ICN Latin America webinar – June 14 2022

The International Council of Nurses (ICN) held a webinar on June 14 2022 to discuss nursing in Latin America.

The webinar, which was chaired by ICN Chief Executive Officer Howard Catton, included contributions from ICN President Pamela Cipriano, Mr Catton, ICN Board members Nora Eloisa Barahona de Peñate and José Luis Cobos Serrano, PAHO Regional Advisor for Nursing Silvia Cassiani, the presidents of 15 Latin American National Nursing Associations (NNAs) and ICN Nurse Consultant Erica Burton.

Dr Cipriano opened the webinar by emphasising how important it is for ICN to hear about the work of NNAs and the situations on the ground in each country so that it can better understand and support NNAs’ work. She spoke about the #nursesforpeace campaign and thanked individual nurses and NNAs for their generous donations to the ICN Humanitarian Fund.

She mentioned that May was a busy month for nurses everywhere: “It is the culmination of many academic organisations with their graduations. It is also a time for gathering planning across our associations as you are looking at the implementation of ways to recover your workforce, to address their wellbeing and protection, as well as planning for the future for how we can have a new status emerging from the effects of the pandemic. I am so pleased that so many of our Latin American members can join us to have these conversations today. It will help us to stay as relevant as possible and to speed on all of the activities and issues of concern.”

ICN Board Member and El Salvador Nurses Association former President Nora Eloisa Barahona de Peñate stressed the importance of the meeting in bringing together nurses from Latin America to share the issues they face. She said that in El Salvador the shortage of nurses was the NNA’s top priority, and that increasing the number of nurses was important across the whole region.

Howard Catton gave an overview of ICN activities in recent weeks including the launch of International Nurses Day (IND), which has been very well received and achieved an extremely wide reach on social media, and the ICN/World Health Organization(WHO)/International Confederation of Midwives Triad meetings. He also highlighted the #nursesforpeace campaign for nurses in Ukraine, and the Caring with Courage project that ICN has undertaken with the BBC, which has created high-quality short films about nursing care around the world.

Dr Cipriano spoke about the Triad meetings and how they were an opportunity for nurses to meet WHO staff to address how to strengthen the profession. The meetings consisted of 650 delegates from 165 countries, and the aim was to ensure that the work of all three organisations is aligned with the Global Strategic Directions for Nursing and Midwifery (GSDNM) and its focus on nursing jobs, education, leadership and practice, to which ICN has added safeguarding and protecting nurses, and nurses’ mental health and wellbeing.

Dr Cipriano said: “Many effects of the pandemic disrupted health services. Nurses were ill, overworked, highly stressed and unable to deliver services. We know we must support the nursing workforce to maintain essential services. We must have new investment so that we can have adequate staffing, good working conditions, career opportunities and professional development and fair pay. We are calling for investment in the nursing workforce - we must invest in nursing if we want to have universal healthcare, reduce preventable deaths, cope with another pandemic and recover from the effects of the current one.”

ICN Nurse Consultant Erica Burton spoke about ICN’s 70-strong delegation to the virtual World Health Assembly, which was also in May. ICN’s official relations with WHO mean that it can contribute to the WHA agenda. Ms Burton said the delegation consisted of nurses from 40 countries, NNA representatives, Global nursing Leadership Institute scholars and alumni and a small group of ICN staff. They delivered interventions on human resources for health, strengthening WHO's preparedness and response to health emergencies, infection prevention and control, the public health dimension of the world drug problem, the Global Health for Peace Initiative, prevention and control of non-communicable diseases and human organ and tissue transplants.

Ms Burton mentioned the support ICN received from WHO Director General Dr Tedros and quoted a Tweet from him, which read: “Nurses have shown over and over that they are the cornerstone of health around the world. I salute all of them for their tireless dedication and resolve. Thank you ICN for your strong collaboration with WHO to advance nursing.”

PAHO Regional Advisor for Nursing Dr Silvia Cassiani congratulated ICN for holding the webinar and its importance for bringing together nurses in the region. She said that all nurses should keep the GSDNM close to hand and look at it daily because it contains all the recommendations, advice and strategic decisions needed to protect the nursing workforce. She said the key issue for nursing is investment by government to advance the profession.

Interventions from Latin American NNAs

Argentina

President of the Argentinian Nurses Federation Ruben Lastra said it is important to acknowledge the impact of the COVID-19 pandemic and the war in Ukraine, which are causing a shock in world economy and increases in inflation. She said that in Argentina, which has the fifth highest inflation in the world, it is having a big impact on the nursing profession and the healthcare sector in general. She spoke about poverty in her country and how its successful vaccination campaign gave nurse hope for the future.

Ms Lastra said many nurses have to work more than one job to be able to afford to live, and she urged countries to adopt the International Labour Organisation’s (ILO) Nursing Personnel Convention to help secure decent pay and working conditions for nurses.

