International Council of Nurses

Biennial report
2004-2006

Patient and public safety matter:

nurses on the front line
Patient and public safety matter: nurses on the front line

ICN mission: Through the ICN Girl

To represent nursing worldwide, Child Education Fund
advancing the profession the orphaned daughters
and influencing health policy. of nurses in developing
countries are getting
back to school.
For more information see page 13.

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 Biennial report 2004-2006

The International Council of Nurses (ICN) is a federation of

129 national nurses associations representing the millions of
nurses worldwide. Operated by nurses, ICN is the international
voice of nursing and works to ensure quality care for all and
sound health policies globally.

ICN’s scope of work

is housed within
three main pillars:
professional practice,
nursing regulation and
the socio-economic
welfare of nurses.
We are pleased to
ICN Board of Members:
share this account Edith Allwood Anderson
Directors
of our work from (Jamaica)
2005-2009 Dulce Dirclair Huf Bais
2004 to 2006 with (Brazil)
all our stakeholders, Officers:
Beatriz Carvallo Suarez
Hiroko Minami
colleagues and President (Japan)
(Colombia)
collaborators. Rudolph Cini
(Malta)
Franz Wagner
First Vice-President (Germany) Anna Karin Eklund
(Sweden)
Rosemary Bryant William Holzemer
Second Vice-President (USA)
(Australia) Euisook Kim
(Korea)
Philda Nzimande Yves Mengal
Third Vice-President (Belgium)
(South Africa) Veronika Pretnar Kunstek
(Slovenia)
Julita Sansoni
(Italy)
Teresa J. C. Yin
(Taiwan)

ICN organisational chart

Council of National
ICN Board of Directors
Representatives ICN Secretariat
4 officers
1 voting member from each Located in Geneva
11 members
of the member associations

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Patient and public safety matter: nurses on the front line

New ICN initiatives

2004-2006

The Wellness Centres for Health Care Workers

Offering a holistic complement of services, including stress management, training
in HIV/AIDS and TB care, a knowledge resource training centre, antenatal expertise,
testing, counselling and treatment for HIV and TB, and occupational health and
safety services. See page 12.

TB and MDR-TB
Training a critical mass of nurses in TB prevention, care and treatment, and tackling
the issues of stigma and discrimination related to TB. See page 12.

Refugee library
Providing nurses and other health workers with access to the latest nursing/health
information and accompanying training to better meet refugee health priorities,
improve patient safety and the quality of care. See page 13.

The International Centre for Human Resources in Nursing

Strengthening the nursing workforce globally through the development, ongoing
monitoring and dissemination of comprehensive information, standards and tools
on nursing human resources policy, management, research and practice.
See page 23.

The International Centre on Nurse Migration

Facilitating collaboration and knowledge sharing among global organisations
involved with migrating nurse professionals and contributing to patient and public
safety and improved health care. See page 23.

Global Nursing Workforce Review

Clarifying the extent of the global nursing shortage; providing an analysis of key
nursing workforce issues globally; identifying priorities for policy intervention; and
developing recommendations to address issues. See page 23.

Regulation Observatory
Anticipating and responding to international regulatory development, and
facilitating a regulatory framework which promotes patient and public safety.
See page 20.

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 Biennial report 2004-2006

Contents

Patient safety: nurses working on the front line

for quality health and nursing care
Message from ICN’s President and Chief Executive Officer 7

Pillar 1 Professional nursing practice

Working for improved health and safe care across settings,
communities and challenges. 8

Tackling the Millennium Development Goals 12

ICNP®, creating a universal nursing language 16

Pillar 2 Nursing regulation, ensuring public safety

Providing and enabling environment for public and patient safety 18

Pillar 3 Socio-economic welfare of nurses

Strengthening and protecting the health workforce 22

Bringing nursing together worldwide 25

ICN nursing networks 28

ICN Awards 29

Florence Nightingale International Foundation 29

5
Patient and public safety matter: nurses on the front line
Facts & figures
30,000 children die each
day globally because of
preventable diseases.
ICN is working to make
vaccinations against childhood
diseases safer.
6
60 percent of children Children living in poverty are
missing out on formal five times more likely to die
education are girls. before reaching the age of five.
ICN’s Girl Child project Nurses’ work for poverty
promotes the healthy alleviation is enabled with ICN
development of urban girls advocacy and education tools.
ages 10-14.
 Biennial report 2004-2006

Patient safety: nurses working

on the front line for quality health
and nursing care

Message from ICN’s President and Chief Executive Officer

Whether increasing access to safer water,
identifying counterfeit medicines, providing
disaster relief or coordinating critical care, the
goal and role of nursing is to ensure that patients
and communities have safe, quality care when
they require it. The more than 13 million nurses
providing care in hospitals, rural health centres,
schools, refugee camps, workplaces and war
zones have patient safety upper most on their
minds, as does ICN.
We have addressed many pressing health
issues over this past biennial, including the
HIV/AIDS pandemic, tuberculosis and malaria,
chronic health conditions, women’s health and
the needs of girl children. A common theme cuts
across all of these issues — the critical shortage
of nurses. Today’s reality is that the number
of staff has fallen, and the ‘acuity’ of patients
has risen. Fewer nurses are taking care of
sicker people without the time, resources and
mechanisms they need.
Evidence indicates that inadequate institutional
staffing levels are correlated with increase in
adverse events such as patient falls, bed sores,
medication errors, nosocomial infections and
readmission rates that can lead to longer hospital
stays and increased hospital mortality rates.
In short, inadequate human resources present
a serious threat to the safety and quality of
health care. As a profession, we are facing our
greatest challenge.
How has ICN taken up this challenge?
In the last biennial we undertook a multifaceted
programme of work in health human resources
aimed at: 1) clarifying the extent of the global
nursing shortage; 2) analyzing key nursing workforce
issues globally and; 3) identifying priorities for
policy intervention and recommendations to
address issues. We have established the Centre
for Human Resources in Nursing (ICHRN) and,
with the Commission on Graduates of Foreign
Nursing Schools, the Centre on Nurse Migration
(ICNM). As well we initiated the Health Worker
Wellness Centre programme in sub-Saharan
Africa, aimed at addressing the well being of all
health workers. We believe addressing the global
nursing shortage addresses the most serious
threat to the safety of patients, the quality of
care and the health of nurses.
This biennial report also highlights ICN’s
activities in the three programme areas that we
believe are crucial to the strengthening of patient
and public safety: Professional Nursing Practice,
Nursing Regulation and Socio-economic Welfare
of Nurses. Whether working with our member
associations, affiliates, UN partners, industry or
the NGO community, our policy, advocacy and
activities are aimed at bettering the health and
health care of people everywhere.
Dr Hiroko Minami
President,
International Council of Nurses
Judith A. Oulton
Chief Executive Officer,
International Council of Nurses

