregiver burden as, “the strain or load borne by a person who cares for a chronically ill, disabled, or elderly family member.” Nurses are all too familiar with the instinctive concern for patients, and often equally so for the person sitting at the patient’s side. Many caregivers give up proper sleep, nutrition, recreation, and financial resources to care for a family member with a disease that requires comprehensive, and often constant, care. Many caregivers work in addition to caring for their loved ones and have personal and family commitments of their own. The caregiver burden begins when the caregiver sees that something has got to give, and the first thing to go is their own well-being.
Because the nurse is responsible for patient care, it may seem like it’s outside a nurse’s scope to address issues with caregivers. In fact, nurses are equipped to empower patient family members to lighten the burden of caring for sick family. This can be done by nurse researchers who can expand on current awareness, and by direct-care nurses who participate in caregiving with family.
In recent years, research has demonstrated the very real physical consequences of caregiver burden. Studies show that caregivers literally age faster. Research is growing in this area and with that, resources are expanding. The devastating effects of caregiver burden reach beyond temporary distress and eventually create an emotional and physical strain on the caregiver. Too often, the caregiver becomes a patient.
Nurse researchers can contribute to the solution by researching and publishing on this topic, empowering family members to take care of themselves, and urging health care professionals to create health care systems and policies that patients and families can trust.
Nurse as Caregiver Support
Nurses can introduce family caregivers to resources that alleviate the stress of being a caregiver. Social services can step in and address insurance, facility transfer, and patient service allocation. Nurses can also encourage family members to leave the bedside and sleep in their own bed, get a coffee or a hot meal, or encourage them to go for a walk and offering to call if anything urgent comes up.
Many caregivers insist on performing nursing tasks, such as bathing, toileting, and positioning, so they can be assured it is done “right.” Perhaps they have had experiences that have weakened their trust in nurses and other providers. Nurses can gain this trust back by offering to perform tasks in front of, or in conjunction with, caregivers, and eventually, give the caregiver the comfort to step away. Lastly, nurses can give caregivers information about support groups which may act as a pressure release valve and allow caregivers to share their experience and concern, and connect to others going through similar circumstances.
Nurse as Caregiver
Any discussion of caregivers is incomplete without acknowledging the possibility of burnout in nurses themselves. The major difference between a nurse as caregiver and a family member is that boundaries of care between nurses and patients are finite. Nurses have a scope of practice that only encompasses a specific range of skills and tasks, and their work as caregivers ends when their shift does.
This assumes that nurses are not caring for their own family members, which many are. Furthermore, nurses are trained to augment their skill set with the practice of compassionate care and empathetic interactions with patients. Many nurses also work more than full time increasing the time they spend as professional caregivers.
Finding a Solution
The analogy of the oxygen mask on airplanes offers caregivers a guiding principle—put the oxygen mask on yourself first. The yardstick of caregiver burden is misery. Caregiving from a state of personal deficit is not only ineffective but creates a situation where there is not only an ill patient, there is also a depleted and distressed family member. There is nothing wrong with being a caregiver unless it starts to take from the giver.
If you’re looking for special gifts to give to people you love or care about this holiday season, give them something they might not expect—even if you are a nurse—a healthy gift.
Teri Dreher, RN, iRNPA, CCM, a Board Certified Patient Advocate and founder of Seniors Alone Guardianship & Advocacy Services and NShore Patient Advocates, came up with a ton of great ideas for health-related gifts that she shared with us.
As for figuring out how to give healthy gifts, Dreher says, “Think in terms of gifts that support a healthy lifestyle and emotional well-being or that emphasize relationships over material things. Such gifts come in all shapes and price points. With a little thought, you can find such gifts for everyone on your list—from your nearest and dearest to your children’s teachers and your neighbors.”
1. A fitness track or smart watch.
For the person who wants to start up or increase their fitness program. “These irresistible gadgets can be highly motivational,” says Dreher.
2. A health club membership or session with a personal trainer.
These are great for someone who has been told to start a fitness program, but needs motivation. (We add that you should make sure this will be received well. Some folks might get upset if they wouldn’t want it.)
3. A getaway for two.
“People who take vacations live longer. Surprise your honey or your bestie with a long weekend somewhere warm and fun.”
4. A massage gift card.
“Who is the most stressed-out friend you have? Gift them with a soothing massage—a gentle reminder to slow down and take care of themselves.”
5. A pet.
“People would get out to walk a dog, thereby getting exercise as well as living longer and healthier. This is a personal gift, though, and should be wanted/needed and come with an offer to sit when the loved older person needs a break. Also think about the lifespan of each party. An older rescue dog who is housebroken may be ideal for a lonely senior. It gives them a reason to get up and care for someone else and is a source of unconditional love and affection. A mild-mannered rescue cat would be a wonderful gift. An older cat would be calmer and sleep on the lap of an older person, providing comfort for both of them.”
6. A gift card for a bookstore or books that will encourage learning or mental, physical, and spiritual growth.
“[Put them] in a basket with coffee/tea, a special mug, a warming neck wrap for sore muscles, etc. Wrap everything in love, not hints to control of change the person. Play on their interests.”