Bolivia

College of Nurses of Bolivia President Elba Olivera said her country shares similar issues, but in addition Bolivia has a section of the population that is vulnerable who have not been vaccinated. “We have a high rate of COVID-19 infections and a long way to go.” She said inadequate salaries were a big problem, and that not having a government level chief nursing officer means it is hard to influence policies at the highest level. She also called for implementation of the ILO convention and said she wanted ICN to be more active in bringing NNAs to the WHA meeting.

Costa Rica

Costa Rica College of Nurses President Carmen Loaiza Madriz described a similar situation. She said an important issue that the country is facing is differentiating between nurses and nursing assistants. Many organisations are hiring assistants instead of nurses, which means nurses are having to accept lower paid precarious employment rather than proper nursing jobs ‘because they have to eat.’ She said nurses are getting increasingly frustrated and it can lead to conflicts between staff. She called for the ratification of the ILO Nursing Convention in Costa Rica.

Ecuador

President of the Ecuadorian Nurses Federation Maria Gerardina Merchan said her country is facing similar problems and expressed her gratitude to ICN for its assistance in ‘technical and research areas’. She said previous governments had weakened nursing institutions and hindered the nursing profession in its attempts to have a major role in providing care. She said there are huge differences in salary levels between public and private health care employees and that job security is scarce. The NNA is focused on growing its membership and ‘working to increase our participation in policy making’.

Guatemala

President of the Guatemalan Association of Professional Nurses Ingrid Patricia Figueroa Salan said many professional nurses are working as assistants or technicians. She said many nurses have a lot of experience, but a lack of funds means they are unable to study for advanced qualifications and certification. “We want nurses to have professional certificates to enable them to access any position, because they have received offered jobs abroad, but they need that official certificate.” She said society does not generally recognise what nurses do or their qualifications. She suggested having agreements with other countries so that nurses could go on exchanges to share their experiences and learn from each other’s public health services.

Honduras

President College of Nursing Professionals of Honduras Ela Dianira Marquez said the reality in Honduras is very similar. Nurses work under precarious conditions, with a high percentage unemployed. She said a health model programme was introduced which make working conditions even worse. Salaries are not equal because a law establishing rights and responsibilities is not complied with. “We have put forward may claims against the Health Ministry to improve conditions and nursing regulation, but the pandemic has made the situation worse. It highlighted the shortage of nurses in public health services and showed the need for specialist nurses.” She said the public university has for the first time created specialist nurses to work in ICU and community health. She said the structure of nursing needs to be adapted so that it can tackle tuberculosis, AIDS and other emerging issues.

Mexico

General Secretary of the Mexican National College of Nurses Celia Avendaño Rojas Mexico said its main priorities are researching into the needs of the nursing workforce, improving nurses’ working conditions - some have two or three jobs to make ends meet. Nurses’ wellbeing and the wellbeing of the population are important because so much health care was cancelled during the pandemic. She called for closer collaboration with ICN to continue with the College’s leadership programme.

Mexico

President of the Mexican Federation of Nursing Colleges Maria Teresa Maldonado said the nursing profession in Mexico is not given enough credibility. She said changes need to be made to close loopholes in the legislation to improve nurses’ working conditions. She requested that ICN tries to influent the Mexican government to sign the ILO Nursing Convention to improve the working conditions of nurses to have salaries that match other professions with the same education and responsibilities as nurses. She also called for nurse managers to have the same remuneration as other health service managers to reflect their similar responsibilities. She said Mexico is short of many nurses and that it is looking to recruit from other countries to fill workforce gaps.

Nicaragua

President of the Nurses Association of Nicaragua Maria Auxiliadora Useda Chavez said nurses in her country are also facing many challenges. She said the main objective of the association is to strengthen leadership in the country’s member associations. She said the voices of nurses must be heard everywhere and what is needed is participation at government level in nursing education, employment, practice and leadership. She said collaboration between the Latin American Professional Nurses’ Federation (La Federación Panamericana de Profesionales de Enfermería), ICN, the Pan American Health Organisation and others is important to make sure that governments invest adequately in nursing. She said it is important to make sure that ministers who attend high level international meetings do not keep any findings secret: “We need to make sure they are applying the recommendations of the World Health Organization.”

Paraguay

President of the National Nurses Association of Paraguay Mirna Gallardo said Paraguayan nurses had secured a law that will, in the long run, mean a better acknowledgement of the work of nurses. She said it would also help nurses to avoid having to have two or three jobs, and the horrible effects that has on their quality of life. She said the next priority is to get nurses into decision making forums so that they can influence healthcare. She said support from ICN would be needed to help to achieve that aim

Peru

Dean of the College of Nurses of Peru Josefa Vásquez Cevallos said Peru, like many other Latin American countries, has a nurse staffing crisis, with many nurses having been laid off. She said the College had met with the government but any promises have not been fulfilled. She asked ICN for help by contacting the country’s President and Minister for Health and asking them to work on new remuneration policies. She said nurses want to have equal pay for the work they do, and that nurses in leadership positions, many with PhDs, are not getting remunerated properly for the responsibilities they have.