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Patient and public safety matter: nurses on the front line

ICN Pillar 1
Professional nursing practice

8
 Professional nursing practice ICN Pillar 1

Patient safety is fundamental to quality health and nursing care. ICN believes that the
enhancement of patient safety involves a wide range of actions in the recruitment, education
and retention of skilled health care professionals in a safe and sufficiently resourced
health care setting. ICN is deeply concerned about the serious threat to the safety of
patients and quality of health care resulting from insufficient numbers of appropriately
prepared human resources. The current global nursing shortage as well as access to
continuing education, are key aspects of this threat.
We are pleased to give a brief overview of ICN initiatives addressing patient and public
safety in the realm of professional nursing practice including: safe staffing; safe medicines;
teaming-up with other health professionals; informing patients; and strengthening the
nursing profession through education and leadership training.

Working for improved health and safe care across

settings, communities and challenges
Safe staffing saves lives
Nurses worldwide called for legislators and policy
makers to address the need for sufficient and
suitable human resources in health care settings.
ICN initiated the global campaign by selecting
Safe Staffing Saves Lives as the theme for
International Nurses Day (IND) 2006. Since 1965,
IND has been celebrated around the world
every May 12 on the anniversary of Florence
Nightingale’s birth.
Inadequate staffing in health care settings is
reaching crisis proportions in all regions. Evidence
indicates that it results in a critical increase in
length of hospital stays, patient morbidity and
mortality and preventable adverse events. High
patient-to-nurse ratios not only have a negative
impact on patient outcomes but also affect
nurses who are at risk of emotional exhaustion,
stress, job dissatisfaction and burnout.
To help nurses, hospital administrators,
government and the public in general to understand
this complex and critical subject, ICN prepared a
toolkit, Safe Staffing Saves Lives. It is available on
the ICN website www.icn.ch/indkit2006.htm
The tool kit supports professional nursing
associations and nurses in their work to advance
the argument for appropriate staffing levels,
and educate policy makers about the positive
relationship between nurse staffing and overall
patient care outcome. The tool kit also addresses
the importance of skill mix and the clarification
of roles and issues, such as healthy work
environments and nurses’ health.
Campaign against counterfeit
medicines
Nurses have a key role in educating the public
about the dangers of counterfeit medicines.
Globally counterfeit medicines pose a serious
threat to patient safety and the quality of health
care. It is estimated that 10 percent of medicines
sold worldwide are counterfeit and do not
provide any medical benefits. Worse, they can
result in poisoning, disability and death.
International Nurses
To inform nurses and to provide them with Day 2006.
tools to tackle this growing problem, ICN selected
Nurses for Patient Safety: Targeting Counterfeit
and Substandard Medicines as the theme for
International Nurses Day 2005. The 2005
International Nurses Day kit can be downloaded
from www.icn.ch/indkit2005
Also in 2005 ICN launched a new initiative
against counterfeit medicines in partnership with
the International Federation of Pharmaceutical
Manufacturers & Associations (IFPMA). The
initiative utilises the two organisations’ worldwide
member networks, as well as the research-based
pharmaceutical industry’s anti-counterfeiting International Nurses
body, the Pharmaceutical Security Institute. Day 2005.
Central to the initiative is the IND kit, Counterfeits
kill: Nurses target counterfeit medicines,
developed by ICN. The multi-sector campaign
involves other health professions, patient groups,
industry and regulators. The International
Alliance of Patients’ Organisations distributes
the ICN kit to its members to further broaden
the fight against counterfeits and to protect
patient safety.

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Patient and public safety matter: nurses on the front line

Leadership for Change (LFC)

Health systems and patients benefit when
nurses have strong leadership skills. The
Leadership for Change™ (LFC) programme is an
action-learning initiative that develops nurses as
effective leaders and managers in a constantly
changing health environment. The specific aim
is to enhance nurses’ contribution to health
services, and to promote patient safety and
quality care, through appropriate and proactive
leadership strategies.
Since its inception in 1996, the LFC programme
has been implemented in more than 60 countries
in all regions. Many of these countries are now
implementing LFC programmes led by trainers ICN/MSD Mobile Nursing Library
certified by ICN through its Training of Trainers
Nurses can provide better and safer patient care
(TOT) programme. To date ICN has certified 209
when they have access to current health care
trainers. New LFC programmes will begin in 2007
information. The ICN/MSD Mobile Nursing Library
in China, Grenada, Portugal and South Africa.
is an innovative resource bringing up-to-date
Participants of the ICN LFC programme work
health information to nurses working in remote
with partners to address health policies at local
areas of developing countries. Initiated in 2001
and national levels. They develop strategic
to help close the gap between nurses’ need for
directions for strengthening health care services
current information and its availability, the
and workforce issues that best meet their
project now encompasses 140 mobile libraries
country and local needs.
in 16 African countries.
Country programme evaluations indicate
These mobile libraries and related training
that LFC graduates build sustainable partnerships
are now serving nurses and their patients in more
and help develop new models to improve patient
than 300 communities in Botswana, Ethiopia,
safety and care. This has been particularly evident
Ghana, India, Kenya, Liberia, Malawi, Mauritius,
in maternal and child health, primary and
Mongolia, Seychelles, Somalia, Sudan, Swaziland,
community health, and elder care. Nurse leaders
Tanzania, Uganda, Zambia and Zimbabwe. Thanks
also are tackling global challenges in HIV and
to information from mobile libraries, nurses and
AIDS prevention and treatment, and malaria in
health workers provide better care for tens of
countries such as Kenya, Uganda, and Tanzania.
thousands of the world’s most vulnerable people.
LFC graduates are addressing human resources
A team of industry and nursing partners
development strategies in Guyana, Tanzania,
work together to make this initiative possible.
Mauritius, and Barbados.
ICN and its member national nursing associations
ICN works with key partners to implement
manage the project. Merck Sharp & Dohme (MSD)
the LFC programme worldwide. Partners have
provide funding and the donation of the Merck
provided valuable learning experiences for
Manual. Elsevier publishing handles the packing
the LFC participants, financial assistance for
and shipping of the libraries.
programme implementation and sustainability,
Many nursing organisations and some
and supportive networking. Partners include:
individuals have donated the US$2000 required
WHO, PAHO, national and regional governments,
to stock, ship and manage each mobile library
development agencies, educational institutions
unit. Any individual or organisation interested in
and national nurses’ associations.
sponsoring a mobile library may contact Linda
Carrier-Walker at carrwalk@icn.ch

