Motion 1: Empowering the nursing voice

Motion:

We ask the OCB Board to ensure that the nursing voice be present in guiding strategy and policy development at the highest decision-making levels in OCB.

This is needed to ensure improvement in quality of care and provision of person-centred care per ambitions of the 2020-2023 strategic orientations. 

 

Background and explanation:

We are asking MSF to change the future of nursing in OCB by expanding opportunities for nurses to lead and diffuse collaborative improvements and efforts that will enable change, advancing healthcare provision. Bring nursing leaders to tables where decisions are made to be a voice for the entire workforce.

Similar motions have recently passed by MSF Sweden and MSF Greece, whereby they propose: “MSF must continue to move towards a more inclusive and equitable workforce… this will take a focused and structured investment in…. meaningful inclusion in leadership and governance…. As the complexity of our programs continues to expand, we need to keep the foundations of quality patient care central. Scaling up our attention and support of MSF nurses and midwives is in line with MSF's current strategic ambitions.”

Nurses account for 59% of health workers globally making them the single largest group of professionals in the health workforce. Within MSF this percentage is mirrored. Often nurses are the sole medical care providers to patients and communities, taking decisions independently on medical treatment and care plans within their scope of practice. Of all healthcare professionals, nurses spend the most time at the bedside of the patient and within communities, which allows an intimate perspective of the patient experience. Therefore, nurses hold a privileged and unique voice to enhance and transform the health care system.

Despite all this, in MSF medical leadership and expert support, nursing is underrepresented, and specific representation of nurses is starkly absent in broader strategy and policy development.  To date, within MSF healthcare leadership has been termed “medical leadership”, and as such lead by medical doctors lacking key nursing direction. To date, specific support to nurses is minimal and quite general, failing to account for specialities such as OT, critical care, paediatrics, or emergency nursing, in the same way these are recognized in medicine. Yet, we continue to venture into increasingly complex levels of care that are not able to function optimally and provide high quality of care with nursing left behind. Like the medical programming increases in complexity, so does the technical nursing care.

Nursing is an autonomous profession and distinct scientific discipline, whereby nurses are bound to independent legal and ethical duties to patients bearing a unique focus and scope of practice. This includes special expertise such as critical care, paediatrics, nursing education, mental health, infection prevention and control, community care, nursing & ward/ hospital management, and much more. As such, nurses train, manage and regulate themselves. More distinctly stated, the medical profession does not define nursing curriculum or manage nurses, nor does it manage nursing services.

In many MSF settings ‘task-shifting’ frequently places additional responsibilities on nurses and nursing assistants. They may be trained to provide and supervise tasks that might otherwise be provided by clinical officers, social workers, counsellors, laboratory staff, and doctors.

Throughout the history of MSF, nurses and nursing have been placed low on a hierarchy led by medical doctors. This has all too often meant that decisions heavily impacting nurses and dependent on nursing expertise have been taken without their involvement, negatively impacting quality and efficiency of care to patients. During 2020 with the COVID-19 pandemic and decisions to respond this has been more apparent than ever. In rapidly scaling up levels of care, the lack of nursing voice in these decisions has proven to have worsen patient outcomes and has left nurses without adequate support and supervision in precarious situations. This has included increasing levels of care to provide level 3 ICU care without nurses trained or experienced in critical care. Task shifting, while broadly welcome where appropriate, has sometimes replaced qualified nurses with nurse aides having insufficient support and training. These decisions have often been in absence of nursing input and can lead to detrimental consequences. Protocols and policies that include nursing components of care have been developed and updated without consultation or input from nurse advisors. Yet, these policies and protocols relate to nursing, being carried out by nurses, and having direct impacts on quality of patient care.

In 2019 the Quality of Care Motion was voted in, where the recognition of nursing care importance was a big part of the debate. Due to COVID the quality of care project that was initiated in late 2019 was abandoned. We ask now, where is OCB with the Quality of Care Motion? Nursing can and will have a huge impact on quality of care if provided the resources and if represented in higher level discussions and decision-making around strategies and policy development.

Harnessing the power of nursing to save lives and alleviate suffering requires the involvement of nurses in policy reviews and all interdisciplinary decision-making that will contribute to the effectiveness of health and social care systems, effecting patient outcomes.  It is therefore essential for MSF to ensure nurses have greater presence in leadership to provide the required input.

The year 2020 was designated the International Year of the Nurse and Midwife in which WHO published the State of the World Nursing Report emphasizing the need for increased presence of nurses in leadership positions contributing to strategy and policy development, as well as increased employment opportunities and education. The report captured “No global health agenda can be realized without concerted and sustained efforts to maximize the contributions of the nursing workforce and their roles within interprofessional health teams. To do so requires policy interventions that enable them to have maximum impact and effectiveness by optimizing nurses’ scope and leadership.” This will be no different in MSF reaching ambitions set forth in strategic orientations for 2020-23 and beyond. For this to happen the nursing voice must be empowered and represented at all levels.

Nursing support circle of OCB (Melissa How, Lucy O’Connell, Dorothy Wuyep, Marybeth Wargo, Chiara Martino, Karolien D’Hollander, Innocent Baluhe Muke, Eva Deplecker), Anja Wolz, Ann Wouters, Chiara Burzio, Francesca Marian, Emmanuel Lampaert, Anne Khoudiacoff, Tom Ellman, Emmanuel Massart, Cecile De Walque, Meinie Nicolai, Kirrily de Polnay, Leen Boersma, Sebastian Spencer, James Kambaki, Elodie Biche, Rosie Burton, Axelle Vandoornick, Daniela Garone, Boubacar Balde, Helmi Mekaoui and Daphne Lagrou

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