The ICN Global Nursing Leadership Institute: Integrating the SDGs into Leadership and Policy Development

Abstract

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article discusses the International Council of Nurses Global Nursing Leadership Institute and its integration of the SDGs into a global leadership and policy development program.

Policy and politics determine the health of populations and the state of the nursing profession—present and future. To shape health and social policy at national, regional, and global levels, senior nurse leaders need high-level professional, political, and policy leadership skills. This is the focus of the International Council of Nurses (ICN) Global Nursing Leadership Institute (GNLI), an innovative and acclaimed program that since its inception in 2009, and with continuing support from the Burdett Trust for Nursing, has graduated over 300 participants from roughly 80 countries.^1–4

Fueled by a vision to create a global community that recognizes, supports, and invests in nurses and nursing to lead and deliver health care for all (see Figure 1 ⁵), the ICN has spearheaded policy related to a variety of issues, including the nursing workforce, access to primary health care, and counterfeit medications. The organization—which cochaired the State of the World’s Nursing 2020 report issued by the World Health Organization (WHO)⁶—was a leader in engaging nurses to develop professionally and is now promoting the implementation of the WHO Global Strategic Directions for Nursing and Midwifery 2021–2025 report.⁷ The ICN has also been a champion of raising nurses’ awareness of the Sustainable Development Goals (SDGs), along with governments’ understanding of nurses’ essential role in the attainment of these goals.⁸ In 2017, it declared the theme of International Nurses Day to be “Nurses: A Voice to Lead, Achieving the Sustainable Development Goals.”⁸

Figure 1.

The ICN Strategic Plan⁵

To foster nursing leadership and policy development, the GNLI recruits participants from senior positions in national nursing associations, national or regional governments, national regulatory bodies, service delivery organizations, academia, nongovernmental organizations in international development, and heads of WHO Collaborating Centers. Though initially an annual weeklong residential workshop in Geneva for approximately 30 leaders, the GNLI has evolved into a three-module program delivered part-time over a period of nine months, using active learning approaches to encourage participants to engage with each other and with other invited experts.⁹ Integrating the experiences of both scholars and facilitators, the program introduces concepts and theories related to policy and leadership development and is rooted in evidence. See The ICN Global Nursing Leadership Institute Expected Program Outcomes⁹ for a list of the expected outcomes.

The ICN Global Nursing Leadership Institute Expected Program Outcomes⁹.

• Shape, develop, support and drive evidence-based health and social policy

• Undertake stakeholder analyses and political environmental analyses in order to influence definition of problems, building of coalitions and framing of solutions

• Use political, strategic and advocacy skills to work effectively with policy stakeholders, including politicians and government officials, other health system leaders, and international and nongovernmental organisations

• Review and frame the evidence base in local, national and international political, health and social care contexts

• Create and strategically communicate clear policy messages that appeal to politicians, policy-makers and the public

• Participate in a network of regional and global nurse leaders in policy

This article highlights exemplars of individual projects spearheaded by GNLI 2020–2021 scholars in the Pan American Health Organization (PAHO) region, all of which promote the SDGs in various contexts and aim to realize the ICN’s aim to recognize, support, and invest in nurses.

VIRTUAL INNOVATION DURING COVID-19

Since 2016, the GNLI has primed graduates to participate in local, regional, national, and global policy discussions and actions related to the SDGs.^{3, 4} With the outbreak of the SARS-CoV-2 pandemic in 2020, the program went fully online for the first time, incorporating a strong emphasis on pandemics, health disparities, and emergency preparedness. In addition, the organization had to adopt a virtual regional approach that would provide a learning experience as valuable as that offered in previous years and encourage networking within and across regions. The 2020 facilitators were former GNLI scholars from across all six WHO regions; to qualify, they were invited to apply for the position; demonstrate their commitment to participate; and complete a training program that included enhancement of facilitation skills, an overview of responsibilities, familiarity with the 2020 program, and reflective self-assessment. Two facilitators per region were selected to ensure continuity.

The GNLI 2020 scholars virtually attended several all-scholar sessions that maintained a global focus and encouraged cross-regional connections. However, most of the program occurred in full-day, biweekly regional sessions that culminated in the creation of a project of regional importance and priority, with an emphasis on the SDGs. Scholars also developed individual policy-related projects aligned with the SDGs.

PAHO scholars had the opportunity to hear about regional priorities from Silvia Cassiani, PhD, RN, FAAN, the regional advisor on nursing and allied health personnel in the health systems and services division of the WHO PAHO regional office. She highlighted several areas of interest, including the expansion of nurses’ role in primary care, advanced nursing practice, workforce educational development, and the economic value of nursing. As the WHO PAHO region includes four primary languages across 36 countries, Cassiani emphasized the importance of being mindful of cultural nuances throughout the PAHO region to maximize the inclusion of multiple countries in the project. The scholars faced the challenge of situating their individual interests within a PAHO regional priority in order to produce a cohesive project that incorporates the region’s diverse cultures, languages, and nursing workforce needs. While the PAHO regional project is currently in development, it will include a health policy summit to elicit input from nurse leaders throughout the region on specific policy priorities, such as maximizing nurses’ role in pandemics.