10

World Health Professions
Alliance: a unique partnership
for world health
One way that ICN works for patient safety and
cost effective, quality health care is through
collaboration with our colleagues in medicine,
pharmacy and dentistry in the World Health
Professions Alliance (WHPA). The WHPA was
founded in 1999 by ICN, the International
Pharmaceutical Federation and the World Medical
Association and expanded to include the World
Dental Federation in 2005.
That same year, WHPA granted official
partnership status to the International Alliance
of Patients’ Organizations (IAPO), representing
patients of all nationalities across all disease
areas. This partnership provides an important
mechanism for health professionals and patients
to work together towards safe and high quality
patient-centred healthcare.
In 2004 nurses, pharmacists and physicians
from more than 60 countries gathered in Geneva
for the inaugural WHPA leadership symposium,
focusing on inter-professional and international
collaboration on health issues.
Patient safety was the primary focus of the
second WHPA Leaders’ Forum, held in Geneva
in 2006. National and global leaders of the
four health professions brought forward the
critical discussion on blame-free reporting
of adverse events in health care and examined
the role of the health professions in combating
counterfeit medicines.
Patient Talk
A key strategy in promoting patient safety is to
encourage patients to be well-informed. The
Patient Talk website, created by ICN and Johnson
& Johnson, offers high-quality health information
to assist patients in making good decisions about
their health. The information can help consumers
prevent disease, obtain correct diagnoses, make
good treatment choices and get the best clinical
care. The series of “informed patient” fact sheets
now covers 25 health issues such as antimicrobial
resistance, depression, nutrition, dementia,
Professional nursing practice ICN Pillar 1
headache and migraine management, obesity,
osteoporosis, sexually transmitted infections,
stroke and tuberculosis, among others. National
nurses associations and consumer groups are
encouraged to link directly to Patient Talk.
The website also contains position statements
on topics of relevance to patient safety such as
counterfeit medicines, tobacco use and protecting
patient rights. The Patient Talk site holds a
HONcode certificate from the Health on the Net
Foundation Code of Conduct.
Vaccines, older persons
and the nurse
ICN undertook to consult its Bank of Experts,
a select group of national nurses’ associations
from industrialised and developing countries,
educational institutions and the available
literature to create an informed understanding
of the use of vaccines by nurses as a health
promotion strategy with older persons. The
result is a comprehensive situation analysis,
which will identify vaccine drivers and barriers
of health professionals and consumers, improve
nursing care of older populations, and guide
future research, policymaking and strategies.
New database for Nursing
Innovations
Worldwide nurses are engaged in innovative
activities on a daily basis. Many of their initiatives
significantly improve patient safety and care,
and result in cost savings for health systems.
In 2005 ICN created a globally accessible
database to facilitate the dissemination of
nursing innovations.
The first of its kind, the ICN Innovations
Database is a web-based resource which fosters
nursing innovation and promotes knowledge
sharing. Nurses can contribute their innovations
to the database, and/or use it to search for new
ideas. Of interest to anyone wanting to learn
about innovative nursing practices and concepts
from around the world, the database can be
accessed at www.icn.ch/innovations/
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Patient and public safety matter: nurses on the front line
Tackling the Millennium Development Goals
Wellness Centres for Health Care
Workers in sub-Saharan Africa
ICN launched a programme of Comprehensive
Wellness Centres for Health Care Workers and
their families in 2006, with the first Centre
opened in Swaziland. Others to follow quickly will
be opened in Lesotho, Zambia and Malawi. The
Swazi Centre, managed by the Swaziland Nurses
Association (SNA), addresses the severe health
worker crisis in Swaziland through attention to
the health, wellbeing and capacity of the health
work force.
The Centre is the result of an innovative
partnership between the SNA, ICN, the Danish
Nurses Organization, the Stephen Lewis
Foundation and BD Corporation. The first of its
kind, the Centre is considered a model of good
practice by many global organizations, including
WHO and Physicians for Human Rights. ICN
and its partners are committed to seeing
Wellness Centres established in all countries
in sub-Saharan Africa.
The Swaziland Centre delivers health and
other professional services to all Swazi health
workers and their immediate families. By offering
quality, confidential health care services responsive
to health care workers’ needs, the Centre helps
address the severe health human resources
crisis affecting Swaziland and much of sub-Saharan
Africa. One of the factors pushing health care
workers out of the country is that they are
over-stressed, under-valued and face many barriers
to health and wellness services. The Centre
facilitates a strengthened health care workforce
which is better able to meet the country’s
enormous health challenges.
Housed in a new, accredited clinic, the
Centre provides a holistic complement of services,
including stress management, a knowledge
resource and training centre for continuous
professional development, antenatal expertise,
testing, counselling and treatment for HIV
and TB, and occupational health and safety
services such as post exposure prophylaxis and
needlestick injury surveillance.
12
Responding to the
TB crisis
Nurses are in the forefront of the global fight
against tuberculosis (TB). ICN works with a
number of partners in developing nursing capacity
on the ground for TB prevention, care and
treatment. As a key player in the Eli Lilly MDR-TB
Partnership, ICN collaborates with its member
national nurses associations, Eli Lilly and
Company, the International Hospital Federation,
the World Medical Associations, WHO Stop TB,
the International Federation of the Red Cross,
Partners in Health and the UNION to battle
the growing threat of multi-drug resistant
tuberculosis (MDR-TB).
Although it is curable, TB kills approximately
two million people every year. An estimated 8.8
million new cases of TB occur annually, of which
approximately 400,000 are multi-drug resistant
TB (MDR-TB). An even more resistant form of
TB – XDR-TB – surged in some regions in 2006,
causing particularly high death rates among
HIV/AIDS patients. TB accounts for one-third of
AIDS deaths worldwide.
In 2005 ICN and partners launched a Training
of Trainers (TOT) programme, targeting nurses
working in primary health care settings in TB
high-burden countries. Approximately three million
nurses work in the 22 TB high burden countries
which account for 80% of TB cases. In most
of these countries nurses are the primary health
care provider. The programme aims to train a
critical mass of nurses in TB prevention, care and
treatment. Training also tackles the issues of
stigma and discrimination related to TB.
In collaboration with its member associations,
ICN conducted TOT workshops in South Africa,
Swaziland, Malawi, Russia and the Philippines in
2005-2006 and will continue to roll out the
TOT programme to other high burden countries
during the next biennium.