7. A season of snowplowing.
“The link between heart attacks and snow shoveling is real. A winter of snow-clearing services make a great gift for an older family member.”
8. An air fryer, hot pot, or sparkling water maker.
“These kitchen appliances encourage easy, healthful food prep. Pair with a cookbook and starter supplies.”
9. Nuts, dried fruit, or a fruit basket.
“A healthier alternative to cookies or candy. You’ll be surprised how many people will love this.”
10. A little of your time.
Don’t forget senior orphans—elderly people who are alone. “Not only do they have no one to exchange gifts with this holiday season, they may be silently struggling to get by. Bringing over an occasional meal and offering a little company allows you to keep an eye on them. And if at some point you see that they need help, contact your local senior organization or social service agency. Don’t let them fall through the cracks,” says Dreher.
National Association of Indian Nurses of America (NAINA) joined the Nursing Now global campaign in July 2019, and NAINA marked the official inauguration of its campaign activities at the 2019 Clinical Excellence conference held on November 2nd in New Jersey. As part of Nursing Now, NAINA is collaborating with the American Nurses Association as well as other local nursing organizations and global campaign supporters.
On February 27, 2018, Her Royal Highness, The Duchess of Cambridge Kate Middleton, patron for the Nursing Now campaign, officially inaugurated the campaign that runs through December 2020. The campaign was launched in response to the World Health Organization’s (WHO) Triple Impact report. The Triple Impact report accentuated that “developing nursing will improve health, promote gender equality and support economic growth.”
A Well-Timed Campaign
The year 2020 will be a historic year for nursing profession as it marks the 200th anniversary of the birth of Florence Nightingale.The nursing world is preparing to honor and celebrate this great nurse. As the global community prepares to celebrate nursing, momentous endeavors are in the planning. WHO has designated 2020 as The Year of the Nurse and Midwife. The WHO State of the World’s Nursing Report that highlights nurses’ role in Universal Health Coverage and the Sustainable Development Goals is anticipated in April 2020. The Robert Wood Johnson Foundation team is releasing another landmark report in 2020 as a follow up of the 2010 Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.” The RWJ report will highlight the nurse’s role in addressing the social determinants of health and health equity. To set the stage for these great events and to create global momentum to mark the epic year, Burdett Trust for Nursing in collaboration with WHO and the International Council of Nurses (ICN) launched the Nursing Now global campaign. As of October 2019, Nursing Now has spread to 103 countries.
Nursing Now Global Campaign
Nurses practice in many settings and in different roles. Nurses have different levels of education and competencies, which makes nurses capable of generating positive outcomes in health care. With their education and training, nurses are adroit in health care policy decisions. However, there is a paucity of nurses’ involvement in health care policy and decision making. As the WHO Triple Impact report highlighted, empowering nurses may create a paradigm shift in health care that will address global health care concerns. To highlight nurses and to improve the status of nursing, the campaign chose five focus areas:
- Health Care Policy – Create global awareness on positive impact of nurses and midwives in health policy decisions
- Clinical Practice and Education – Influence investment in nursing education and training
- Leadership – Empower nurses to assume leadership positions; increase the number of nurses in leadership positions.
- Research Priority – Identify areas where nurses have a potential for the greatest impact, explore impediments to achieving their full potential and practicing at the scope of their training, and generate practical solutions for workplace conundrums
- Best Practice – Share examples of best nursing practice
Nursing Now USA
American Nursing Association, U.S. Public Health Service Chief Nurse Officer, the University of North Carolina Chapel Hill School of Nursing, and the University of Washington School of Nursing collaborate in leading the Nursing Now USA campaign. With the vision, ‘Nurses Lead America to Health,’ Nursing Now USA is developing and leading activities focused on creating public awareness on nurses’ vital role in achieving equitable quality health care for all.
Nursing Now NAINA
National Association of Indian Nurses of America (NAINA) decided to join the global campaign as a local group because NAINA’s vision and goals align with the campaign focus. The official launch of Nursing Now NAINA campaign took place at the 2019 Clinical Excellence Conference. The theme of the Clinical Excellence Conference – ‘Population Health: Bridging Gaps and Improving Access to Care’ aligns with the overarching aim of the campaign. The Clinical Excellence Conference provided a venue for NAINA nurses to share examples of best clinical practice, which is one of the priority areas of the global campaign. Susan Michaels-Strasser, PhD, MPH, RN, FAAN, Senior Implementation Director & Associate Director for Nursing Programs at Columbia University discussed “Nursing Now: Empowering Nurses and Tackling Health Care Challenges” and NAINA lead the campaign. Letha Joseph, DNP, AGPCNP-BC discussed NAINA programs that commemorate with the campaign. Nursing Now NAINA will create opportunities for NAINA nurses to improve their competencies, maximize their professional contributions, and enhance their influence. NAINA’s campaign focus areas are enhancing clinical practice by ongoing education, empowering nurses to be leaders at bedside and beyond, and sharing examples of best nursing practice while recognizing nurses for their contributions to health care and professional nursing community.
More information on the Nursing Now global campaign is available at www.nursingnow.org. Updates on NAINA’s activities are available at www.nainausa.com.