Current Issue
New Allies in Global Health
Rules of the Road
Making Bigger Beds
Health Care Hero
Passport for Change
From the Dean
News Briefs
Alumni News
Past Issues
Contact Us
Make A Gift
Other Publications
School of Nursing

  
  
  
  


he nursing leaders were enthusiastic and a little nervous. All eyes were focused on the group—15 government chief nursing officers (CNOs) from different parts of the world—as they stood before their audience for a voluntary exercise. Their instructions: Without talking, place yourself in line according to how powerful you see yourself.
     As the CNOs jockeyed for position, some stood in the middle and some to the right, the “most powerful” side of the line. Upon reflection and some good-natured gesturing, most of the CNOs inched their way from the middle over to the right for good.
     “Standing on your own where you think you belong is a very powerful statement,” said Emory nursing Dean Marla Salmon, who led the exercise. “It takes tremendous courage to put yourself in a position of uncertainty.”
     Indeed, Salmon hit the proverbial nail on the head regarding leadership and risk-taking. Empowering nurses as leaders and partners in health care was the key purpose behind the 2004 Government Chief Nursing Officers Institute and Network meeting, hosted in Atlanta last June by the Lillian Carter Center for International Nursing and sponsored by Johnson & Johnson’s Campaign for Nursing’s Future.
     Developing leaders is also a key mission of the Lillian Carter Center, established four short years ago in the Nell Hodgson Woodruff School of Nursing. CNO partnerships themselves have a recent history, beginning informally when Dame Yvonne Moore, formerly CNO of England, brought leaders together during an International Council of Nursing meeting in the early 1990s. Interest in establishing a formal network grew, and in 1999 Lillian Carter Center staff conducted an international survey resulting in the first CNO Institute in 2001.
     During that meeting, the CNOs asked the Lillian Carter Center to serve as the secretariat of the Global Government Chief Nursing Officers Network. In this role, the Lillian Carter Center promotes the professional development of nurses in senior government leadership roles; strengthens their collaborations with key partners in education, government, business, and the nonprofit sector; and maintains a website for networking and communication.

POWER THROUGH PARTNERSHIP

ower” and “partnership” definitely were the buzzwords for participants at the 2004 CNO Institute. Like the first gathering in 2001, the institute brought CNOs from developed and developing nations together for candid and compelling discussions about professional development, best practices, leadership models, and resource allocation. By the time the institute ended, nursing leaders were better prepared to guide and shape health policy in their respective countries and address health issues on a global scale. Reinvigorated, the CNOs then joined medical and public health experts for the Global Government Health Partners Leadership Forum (see related story on “New Allies for Global Health”).
     Rosa Santamaria of Ecuador is definitely part of the global nursing leadership network. She attended the 2001 CNO Institute, where her “eyes were opened” regarding leadership skills to advance her profession and her nation’s health. “We needed more support for nursing, and wages have gone up as a result,” Santamaria said during the 2004 Institute. “Nurses don’t have the same level of authority in Latin America, and the nurses union took the initiative to get more involved. We are looking to play a more permanent leadership role.”
     In Eastern Europe, CNOs and their colleagues there are struggling to rebuild health care systems in countries torn apart by civil war. “My participation here is a very big contribution to my country,” said Fetije Huruglica, CNO for Kosovo, where she helped lead the effort to establish a university-level college of nursing and a center for continuing education. “We used to have to go to Croatia or Belgrade to study.”
     For the CNO from Yemen, the 2004 Institute provided him with new ideas for communication and collaboration in a nation where relations between physicians and nurses are sometimes strained. “We need to remember we have the same goal—caring for our patients,” said Yousef Ahmed Ali Al-Shaabi, patting his suit jacket over his heart.


VOICES OF EXPERIENCE

or nursing leaders, there is definitely power in networking as the world shrinks in proportion to the number of nurses they know. “It’s a small world,” said Denise Geolot, director of the Division of Nursing in the US Department of Health and Human Services. “What you accomplish is often not a result of who you are but the relationships you have. Invest in networking.”
     Geolot offered her perspective during a panel session in which leaders from four nations shared key lessons they had learned as CNOs. “Be decisive,” said Jean Jacob of Dominica. “Do not take your job for granted. Use your nursing experience and training. The CNO has got to be the one who leads the way.”
     In Iceland, Ragnheiour Haraldsdottir has served her nation as CNO for 10 years—a journey characterized by “blood, sweat, and tears.” During that time, she has maintained a broad view of people’s health, built
alliances, adopted suitable language
to portray her profession properly at an administrative level, developed a sixth sense, and welcomed new tasks to continue growing. Serving as CNO is “one of the greatest roles anyone can imagine,” she told participants. “It’s something that should be celebrated in all our countries. ”
     Of course there are challenges. “It’s lonely when the minister of health opposes you and you must adhere to the principles of nursing,” said Anne Jarvie, recently retired as the CNO of Scotland. “It’s important to find ‘safe zones’ in networks of people who can advise you.”
     Though not a government nurse, Jane Salvage offered a global perspective on CNOs as then-nursing and midwifery advisor to the World Health Organization. “The CNO is an enabler, a facilitator, and a steward,” Salvage explained. “Whether a country is rich or poor, these principles apply wherever you work and will lead to better health for our planet.”