The Global TB Resource Centre
On World TB Day 2005, ICN launched an online
Global TB Resource Centre (www.icn.ch/tb/).
The Centre provides multiple tools for nurses:
TB guidelines; fact sheets on TB and HIV/AIDS;
positions statements; a toolkit on stigma; and the
opportunity to exchange experiences through
two interactive forums. It was made possible by
an educational grant from Eli Lilly and Company.
ICN is a member of the WHO Stop TB
Partnership, and is part of a Nursing TB Task
Force involving WHO and the International Union
against TB and Lung Diseases.
The Nursing Library
for Refugee Health
A new collaboration launched in 2006 by the
United Nations High Commissioner for Refugees
(UNHCR), Merck Sharp & Dohme (MSD) and ICN,
is delivering nursing knowledge and training for
health workers in refugee populations in Africa.
Last year 50 ICN/MSD Nursing Libraries for
Refugee Health hit the ground in Tanzania and
Zambia, where more than 770,000 refugees
are currently living in numerous camps and
communities. The libraries provide access to
the latest nursing/health information and
accompanying training to better meet refugee
health priorities, improve patient safety and
the quality of care. The goal is to expand the
programme over the next five years to reach
nurses and other health personnel in refugee
settings across Africa, improving the quality of
health care provided to the continent’s almost
three million refugees. Elsevier publishing is
also partnering with MSD, ICN and UNHCR to
produce and ship the mobile libraries, bringing
valuable health information to more than 50
remote refugee camps.
Refugees are among the world’s most
vulnerable and excluded populations, and constantly
face serious risks to their health. The health
Professional nursing practice ICN Pillar 1
workers who work alongside UNHCR staff in the
field rarely have up-to-date health care information
and are far from well furnished hospitals for
expert advice on critical health issues. The
access to current health information provided
by the ICN/MSD Nursing Libraries, and the
related training, help to fill a serious gap in refugee
health care.
The partners are building on success of the
classic ICN/MSD Mobile Library, launched in
2001 and now present in more than 140 African
communities. Each library unit, consisting of a
transportable trunk resistant to moisture, insects
and hard knocks, contains about 80 titles,
covering topics from malaria case management,
reproductive health and gender violence to
disease prevention, health promotion, surgery
and anaesthesia.
Girl Child Education Fund
Nurses are helping to educate the orphan
daughters of lost colleagues by contributing to a
fund created by ICN and its sister organisation,
the Florence Nightingale International Foundation
(FNIF). The Girl Child Education Fund supports
the schooling of girls whose nurse parent or
parents have died. The Fund, established in 2005,
is part of the ICN/FNIF Girl Child Initiative and is
currently schooling orphaned girls in Kenya,
Swaziland, Uganda and Zambia.
The Fund presently concentrates on sub-Saharan
Africa, where the need is greatest. Education
contributes directly to the economic independence
of women. It is an important tool for reducing the
social and economic vulnerability that exposes
girls and orphans to a high risk of HIV/AIDS.
Through the Fund, ICN and nurses are contributing
to the achievement of the UN Millennium
Development Goals of universal primary education
and the promotion of gender equality. Donations
can be made on the following secure online site:
www.fnif.org/girlfund.htm
13
Patient and public safety matter: nurses on the front line
Safer water for children
and families
In developing countries, diarrhoea is a major
cause of illness and death in children under five.
Children living in orphan centres are particularly
vulnerable as their access to safe, clean water is
far from guaranteed. Orphaned and vulnerable
children in 5 centres in Uganda, Kenya and
Malawi are getting that access now, thanks to a
safe water programme launched in 2004. The
initiative, involving a partnership between ICN,
the Ugandan, Kenyan and Malawi national nurses
associations and the Procter & Gamble Health
Sciences Institute delivers access to safe drinking
water and has seen diarrhoea rates drop by as
much as 90% where the programme has been
implemented. In Malawi, the Norwegian Nurses
Association is also a key partner.
The project involves the donation of a point
of use water purification product, PuR, to AIDS
orphanages in Uganda, Kenya and Malawi and a
nurse-led sanitation and hygiene education and
monitoring programme. This is supplemented by
research on the impact of the intervention on the
children’s health. A further component is outreach
and education for nurses and midwives so that
they, in turn, can educate
other health providers and
their local communities.
ICN and the P&G Health
Sciences Institute have
worked together since
2003 to improve access to
safe household water in
developing countries.
14
Girl Child Policy
and Research Project
The Girl Child Policy and Research Project
mobilises nurses to promote the healthy
development of girls between the ages of 10 and
14 living in large cities. The project has brought
together leaders in government, health, education,
and social welfare agencies to address the needs
of young girls. The Swedish Association of Health
Professionals and the Nurses Association of
Botswana piloted the project. In 2005, ICN’s
member nursing associations in Portugal and
Swaziland joined.
In Sweden, the results were put into action
through a government sponsored project called
FLICKA which focuses on the same target group
and aims to boost girls’ self-confidence. In
Botswana, results of focus group research were
presented at a conference in Gabarone attended
by community and government leaders. The
work in Portugal and Swaziland is ongoing.
Meeting the challenge
of malaria in Zambia
In the past three decades, the incidence of
malaria in Zambia has tripled, making it the
country’s greatest public health problem. ICN
works with nurses in Zambia to address this
challenge, and in collaboration with Novartis,
on a programme to build malaria case
management capacity and expertise related to
new artemisinin-based combination therapies
for malaria. The programme, led by the
Zambian Nurses Association, delivers capacity
building for nurses and other health care workers
midwives in the nine provinces of Zambia.

