From the vantage point of severe disruption across healthcare settings, how do we keep moving forward, supporting nursing across the world? The challenges will take long-term strategies, not simply “producing” more nurses or moving nurses from country to country to solve immediate staffing shortages.
I am writing this editorial from Edinburgh, Scotland, where I am attending the Sigma Theta Tau’s 33rd International Nursing Research Congress. The setting is lovely and the international nurse audience of 1,000 nurse researchers, students, clinicians, and leaders coming together after several long years of pandemic isolation is filled with excitement and passion for nursing practice and science. With this perspective, while outside of the United States but surrounded by passionate nurses, most from resource-rich countries, I am wondering what can we learn about the state of international nursing, and particularly, oncology nursing across the world.
Nursing as a discipline faces pivotal challenges in multiple contexts, from existential threats to lack of viable career-spanning trajectories that promote clinical and scientific disciplinary outcomes, while providing for professional continuity and growth of individual nurses. The nursing shortage challenges a spectrum of nursing roles and career paths. Globally, the situation is dire. In a global nursing workforce of 27.9 million individuals, there are severe inequities in the distribution of nurses. Ninety percent of the global nursing shortage spans across Africa, Southeast Asia, and the Eastern Mediterranean. Contrasting economic challenges and unbalanced opportunities contribute to the disparate toll on nursing and other aspects of health care across the world (The Lancet, 2020). For middle- and lower-resourced countries, the emigration of nurses to higher-resourced countries poses additional challenges. In high-resourced countries, increased payments for traveling nurses have led to changes in traditional employer/employee relationships. Healthcare systems, including oncology services, have faced multiple challenges that have been magnified by the unparalleled effects of the COVID-19 pandemic on healthcare and its workers (Challinor et al., 2020).
From the vantage point of severe disruption across healthcare settings, how do we keep moving forward, supporting nursing across the world? The challenges will take long-term strategies, not simply “producing” more nurses or moving nurses from country to country to solve immediate staffing shortages. Innovative strategies for career spanning retention are needed in the United States and across the world. In the United States, one idea that is gaining prominence is the designation of nursing as a STEM (science, technology, engineering, and mathematics) discipline. Defining nursing as a STEM discipline could provide further validation of our profession as a scientific discipline, which could help to advance the contributions of nurses in multiple settings, including practice, policy, education, and research, across the world (Dreisbach et al., 2022). STEM designation could also draw individuals to the United States for further training to take back to their home countries (Davidson, 2019). For current oncology nurses, further focus on education levels and career paths, both inpatient and outpatient, is needed (Mezgebu et al., 2021). With the advent of the Doctor of Nursing Practice and the increased focus on quality improvement and evidence-based outcomes, a well-articulated program of study with a focus on oncology nursing could provide clinicians who also have the perspective and knowledge to lead both clinical and research endeavors at the bedside.
Focusing on the future of oncology nursing, across clinical practice and oncology nursing science, could be led by the Oncology Nursing Society and other nursing leadership organizations. Looking broadly, accompanying research foci with bold plans to reconceptualize practice and research could be done as another strategy. Although there are multiple oncology-focused nursing organizations with different foci and missions, further connection among nursing and other healthcare organizations can support the development of sustainable career pathways for nurses. We must continue encouraging global perspectives by integrating national and international organizations, such as the Recognizing European Cancer Nursing, a major project led by the European Oncology Nursing Society and supported by the European Cancer Organisation. Encouraging authors and setting up pipelines for research studies and dissemination may require further consideration for resources such as translation and writing services in addition to support for research grants. Further development of grant opportunities for research that combine the skills and knowledge of researchers across borders could lead to sustained international collaborations.
In all, multiple new strategies will be needed to face the challenges to continue the development and progression of nursing as a discipline. Working together, we must continue to raise status of nursing in the United States and globally; patients and families are depending on us.
Debra Lyon, RN, PhD, FNP-BC, FAAN, is the executive associate dean and Kirbo Endowed Chair in the College of Nursing at the University of Florida in Gainesville. Lyon can be reached at ONFEditor@ons.org.
Challinor, J.M., Alqudimat, M.R., Teixeira, T.O., & Oldenmenger, W.H. (2020). Oncology nursing workforce: Challenges, solutions, and future strategies. Lancet Oncology, 21(12), e564–e574. https://doi.org/10.1016/s1470-2045(20)30605-7
Davidson, P.M. (2019). Is nursing a STEM discipline–Does it matter and what can we do about it? Journal of Advanced Nursing, 76(1), 1–3. https://doi.org/10.1111/jan.14212
Dreisbach, C., Wright, M.L., Walker, R.K., Do Byon, H., & Keim-Malpass, J. (2022). Nursing science as a federally-recognized STEM degree: A call to action for the United States with global implications. International Journal of Nursing Studies Advances, 4, 100084. https://doi.org/10.1016/j.ijnsa.2022.100084
Mezgebu, E., Anwarali, S., Durañona, M., & Challinor, J. (2021). Pediatric oncology nursing research in low- and middle-income countries: Exemplars from three regions. Seminars in Oncology Nursing, 37(3), 151168. https://doi.org/10.1016/j.soncn.2021.151168
The Lancet. (2020). The status of nursing and midwifery in the world. Lancet, 395(10231), P1167. https://doi.org/10.1016/s0140-6736(20)30821-7