Uruguay

President of the College of Nurses of Uruguay Silvia Calveira said that nursing needs to be more visible and that the voices of nurses need to be heard wherever health policy decisions are made. She called for greater collaboration with others: the country has 25,000 nurses but 73,000 nursing assistants who are doing technical work but not being recognised for it. “We are key stakeholders and the pandemic has shown how we are important to be there to work together to design national health strategies and programmes. We need to be well represented and to participate in organisations when budgets are being designed.” She said that, as in other Latin American countries, many nurses have more than one job because pay is inadequate. She expressed her pride in the success of Uruguay’s COVID vaccination programme, which had succeeded 90% of the population having received two doses, and 70% three doses.

La Federación Panamericana de Profesionales de Enfermería (FEPPEN)

FEPPEN President Maria Concepción Chavez said the issues raised showed the need for a working group to be set up between ICN and FEPPEN to look at a number of aspects relating to the nursing workforce, including nurse training and working conditions.

Columbia

President, National Nurses Association of Colombia Gilma Rico González said major areas of concern for nurses were their working conditions, education and leadership. She said it is hard to make employers aware that nurses are the backbone of all healthcare. “We have to improve nurses’ working conditions. “We need a quick intervention because nurses are leaving our country and we are suffering. We have to work on retaining nurses nursing and strengthen nursing in Columbia and the world.”

Cuba

President of the Cuban Nurses Association Idalmas Infante CUBA said since the pandemic Cuba’s nurses are working on strengthening primary care. She said good use of data had enabled nurses to take chronic illness and vulnerable groups into account, including older people, teenagers and pregnant women. She said nurses who qualify have guaranteed jobs and that a new Masters programme in older people’s care had recently been developed. She said Cuban nurses are keen to collaborate with others in the Latin American region to increase support internationally.

Panel Discussion chaired by Howard Catton

ICN Board Member & Consejo General de Enfermería de España, Dr. José Luis Cobos Serrano remarked on the similarities between the issues faced by countries in the region. He said it was important to work with ICN but also for countries to be proactive and for NNAs to share whatever they can with their colleagues. “As a member of ICN board I am going to ensure that everyone will commit to share and to work with NNAs and work on nursing around the world.

ICN President Dr Pamela Cipriano recognised how important it is for nurses to influence presidents and government ministers. She said NNAs should look at their media strategies and how best to “tell our stories.” “How can we get others to join us, to set up campaigns to talk to ministers so they can hear the issues that we have heard today? They will have to listen. The workforce has suffered tremendously, and if they want a workforce, they are going to have to pay attention. There are likely other organisations from other professions that will join in this discussion - so many other disciplines were affected as well. Clearly, we have a real need to cooperate together around these mutual issues.”

ICN Board Member & El Salvador Nurses Association, Nora Eloisa Barahona De Peñate emphasised the importance of identifying key stakeholders who could be enlisted as collaborators. “We cannot work alone. We need to work with others and have one single voice. We can see how alliances will help us to improve our outcomes to meet the needs expressed today.”

Regional Advisor for Nursing, PAHO, Dr. Silvia Cassiani summarised the challenges faced by nurses in the region, including the need to have a strategic plan, increasing political dialogue, increasing the number of students in training, reducing the number of nurses who want to leave a particular country to practice elsewhere, the importance of adequate remuneration to prevent nurses having to have more than one job, the necessity for continuous professional development and leadership development, especially in relation to transformational leadership. Dr Cassiani said there were lots of important positive examples given during the webinar that showed the advancement of nursing in the Latin American region. She praised Columbia and its Ministry of Health for having developed a national policy for nursing and a ten-year strategic plan, and encouraged other NNAs to use Columbia’s experience to develop their own similar policies. She said Honduras and Cuba’s success in raising the number of nursing students in training were good examples that others could also follow. Dr Cassiani agreed that a taskforce is needed to address the common issues discussed in the webinar and said PAHO would be willing to join it.

Closing remarks

ICN President Pamela Cipriano thanked everyone for their participation and said the meeting had identified important issues that must be addressed, including workforce shortage, pay and the strain nurses are under, including from the threat of unemployment, having to work multiple jobs and not having safe working conditions.

“We heard you loud and clear about the continuing need for leadership development and our ability to come together to support you in those efforts to influence laws, regulations and policies in your countries. This only strengthens our ability to come together with the resolve that we want to help all of our NNAs and all of our regions to address the unique issues that that they have but also, we know that we share many of these issues around all of our regions. I want to thank everyone for your honesty, your clarity and your commitment to working together to be able to make ICN’s impact even stronger – our ability to influence change in all of these areas is what it’s all about.”

Download the communique here

Watch the webinar recording here (ENG)