Making every child count
– campaign for birth registration
Every year 48 million newborns are not officially
registered. Unregistered children are extremely
vulnerable to exploitation of every kind. Because
there is no official recognition of their existence,
they may be excluded from education and health
care services, and may never have a passport or
the right to work. While most unregistered births
take place in South Asia and sub-Saharan Africa,
the problem exists in every country.
ICN and the International Confederation of
Midwives (ICM) have developed a birth registration
toolkit, to raise awareness among nurses and
midwives of the importance of birth registration
and spur action to address the issue in their
country. ICN, ICM and Plan, the international
child’s rights organisation, are working together
to promote birth registration, and call for
governments everywhere to encourage and
improve the birth registration process.
Professional nursing practice ICN Pillar 1
Working with the poor
against poverty
Recognising poverty as the greatest misery we
face today, ICN chose this theme for International
Nurses Day in 2004. Poverty and poor health go
hand-in-hand, with the poor sharing an unequal
burden of ill health. As the most trusted of health
professions, nurses can work effectively with and
on behalf of poor people to ensure that their
voices are heard. Nurses can advocate so that the
poor are included in decisions concerning them,
and that the inequalities of access, employment,
services, gender, ethnicity and race are addressed.
Reducing mother-to-child
transmission
In an important first step in ICN’s efforts to
strengthen health care infrastructure by securing
access to antiretroviral therapy for health care
workers in countries with a high burden of
HIV/AIDS, pregnant health sector employees in
Zambia benefited from a new programme of HIV
testing, counselling and treatment, delivered by
the Zambian Nurses Association in 2003 and
2004. Supplementing ministry of health efforts
at a time when access to antiretroviral medicines
was limited, the initiative ensured free access to
the antiretroviral drug nevirapine, effective in
reducing mother-to-child HIV transmission.
The initiative was collaboratively developed by
ICN, the Zambia Nurses Association and the
Norwegian Nurses Association.
15
Patient and public safety matter: nurses on the front line
ICNP®: creating a universal nursing language
The International Classification
of Nursing Practice (ICNP®)
The ICNP® is a unified nursing language system
that provides terminology to represent nursing
diagnoses, interventions, and outcomes. As such,
it facilitates the cross mapping of local terms and
existing vocabularies and classifications, allowing
comparisons across various systems and health
care delivery settings. The ICNP® can provide
regional, national, and international solutions to
standardizing nursing terminology, enhancing
nurses’ efforts to provide safe and high quality
patient care.
16
The development of the ICNP® requires the
collective involvement of national associations,
individuals and nursing opinion-makers. More
than 160 nurses, representing 47 different countries,
serve as nursing practice expert reviewers.
They provide their knowledge and expertise to
evaluate terms and definitions in the ICNP®.
In 2005, Version 1 of the International
Classification for Nursing Practice (ICNP®) was
launched, providing the concepts or values for
the International Standards Organization (ISO)
standard for a reference terminology model
for nursing diagnoses and nursing actions.
A major advancement of ICNP® Version 1 is that
it is computer-based, with the advantages of
description logic and associated software tools
and therefore easier to implement and maintain.
ICN Research and Development
Centres
The first ICN Accredited Research & Development
Centre: Deutschsprachige ICNP® Nutzergruppe
(German-Speaking ICNP® User Group) was
established in 2005. An ICN Centre is an
institution, organisation, department, national
association, or other group which, through
information, research, training and other services,
advances ICNP® and its use in patient care.
The Deutschsprachige ICNP® Nutzergruppe
consists of three national nurses’ associations,
Austria (OeGKV), Germany (DBfK) and Switzerland
(SBK/ASI) and the three national ICNP® User Groups
of these countries. Currently there are also Centres
in: the Department of Nursing at the University
of Concepción, Chile; Canberra Hospital/University
of Canberra, Australia; and, the University of
Wisconsin, College of Nursing, USA.
17
Patient and public safety matter: nurses on the front line

ICN Pillar 2
Nursing regulation, ensuring
public safety

18

Nursing regulation includes all of those legitimate and appropriate
means – governmental, professional, private, and individual – whereby
order, consistency, identity and control are brought to the profession.
Providing and enabling environment for
public and patient safety
For more than a century, ICN has played a
leadership role in nursing regulation, working to
ensure that the regulation of the profession
provides a framework within which patient safety
can be assured, and nurses can respond rapidly
and flexibly to changing health needs.
Credentialing Forum
Eleven associations currently actively involved
in credentialing activities, or with well-advanced
plans to become involved in this field, attended
the first meeting of the Forum in December
2006. The Credentialing Forum aims to:
l Serve as a vehicle for countries with dynamic
credentialing programs to communicate,
consult, and collaborate with one another on
trends, problems, solutions, etc.
l Promote and enable nursing’s role at the
forefront of healthcare and professional
credentialing and quality assurance.
l Advise ICN on developments and needs in
the field of regulation, credentialing, and
quality assurance.
Nursing regulation, ensuring public safety ICN Pillar 2
Regulators’ Forum
With increased mobility of staff and patients, the
environment within which competent authorities
operate is becoming more dynamic and complex.
Recognising this fact, ICN and the International
Confederation of Midwives furthered their
longstanding commitment to regulation and
patient safety by creating the Regulators Forum.
The forum facilitates global networking and
exchange among regulators in many countries.
The first annual forum was hosted by the Spanish
General Nurses Association in Madrid in 2005.
Nursing and midwifery regulators from North
America, the Caribbean, Africa, Asia, Australia
and Europe gathered to address issues affecting
safe patient care.
In 2006, the Regulation Forum met in
Geneva, attended by 60 regulators from around
the world, including developed and developing
regions. The regulators focused on the assessment
of continuing competence and the opportunities
and threats related to the assessment of
overseas applicants for a country’s register.
19
Patient and public safety matter: nurses on the front line
The ICN Observatory
on Licensure and Regulation
In 2005, ICN established the ICN Observatory
on Licensure and Registration. The small
cross-sectional expert group advises ICN on key
issues and offers insights into emerging and
future trends in regulation. It enables ICN and
the nursing profession to anticipate and respond
in a timely, appropriate manner to international
regulatory developments, and to facilitate a
regulatory framework which promotes patient
and public safety. In addition it provides leadership
in influencing policy on global regulatory matters.
The inaugural meeting of the ICN Observatory
took place in Madrid in 2005.
In 2006, the Danish Nurses Organisation
hosted the Observatory event, focusing on
future work in the following areas: principles of
regulation and the associated ICN framework;
potential for developing the competencies
associated with the continuum of nursing care;
a potential major research proposal to map
legislation from countries across the world
and conduct a comparative analysis; and,
consideration of policy statements.
ICN/WHO Futures Perspective
Nursing Regulation: A Futures Perspective was
published by ICN and WHO in 2005, exploring the
intent, scope and nature of professional regulation
for nursing. It discusses new challenges to
professional regulation such as increased mobility
of professionals, growing trade in the health
services, health sector reform and a greater
public interest in the quality of health services.
20
New Regulation web page
Additional information about ICN’s activities
in the field of regulation is available at
www.icn.ch/regulation.htm. ICN Position
Statements and regulation publications are posted
on the web page. It also provides links to the
Regulation Network, the Credentialing Forum,
and the ICN Registry of Credentialing Research.
Seventh international
Regulation conference
Globalisation and Regulation was the central theme
of the 7th International Regulation conference, held
in Taipei, Taiwan in 2005 and co-hosted by Taiwan
National Nurses Association, the Taiwan Department
of Health and ICN. Representatives from 63
countries addressed professional self-regulation,
issues related to the General Agreement on Trade
and Services (GATS), as well as migration and
future perspectives on professional regulation.
Inaugural Triad Meeting
Government chief nursing and midwifery officers,
representatives of national nursing and midwifery
associations and regulatory bodies from 101
countries came together in Geneva in May 2006,
for the inaugural ‘Triad Meeting’ of the
International Confederation of Midwives, the
International Council of Nurses and the World
Health Organisation. The trilateral group
addressed issues critical to the provision of safe,
quality nursing and midwifery care and professional
regulation. A resolution on nursing and midwifery
was issued, urging the World Health Assembly
to address the global nursing and midwifery crisis,
with a commitment to health as a basic human
right providing for equal access to equitable
health care based on need rather than the ability
to pay. ICM, ICN and WHO, together with the
participants of this inaugural triad meeting,
agreed to work locally, regionally and globally to
meet the commitments in the resolution and
to continue to address issues that advance
nursing and midwifery in pursuit of global public
safety and better health.
21
Patient and public safety matter: nurses on the front line

