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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.
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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.”
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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.” |
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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.” |
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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.” |
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