GNLI AND THE SDGs: PROJECT EXEMPLARS

The GNLI responds proactively to changing priorities in health and nursing worldwide. For the past five years, the program has identified and championed opportunities for nursing within a global movement committed to sustainable development, in alignment with the SDGs, whose focus transcends health systems and includes such factors as gender equality, climate change, employment, and economic growth. The organization also examines the nursing initiatives created to respond to the SDGs, including the Nursing Now campaign and the WHO International Year of the Nurse and the Midwife.

Below are exemplars of individual projects led by three GNLI scholars that advance various SDG targets through leadership and policy development:

Exemplar 1—Policy to action: public health nursing workforce initiative.

In the fall of 2020, the Association of Community Health Nursing Educators policy committee and the Council of Public Health Nursing Organizations became increasingly concerned with the limited advocacy and rising complexity related to access to the COVID-19 vaccine.¹⁰ The emergency authorization of multiple COVID-19 vaccines called for multiple state- and community-level action plans, complicated by workforce shortages, population density, and local storage capacity. The logistics of distribution became highly problematic, significantly limiting or prohibiting access for at-risk populations, especially those living in rural areas.¹¹ Despite the public health recommendations and demand for vaccination, distribution centers offered limited vaccination schedules, as nurses were simultaneously needed to staff COVID-19 testing centers and manage inpatient COVID-19 hospitalizations.

This project, led by coauthor Chesanny Butler, addressed SDG targets 3.3 and 3.8, which focus on the mitigation of pandemics and epidemics caused by communicable diseases (see Sustainable Development Goal Targets 3.3 and 3.8¹²). Its genesis was a national policy strategy statement encouraging nurse leaders to lobby and engage state governors, through state boards of nursing, to create emergency legislation temporarily allowing trained medical students, nursing students, and retired qualified nurses to administer vaccines during this crisis.^13–15 To meet the demands of emergency distribution policy and create additional vaccination sites, state and local agencies partnered together, increasing local community access to the vaccine and providing a much-needed mechanism to reduce health inequities for populations that might otherwise have gone unvaccinated.

Sustainable Development Goal Targets 3.3 and 3.8¹².

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

Exemplar 2—Nursing contributions to policy coherence for health policy action.

Around the world, calls have increased for nurses’ participation in policy making. From the WHO’s State of the World’s Nursing 2020 report⁶ to the recognition of nursing contributions during the COVID-19 pandemic, policy work is being recognized as an essential component of nursing practice. However, nurses’ ability to engage in policy is hindered by a lack of “policy coherence,” which can be defined as systematic coordination and collective action between agencies and actors to achieve health goals.^{16, 17} The coherence of the policy environment enables nurses to meaningfully engage with health policy, using the right interventions at the right level. Without coherence—both within the profession and in the policy environment—nurses are less likely to be successful in this area. The need to address policy coherence is in fact noted in SDG 17.14: “Enhance policy coherence for sustainable development.”¹² The Organisation for Economic Co-operation and Development has also identified policy coherence as essential to achieving ambitious social policy.¹⁷

In the context of the 2020 GNLI program, a Canadian-based project led by coauthor Angela Wignall was developed to examine the structural barriers to coherence in nursing policy. Starting with exploratory conversations with key nursing leaders, the project aims to strengthen national and global conversations on making policy integral to nursing practice, charting the variety of locations where nurses can engage with policy, and identifying structural gaps that interrupt coordinated, coherent action.

Exemplar 3—Advancing palliative care advocacy: local to global.

Per the 2020 Global Atlas of Palliative Care, 57 million people worldwide need palliative care services annually but only 12% receive it.¹⁸ By 2060, the international burden of serious health-related suffering at the end of life requiring palliative care is expected to increase by 87%.¹⁹

At the 2019 United Nations high-level meeting on universal health coverage (UHC), the provision of accessible palliative care was officially integrated into the definition of UHC, as a component of SDG target 3.8.²⁰ In other words, UHC is impossible to achieve without universal access to palliative care.

This project, led by coauthor William E. Rosa, focused on leveraging the palliative nursing workforce to achieve universal access to palliative care, locally and globally.²¹ First, through an academic cancer center–sponsored virtual conference in New York City, participants, who formed a global interdisciplinary community, identified lessons learned during the COVID-19 pandemic that could be of benefit to palliative care specialists.²² Next, Rosa accepted a role as the International Association for Hospice and Palliative Care USA Advocacy Focal Point to work with various U.S. stakeholders to advance palliative care policy.²³ Finally, a series of papers were published promoting policies that highlight evidence-based palliative care, engage the nursing profession in achieving access to universal palliative care (and by extension SDG target 3.8), and call on nurses to strengthen and contribute both primary and specialist palliative care expertise during the COVID-19 pandemic and in future humanitarian crises.^{21, 24–26}

CONCLUSION

COVID-19 has hindered the achievement of the SDGs worldwide.²⁷ To meet the demands of SDGs at local and global levels, the nursing workforce needs to develop leadership skills and effectively engage with policy formulation.^{28, 29} The ICN GNLI program provides the training, networks, and reflective practice necessary to nurture nurse leaders capable of meeting society’s rapidly evolving health needs.