NEVER WORK ALONE

hen Bill Gates built his first computer system, he worked in his garage. That system—Microsoft—made him one of the richest men in the world. When Gates wanted to share his good fortune by providing every child with a computer, others convinced him to take a different path, leading him to donate $750 million to immunize children by age 5. Whether saving lives by vaccinating the world’s children or stemming the flow of nurses from the Caribbean, such goals are unattainable without partnerships.
     “The magnitude of problems is insurmountable if you work alone,” noted Wendy Rhein, director of service learning in the School of Nursing.
      For nurses in Ireland and Northern Ireland, collaboration was a fleeting notion until the Belfast Agreement of 1998, which officially ended the civil conflict between both nations. Today, nurses there are working on joint initiatives to improve public health practices and cancer services. Judith Hill, CNO of Northern Ireland, and Mary McCarthy, CNO of the Republic of Ireland, are leading these efforts. They met for the first time while traveling together to the 2001
CNO Institute in Atlanta. Their journey together laid the foundation for friendship and collaboration.
     “We discovered we are all normal people working together on similar things, and we could achieve more by working together,” said McCarthy.
     The same notion holds true for Frances Hughes, chief advisor for nursing in New Zealand, and Jill White, dean of nursing at the University of Sydney in Australia. Though they work in different sectors, they have collaborated to improve nursing retention, rethink educational standards, and understand the impact of SARS on nurses and countries in Southeast Asia and the Western Pacific. Working together “has broadened our world view,” said White. “It helps keep us focused on our reason for being—making a difference in patient care—and changing nursing through education and research.”
RICH REWARDS

he 2004 Institute provided an opportunity to celebrate the professional contributions that CNOs have made. Of the more than 60 CNOs who attended, 11 are retiring, including Diana Tuinei of the American Samoa, who was the oldest CNO present at age 70 and the longest-serving nurse at 49 years.
     The Lillian Carter Center also honored four outstanding leaders for their contributions to nursing. Those honored included Andrea Higham, director of Johnson & Johnson’s Campaign for Nursing’s Future, and Nancy Lewin, who preceded Higham in that role. Both leaders played an important role in developing a similar campaign for recruiting and retaining nurses in the Caribbean. Also honored were Dr. Jean Yan, chief scientist for nursing and midwifery with the World Health Organization, and Dr. Anna Maslin, international officer for nursing and midwifery for the Department of Health in London and chair of the Commonwealth Health Ministers Steering Committee for Nursing and Midwifery.
     As the recipients accepted each of their awards—a Fräbel glass sculpture of dogwood blossoms, Georgia’s state flower—all acknowledged the valuable roles that nursing leaders play around the globe.
     “You truly are making a difference,” Higham told the CNOs. “What you do for your communities is outstanding.”
     
     
 

n Afghanistan, 20 years of civil conflict have destroyed millions of lives along with the nation’s health and education systems. In Sudan, in the same amount of time, civil war has claimed 2 million lives and displaced 40 million people. Two School of Nursing alumna hope to improve the lives of people and caregivers in both nations as US Public Health Service officers with the CDC.
     More than a year ago, Kitty MacFarlane, 81N, 92MN/MPH, a nurse consultant with the National Center for Chronic Disease Prevention and Health Promotion, traveled to Afghanistan to assess war’s impact on the health and performance of maternal, infant, and pediatric nurses at a hospital in Kabul. MacFarlane observed a high rate of absenteeism; a lack of empathy for staff, patients, and each other; hoarding of supplies; and a refusal to use proper ID on their name badges. She also found that less than 10% of the staff had been vaccinated for Hepatitis B, some experienced vision and back problems, and some were clinically depressed. As a result, MacFarlane’s team is developing a program of health, safety, and emotional support that ultimately may serve as a model for all hospital workers.
     “We’ve started to think about whether there is a particular constellation of symptoms of health care workers in war trauma,” MacFarlane told chief nursing officers (CNOs) and chief medical officers (CMOs) attending a series of workshops held prior to the 2004 Global Government Health Partners
Leadership Forum in Atlanta.
     Fellow officer Jenny Williams, 96N, 01MSN/MPH, traveled to southern Sudan in 2002 to assess sexually transmitted infections and behavioral risks. Her team conducted household surveys of people ages 15 to 49, collected blood specimens to screen for HIV and syphilis, provided culturally sensitive education materials and counseling, distributed condoms, and treated people with syphilis. All had to be accomplished before the rainy season began and in remote communities with low literacy rates and where sexually transmitted disease carried the risks of stigma and vviolence for women.
     “We had to ask ourselves was it wise to inform someone,” said Williams, a nurse epidemiologist with the CDC’s National Center on Birth Defects and Developmental Disabilities. “We decided to refer people to local services where they could seek confidential counseling and treatment.”
     For Dragica Simunec, the CNO
of Croatia, the health of patients and caregivers is never far from heart or mind. Although the civil war between Croatia and Serbia ended several years ago, her nation is still struggling to recover. During the height of the war, people’s homes were destroyed, and many sought shelter in hospitals.
     “The hospital was the only place anyone could go,” said Simunec, a workshop attendee. Health care workers did not go home for months. Water and electricity were scarce. Transportation for the wounded was lacking. And the influx of refuges from Bosnia strained limited health care resources even more.
     “They did not have enough attention from us,” Simunec said. “Some people did not even know where they were.”
     Whatever the challenge, nurses were on the frontlines, day and night, summer and winter. “You had no idea what was put in front of you,” she said. “You just had to do it.”
 
     



   
   
   
   
   
   
   
 

Copyright © Emory University, 2005. All Rights Reserved