ICN Pillar 3
Socio-economic welfare of nurses

22

The nursing shortage occurring in health systems around the world is bringing in its
wake a serious crisis in terms of adverse impacts on the health and well-being of
populations. It poses unprecedented challenges for policy makers and planners in both
high and low income countries alike.
Socio-economic welfare of nurses: strengthening and
protecting the nursing workforce
ICN is deeply concerned about the serious
threat to the safety of patients and quality of
health care resulting from insufficient numbers
of appropriately trained nurses. The global nursing
shortage occurring in health systems around the
world is the result in many cases of insufficient
attention to the health, safety and well-being of
the nursing workforce. ICN works in a multi-faceted
way to address the many forces and issues
impacting the health care workforce.
The International Centre
for Human Resources in Nursing
(ICHRN)
www.ichrn.org
To inform policy making and to build capacity in
nursing human resources, ICN and its premier
foundation, the Florence Nightingale International
Foundation (FNIF), established the International
Centre for Human Resources in Nursing (ICHRN).
Inaugurated in 2006, the Centre provides open
access to nursing HR knowledge, practice and policy.
It allows nurses and others to remain up to date
with national, regional and global issues and trends.
ICHRN is a gateway to information, tools,
standards and training in nursing HR policy,
management, research and practise. The Centre
tracks and develops nursing HR policy and
standards. The Centre’s web site, www.ichrn.org,
enables open access to its Knowledge Library
which offers a web based, interactive and fully
searchable database. The database holds a
comprehensive range of information and
documents covering all aspects of nursing HR,
including innovative work published by ICHRN.
The Centre is supported through funding
from the Burdett Trust for Nursing and ICN.
Socio-economic welfare of nurses ICN Pillar 3
The International Centre on
Nurse Migration (ICNM)
Responding to growing concerns about migration
and the health human resources crisis, ICN and
the Commission on Graduates of Foreign Nursing
Schools launched a much needed, new global
resource – The International Centre on Nurse
Migration. Established in 2005, the Centre facilitates
collaboration and knowledge sharing among
global organizations involved with migrating
nurse professionals and contributes to patient
and public safety and improved health care.
The Centre is an important asset in
understanding and acting on the needs of
migrating nurses, employers and policy makers
throughout the global community. It addresses
gaps in policy, research and information regarding
the migrant nurse workforce. The centre’s web
site, www.intlnursemigration.org, acts as a portal
for policy, research studies and other information
regarding migration trends and statistics.
A global picture of the
nursing shortage
In 2004, ICN and the Florence Nightingale
International Foundation, supported by the
Burdett Trust for Nursing, undertook a two-year
analysis of the world’s nursing workforce – the
Global Nursing Review Initiative: Policy Options
and Solutions. The results of this detailed
investigation highlighted three critical challenges
related to nursing shortages: HIV/AIDS in
sub-Saharan Africa; internal and international
migration, and international recruitment of
nurses; and the effects of health sector reform
and restructuring.
As part of the Initiative, seven ‘issue papers’
informed a high level consultation of health
human resource experts, feeding into an ICN
plan of action presented to nursing leaders
for input and validation at the Global Nursing
Summit convened by ICN in 2005. Project
activities culminated with the publication of a
final report, The Global Nursing Shortage:
Priority Areas for Intervention. The reports and
issue papers are available in English, Spanish
and French on the ICN Global Nursing Workforce
Project website www.icn.ch/global.htm
23
Patient and public safety matter: nurses on the front line
Dealing with violence in the
health care workplace
Violence in the health care workplace has been a
topic of concern for ICN for many years, as we
see the incidence and severity of violence against
nurses in particular on the rise. While nurses are
not trained to handle violence a global shortage
of 4 million health care workers has worsened
the situation. In Africa, the HIV/AIDS pandemic is
also a contributing factor, as long queues of
patients requiring time-consuming treatment
often engender frustration, despair and anger.
In cooperation with the Norwegian Nurses
Association, and the SADC AIDS Network of
Nurses and Midwives (SANNAM), ICN supports
an initiative in five African countries, aimed at
reducing violence in the health care sector.
Through workshops and follow-up activities in
Botswana, Lesotho, Mauritius, Swaziland and
Tanzania (Zanzibar), a new consciousness is
being created. The goal is to provide nurses with
workable techniques to handle and reduce
workplace violence.
ICN also undertook work with WHO, the
International Labour Organization and Public
Services International to reduce workplace
violence in the health sector. The four organisations
have commissioned research on workplace
violence in the health sector internationally,
developed framework guidelines and piloted a
training programme manual. The guidelines,
related training manual and other materials are
available at www.icn.ch/sewworkplace
Leadership in Negotiation
The Leadership in Negotiation (LIN) initiative
teaches nurses skills to promote patient and
public safety, achieve safer working environments
and just compensation, and influence health and
nursing legislation.
Introduced in 1982 in Africa, this action-learning
project has since been adapted to the needs of
nurses in the Caribbean, Eastern Europe, Latin
America, South East Asia, the Pacific Rim and
the South Pacific and has been delivered in more
than 40 countries. It facilitates the training of
nurse leaders in problem solving, negotiation,
communication, human resources development,
occupational health and safety, association
management, and marketing. At the same time,
it sensitises participants to the impact of labour
24
issues and the work environment on the safety
and delivery of patient care.
In recent years LIN has been financially
supported through the Danish Nurses Organisation
and the LO/FTF Council for International
Development Co-operation with funds from the
Danish International Development Agency and by
the Swedish Association of Health Professionals
and LO/TCO Secretariat of International Trade
Union Development Cooperation with funds from
the Swedish International Development Agency.
Safe injections for nurses
and patients
Nurses and health workers experience an average
of one to four needlestick injuries per year,
potentially exposing them to serious or fatal
infections. In fact, accidental needlestick injuries
account for 86% of all occupationally related
infectious disease transmission.
In 2005, ICN and the World Health Organization
(WHO) implemented a Needlestick Prevention
Project in Vietnam, South Africa and Tanzania
and developed a new tool kit, Preventing
Needlestick Injuries and Occupational Exposure
to HIV/AIDS. The goal is to reduce needlestick
injuries and occupational exposure to blood-
borne pathogens.
Addressing this same issue in Europe, ICN
joined forces with the Standing Committee
of Nurses in the EU to demand immediate EU
action to provide safer needles to protect health
workers from the threat of HIV/AIDS and other
blood-borne diseases. It is estimated that health
care workers in Europe suffer one million
needle stick injuries each year, of which 40%
relates to nurses.
Bringing nursing together
worldwide

