Following in the Footsteps of Florence: We need better policies to protect nurses at the frontline of crises

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This article is part of a series in which OECD experts and thought leaders – from around the world and all parts of society – address the COVID-19 crisis, discussing and developing solutions now and for the future. It aims to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge. Opinions expressed do not necessarily represent the views of the OECD.

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British social reformer, statistician and nurse Florence Nightingale’s influence on society and politics, philosophy, science, education and literature is well established. On political matters, she was an astute behind-the-scenes activist. She relied on data as she campaigned politicians to improve nurses’ working conditions.

"Florence Nightingale relied on data as she campaigned politicians to improve nurses’ working conditions"

Throughout European history, since the time of Florence Nightingale, when health crises occur, the nursing profession is always at the frontline serving citizens and patients. In times of war and pandemics, when populations need healing and support, nurses are always exposed, day and night. For that reason, European nurses expect EU and national leaders and health stakeholders to take concrete and immediate actions to support them.

In the current context, it is key to reflect on existing EU legislation to strengthen healthcare systems in the bloc and – importantly – support and protect frontline nurses as they put their own lives at risk. The COVID-19 outbreak is having an unforeseen impact across all EU countries, and it is affecting all layers of society. It is reshaping EU political priorities, strategies and budgets to ensure the EU takes cohesive and co-ordinated action. The European Commission is a key stakeholder for the nursing profession, but a new area of co-operation has emerged: the co-ordination of actions to tackle the health crisis with EU Member States.

Resilient Health Systems: What we are learning from the COVID-19 crisis, by Francesca Colombo, Head, Health Division, Directorate for Employment, Labour and Social Affairs, OECD

The main takeaway of the COVID-19 outbreak is that the European Commission needs to look for formulas to solve the “subsidiarity nightmare”, at least in the context of the health crisis, and ensure that the EU can act in a co-ordinated and even manner across all EU countries. If the European Commission and Member States fail in this, there is a risk that EU institutions might be perceived as a bureaucratic, complex and potentially unreliable in the context of health emergencies. The COVID-19 crisis is proving that keeping healthcare governance at the national level is creating more problems than solutions, as different approaches to tackle the emerging health crisis confuse and even upset EU citizens, putting their trust in the EU at risk. The European Commission should not only facilitate collaboration among Member States but aim to increase its set of competences in the health area.

Read the OECD's analysis on the State of Health in the EU

Read the OECD's analysis on the State of Health in the EU

EU institutions should actively engage with all EU health stakeholders, especially nurses. In doing so, EU countries would be much better prepared for frontline action, now and for the next health emergency. This can be done by focusing on the collection of robust data at EU level from the professions concerned – in our case, 3 million nurses – to assess the impact of the lack of preparedness, draw lessons and anticipate the next crisis.  

All stakeholders need to turn the COVID-19 crisis into more EU action – not just another awareness campaign, lifelong learning course, National congress or webinar discussing the challenges rather than solving them. A frontline approach, supported by the EU institutions, Parliament, Commission and Council, is urgently needed to protect EU citizens and its health workforce in times of emergency and crisis.

Unions must support a stronger public COVID-19 response and a new global economy, by Rosa Pavanelli, General Secretary, Public Services International

The COVID-19 crisis further reveals the importance of the Nursing Now! campaign, which aims to improve health by raising the status and profile of nurses globally and maximising their contribution to Universal Health Coverage, women’s empowerment and economic development. The European Federation of Nurses Association is Europe’s regional campaign co-ordinator, elevating the role of nurses in the healthcare ecosystem, and now seizing the COVID-19 pandemic as an opportunity to demonstrate the critical nature of their contribution to patients and citizens’ health.

Nursing Now!

Florence Nightingale sought to improve the precariousness of nurses’ working conditions and set standards for hospitals and patient care. These became foundational to the development of modern nursing. She elevated the nursing profession’s reputation with better education standards, which in turn encouraged more women to enter the profession than ever before. The European Federation of Nurses Association encourages the OECD to follow in Florence’s footsteps and support nurses and nursing through fit-for-purpose policies.

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Tackling COVID-19 Health

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Go to the profile of Paul De Raeve

Paul De Raeve

Secretary-General, European Federation of Nurses Associations

In 2002, Paul was appointed as General Secretary of the European Federation of Nurses Associations (EFN). EFN activities relate to the promotion and protection of nurses and the nursing profession with particular reference to the EU. In 2014, he became coordinator of ENS4Care, a European Thematic Network focusing on evidence based guidelines for e-services in healthcare.

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