Nurses are the glue to clinical life. They are on the front line of care provision, they make us feel at home at our most desperate and vulnerable, and they make up 90% of healthcare provision worldwide.  They are undisputedly invaluable to every society and nation and this is celebrated through an annual day of interactive recognition, education and empowerment: International Nurses Day (IND).
IND takes place every year on the anniversary of Florence Nightingale’s birthday, 12th May. Each new year brings a new theme of international focus to act as encouragement for nurses to raise awareness across communities about their profession through public engagement. Each year an IND kit is distributed containing a range of educational and public materials, which can then be utilised as material both for outreach and independent learning. Previous themes have included: Mental Health: Nurses in Action (1991), Nurses Always There for You: Caring for Families (2002), Safe Staffing saves lives (2006) and Closing the Gap: Increasing Access and Equality (2011). IND 2016 brought the theme of, Nurses: A Forces for Change: Improving Health Systems’ Resilience.
“The resilience of a health system is its capacity to respond, adapt, and strengthen when exposed to a shock, such as a disease outbreak, natural disaster, or conflict.” This year’s theme is particularly pertinent as the necessity for health systems that are strong, resilient and able to respond quickly and effectively to challenges is central to the actualisation of the United Nations’ Sustainable Development Goals (SDGs). Despite substantial progress achieved by the millennium development goals, it was not as equitable, effective or sustainable as it could have been. This was largely due to the fact that health systems lacking core capacity in governance, financing, health workforce, or information systems often struggle with essential health service provision and planning for unexpected changes. As a result, their ability to respond in a crisis is usually limited and improvements can easily revert. This was clearly illustrated in the recent Ebola outbreak which showed how the fragility of a health system can undermine even the best of efforts.
As the largest group of health professionals present in virtually all healthcare settings, nurses have considerable influence on the resilience of health systems. They have a long-standing reputation for their ability to adapt as the needs of society change, and the World Health Organisation and a number of governments are increasingly attesting to nurses’ contribution to clinical and public health. In the IND Kit, there is a list of nine suggested areas where nurses can have a substantial input on health systems and health workforce strengthening.  These are:
Leading and supporting inter-professional education (IPE) and inter-professional collaborative practice (IPCP).
Advocating for a paradigm and operational shift in health care that balances illness focused care with population health.
Identifying and championing global and national strategies to address health workforce maldistribution and migration.
Strengthening and diversifying primary health care.
Ensuring a strong nursing voice in all health and social system policy development and planning dialogues.
Considering the influence of regulation and legislation on the health system and HRH planning issues.
Designing and improving information infrastructures and data collection to support health system redesign and planning.
Participating in research related to HRH and in health systems research and evaluation
Considering the influence of complex, ubiquitous social and gender issues such as the determinants of health, and inequality and inequity.
In light of ongoing Brexit discussions, it is interesting to consider the National Health Service’s ‘capacity to respond, adapt, and strengthen’ should Britain leave the EU.
The establishment of the European Union has made it possible for workers to freely move around the EU without visas, enabling UK industries, like the NHS, to easily recruit workers from other EU countries. There are around 350,000 nurses working in the UK, about a third of whom come from abroad. As a result, of the countries that make up the EU, the UK is the most reliant on healthcare professionals from abroad. [4, 5] The highest number of immigrated qualified nurses come from the Philippines and India. However, EU countries such as Poland, Portugal and Spain also provide a significant number of nursing staff to the NHS.
With the upcoming referendum that will decide whether or not Britain will leave the EU, politicians and senior NHS Trust spokespersons have expressed concerns about how to fill job vacancies without the luxury of EU recruitment. Although the rights of the 2.2 million EU citizens already residing in Britain would apparently remain unchanged, a South Warwickshire Foundation Trust spokesperson expressed concern that finding staff would be an issue since “there is a national shortage of UK nurses and therefore we are recruiting EU nurses for vacancies”. [6, 7] The Health Secretary Jeremy Hunt has pointed out that the potential of “losing some of the 100,000 skilled EU workers who work in our health and social care system” would cause severe damage to the NHS.  He also argued that leaving the EU would negatively impact on the economy, leaving less money for the NHS. However, others highlight that “Brexit” would not affect NHS staff as much since the majority of foreign healthcare staff come from outside the EU and in fact more money would be available to fund the NHS.
Depending on the outcome of the upcoming referendum, the NHS may soon experience further shortages in its nursing staff, which may bring to light just how reliant our health system is on our nurses. Health systems around the world all face various challenges, and International Nurses Day is an opportunity highlight and appreciate the essential role nurses play in tackling these challenges and providing health care to people in the UK and worldwide.
 Campbell J et al. (2015). Improving the resilience and workforce of health systems for women’s, children’s, and adolescents’ health. BMJ 2015;351:h4148
 Shamian J et al, (2015) No global health without human resources for health (HRH): The nursing lens, Canadian Journal of Nursing Leadership Vol. 28 No. 1.