25
23rd Quadrennial
More than 4,500 nurses from 148
countries and every region of the
world participated in ICN’s 23rd
Quadrennial Congress held in Taipei,
Taiwan, 21-27 May 2005. Participants
joined in an international summit
on the global nursing workforce,
which continued critical work by
ICN and the FNIF in addressing the
global nursing shortage.
26
Congress highlights included inspirational words
from Gretta Styles, as she accepted nursing’s
highest honour – the Christiane Reimann Prize
and a moving address by Stephen Lewis, UN
Special Envoy for HIV/AIDS in Africa, recipient
of ICN’s Health and Human Rights Award.
Hiroko Minami, an outstanding nursing leader
in Japan and internationally, was elected and
installed as the 25th ICN President. Since its
founding in 1899, ICN has had a tradition that
each President choose a watchword as a theme
for her presidency. Dr Minami chose the word
“Harmony”. She follows Christine Hancock
who served as ICN President from 2001-2005.
In an impressive celebration of nursing innovation
and knowledge, the programme offered more
than 1500 scientific presentations and 29 main
sessions given by international health care
experts. Participants discussed health challenges
such as HIV/AIDS, malaria, TB and SARS.
Congress

Samoan nurse Pelanetete Stowers delivered

a keynote address on the impact of knowledge,
innovation and vitality on nursing and
health care. Frances Hughes of New Zealand
led a discussion of nursing at the forefront
of innovation.

Women’s health advocate, Dr Afaf Meleis,

was the guest speaker at the FNIF Celebratory
Luncheon.

Nursing on the move:

Knowledge, innovation and vitality
27
Patient and public safety matter: nurses on the front line
ICN nursing networks
Further information ICN creates forums for the international
about these and exchange of ideas, experience and expertise.
other ICN Networks Such exchanges help nurses improve patient
is available at safety and the quality of care by exposing
www.icn.ch them to new ideas, and supporting them in their
work. Established networks include Advanced
Practice, Regulation, Research and Leadership.
Over the recent biennium ICN created three
new networks: HIV/AIDS; Nurse Politicians; and
Remote and Rural Nursing.
Supporting nurses who care
for HIV/AIDS patients
The ICN HIV/AIDS Network provides opportunities
for exchange of HIV/AIDS-related knowledge and
experience. Members also help identify trends in
HIV/AIDS prevention, care, support and treatment.
Over 100 nurses working in HIV/AIDS care and
prevention have joined the network to date. The
network is moving forward as linkages are established
with its members and other groups. Plans are
underway to organise meetings and conferences.
28
Nurse politicians around the
world caucus via ICN
The Network offers nurse politicians, often working
in isolation, a vehicle to share knowledge and
experience and exchange and test ideas. As well
it provides new and experienced politicians with
the opportunity to develop mentoring relationships.
In addition to being a vehicle of support to current
politicians, the Network members are invited to:
share their expertise in policy and advocacy with
global nursing; assist ICN in identifying and
monitoring political trends and issues affecting
health care, nursing and society in general; serve
as a political opinion resource to ICN.
Networking nurses in rural
and remote areas
Nearly half of the world’s population lives in rural
or remote areas. ICN has established a new network
to improve the health of rural populations, and to
support nurses who work in remote areas.
By providing a global forum, the ICN Rural
and Remote Nurses Network promotes sound
rural nursing practice and research by creating
opportunities for the exchange of knowledge
and experience. Network members and others
communicate in a variety of ways including via
the ICN web site, an online bulletin board, a
network bulletin, and meetings and conferences,
the first of which was held in 2005.
 ICN Awards and FNIF

ICN Awards Florence Nightingale

International Foundation
Christiane Reimann Prize
Margretta Madden Styles, As ICN’s premier foundation, Florence
a past president of ICN, Nightingale International Foundation (FNIF)
was awarded the 2005 supports and complements the work and
Christiane Reimann objectives of ICN, including the advancement
Prize for her remarkable of nursing education, research and services for
achievements and the public good. FNIF’s research projects aim
contributions to the nursing to advance health issues internationally and
profession internationally. increase nursing knowledge.
A nurse scholar
renowned globally as an international leader in The Girl Child Initiative
nursing education, regulation and credentialing,
Dr “Gretta” Styles was the architect of the first
comprehensive study of nursing credentialing in
the 1970s. In the 1980s, she spearheaded ICN’s
definitive work on nursing regulation, including
the publication of a guidebook on nursing regulation.
She was also a past president of the American
Nurses Association and the American Nurses
Credentialing Center. Known as nursing’s top
international award, the prize bears the name
of ICN’s first full-time Executive Secretary,
Christiane Reimann. ICN bestows the prize every
four years to a nurse who has had a significant
The Girl Child Initiative (GCI) provides a focus
impact upon the nursing profession. Margretta
for the global nursing community’s efforts on
Madden Styles died in November 2005.
behalf of girls.
Health and Human Rights Award The Girl Child Initiative consists of two related
projects:
Stephen Lewis, United
Nations Special Envoy for l The Girl Child Policy and Research Project aims
HIV/AIDS in Africa, was to review national programmes and policies
awarded the 2005 Health available to address the needs of girls between
and Human Rights Award. the ages of 10 and 14, interview girls with respect
ICN gives the award every to their needs, and lead an interdisciplinary team
four years in recognition of to determine gaps in policy and programming
outstanding humanitarian and advocate for changes nationally
l
contributions and achieve- The Girl Child Education Fund, a nursing initiative
ments in the domain of health and human rights. for orphaned girls, supports the primary and
It is ICN’s only award given to someone who is secondary schooling of the orphaned daughters
not a nurse. of nurses in developing countries, through the
Lewis is a passionate advocate for the world’s provision of school fees, uniforms and books.
most vulnerable people. He epitomises the goals Please see more on the GCEF on page 13.
and values of ICN and nursing in the promotion
of health and human rights. Lewis has focused
attention on the suffering and powerlessness of
women, and advocated relentlessly for women’s
rights and gender equality.

29
Patient and public safety matter: nurses on the front line

The International The Resource Nurse Volunteer

Achievement Award
Every two years, the Florence Nightingale
International Foundation (FNIF) recognises a
practising nurse’s contribution to nursing
internationally. The 2007 recipient of this
International Achievement Award is Anneli
Eriksson, RN and President of Médecins Sans
Frontières (MSF) in Sweden for her outstanding
work helping endangered communities during
catastrophes and for her leadership in
international nursing. The Award is given to a
mid-career practising nurse who is currently
influencing nursing internationally in two of
nursing’s four domains: direct care, education,
research and management. It accords worldwide
recognition of the recipient’s achievements
and contribution to nursing internationally.
With funding from the Burdett Trust for Nursing,
ICN and FNIF conducted two feasibility studies:
the first examined the demand for a volunteer
register of nurses to provide services in the
form of advice, consultation, mentorship and/or
training to organisations in English-speaking
Africa and the Caribbean; while the second
explored the level of interest among UK nurses
(active and recently retired) in undertaking
short-term overseas volunteer assignments.
Results from both surveys indicate need and
interest; however, findings highlight insufficient
financial resources as a major organisational
constraint to the placement of nurse volunteers.
More information about FNIF is available at
www.fnif.org

Front cover: p. 4 Wellness Centre: Swaziland p. 11 Berry van Schaik p. 20 ICN

Photo credits
Top row, from left to right:
AKF/Jean-Luc Ray; ICN; ICN
Second row, from left to right:
ILO/P. Deloche;
Finnish Nurses Association
Nurses Association
TB: WHO
Refugee library: ICN
ICHRN: WHO
ICNM: WHO/Carlos Gaggero
Global Nursing Workforce: ICN
p. 12 Swaziland Nurses Association
p. 12 AKF/Jean-Luc Ray
p. 13 ICN
p. 14 P&G/Greg Allwood
p. 21 AKF/Jean-Luc Ray
p. 22 AKF/Amit Pasricha
p. 24 AKF/Jean-Luc Ray
p. 25 ICN

Third row : Regulation: ICN p. 15 AKF/Jean-Luc Ray & p. 26-27 ICN

both AKF/Jean-Luc Ray p. 6 Finnish Nurses Association AKF/Amit Pasricha p. 28 WHO & AKF/Jean-Luc Ray
Bottom row: WHO p. 7 ICN p. 17 WHO p. 29 ICN
Inside cover: ICN p. 8 AKF/Jean-Luc Ray p. 18 AKF/Jean-Luc Ray p. 30 Anneli Eriksson
p. 3 ICN p. 10 ICN p. 19 ICN p. 31 AKF/Jean-Luc Ray

30
ICN National Nurses Associations
Andorra Egypt Liberia Sao Tome & Principe
Angola Estonia Lithuania Serbia
Argentina Ethiopia Luxembourg Seychelles
Aruba Fiji Macao Sierra Leone
Australia Finland Malawi Singapore
Austria France Malaysia Slovak Republic
Bahamas FYR of Macedonia Malta Slovenia
Bahrain Gambia Mauritius Solomon Islands
Bangladesh Georgia Mexico South Africa
Barbados Germany Monaco Spain
Belgium Ghana Mongolia Sri Lanka
Belize Greece Morocco St. Lucia
Bermuda Grenada Mozambique St. Vincent
Bolivia Guatemala Myanmar & the Grenadines
Botswana Guyana Namibia Swaziland
Brazil Haiti Nepal Sweden
British Virgin Islands Honduras Netherlands Switzerland
Brunei Darussalam Hong Kong Netherlands Antilles Taiwan
Burkina Faso Hungary New Zealand Tanzania
Canada Iceland Nicaragua Thailand
Chile Indonesia Nigeria Togo
Colombia Ireland Norway Tonga
Congo Democratic Israel Pakistan Trinidad & Tobago
Republic Italy Panama Turkey
Cooks Islands Jamaica Paraguay Uganda
Costa Rica Japan Peru United Arab Emirates
Croatia Jordan Philippines United Kingdom
Cuba Kenya Poland United States of
Cyprus America
Korea Portugal
Czech Republic Uruguay
Kuwait Romania
Denmark Venezuela
Latvia Russia
Dominican Republic Zambia
Lebanon Salvador (El)
Ecuador Zimbabwe
Lesotho Samoa

International Council Editorial

of Nurses Linda Carrier-Walker
3, place Jean Marteau Lindsey Williamson
1201 Geneva
Switzerland Design & Production
Chamberlain Dunn Associates, London
Tel +41 22 908 0100 Tel +44 (0)20 8334 4500
Fax +41 22 908 0101
email icn@icn.ch
www.icn.ch