Insights from Howard Catton: Part 2 - Addressing global nursing challenges

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Insights from Howard Catton: Part 2 - Addressing global nursing challenges

December 11, 2024

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This is the final part of the two part interview with Howard Catton, CEO of the International Council of Nurses. In this segment, he discusses migration and brain drain, workplace environment and mental health, uniform and practical challenges, as well as policy and advocacy.

In the first interview, titled Insights from Howard Catton: Part 1 - Addressing global nursing challenges, he provided an overview of various nursing challenges, including poor welfare and salary schemes, workload and staffing issues, and career development and education. Howard was in Malaysia from November 19 to 21 to attend the 22nd Asia Workforce Forum (AWFF) and the 18th Alliance of Asian Nurses Associations (AANA) meeting, which were hosted by the Malaysian Nurses Association (MNA) and the International Council of Nurses (ICN).

The article is presented in a conversational format, featuring questions followed by Howard's insightful responses.

On migration and brain drain
Question: What measures can countries take to reduce the brain drain of nurses to more developed nations? Can international collaboration provide a solution to brain drain, such as exchange programs or training partnerships? How do we ensure ethical recruitment practices for nurses globally to avoid depleting resources in lower-income countries?

Howard: The global shortage of nurses has made Malaysian nurses highly sought after. Factors such as education level, skill set, and proficiency in the English language attract countries experiencing their own nursing shortages to recruit Malaysian talent. While there are strong pull factors driving this recruitment, there are also significant push factors, including poor pay, challenging working conditions, and a lack of respect for career development. This combination places Malaysia at greater risk of losing its experienced nursing workforce.

This trend is detrimental to the health of the Malaysian population. Historically, nursing has been a profession characterized by mobility and migration, offering numerous benefits in terms of learning and knowledge exchange. In recent years, there has been a notable increase in aggressive recruitment efforts, with reports of agencies arriving on graduation day to secure new talent.

Countries should prioritize planning to achieve self-sufficiency in their nursing workforce, ensuring they develop enough nurses to meet domestic needs. Where recruitment does occur, it is essential to establish a mutually beneficial relationship between sending and receiving countries.

For instance, when a high-income country recruits nurses from a low-income country, even the loss of one or two specialist nurses can significantly impact healthcare services in the sending country. Therefore, receiving countries should provide tangible support in return. Countries like the US, Canada, and the UK have made commitments to build nursing schools and support faculty development for at least five years to help replenish the nursing workforce.

Unfortunately, there is often a lack of such reciprocal benefits. The WHO maintains a red list of vulnerable countries from which recruitment should be avoided, yet this practice continues.

At the same time, it’s important to recognize that there are countries with unemployed nurses struggling to find work. This situation typically reflects a lack of investment in nursing, insufficient job creation, and inadequate compensation. It is paradoxical that these countries educate nurses but fail to utilize them to provide care for their own populations, resulting in a loss of talent to overseas opportunities without fair compensation.

On workplace environment and mental health
Question: What are some best practices for creating a supportive and respectful workplace for nurses? How can hospitals address issues of workplace abuse, both from superiors and patients, to protect nurses? What mental health support systems should hospitals implement to help nurses cope with job stress?

Howard: The mental health challenges faced by nurses often outweigh the physical strains and stresses inherent in their daily work. This is an area of nursing that has not received enough attention.

Many people recall a time when the prevailing attitude was to simply endure the hardships—“that’s just how it is.” Nurses were often encouraged not to voice their concerns at work and to find personal strategies for coping. However, the pressures on mental health are escalating, leading to increased stress, burnout, absenteeism, and ultimately, nurses leaving the profession. This not only affects their well-being but also impacts their families and loved ones.

Addressing this issue requires open dialogue. There exists a "hero culture" within healthcare, where nurses are often portrayed as saviors who can handle the most challenging situations. During the pandemic, politicians frequently referred to nurses as heroes, which, while well-intentioned, is misleading. Nurses do not possess superpowers; they are human beings who need support. It is crucial to discuss these challenges openly and explore effective coping strategies.

Healthcare leaders play a vital role in this conversation. When executives, such as CEOs and finance directors, openly discuss the importance of mental health and share their own experiences, it fosters a culture where vulnerability is accepted. This cultural shift can have a profound impact on workplace practices and behaviors. Organizations must address the root causes of stress and provide support, education, and welfare initiatives.

Safe staffing levels are essential, especially given the rising incidents of violence and aggression in hospitals, which can sometimes stem from both patients and staff. Many patients express frustration due to anxiety about their loved ones' health, compounded by busy hospital environments, poor communication, and long wait times for treatment.

These issues highlight weaknesses in healthcare systems, particularly in those that were unprepared for the pandemic. The responsibility lies with those who made decisions regarding preparedness, which ultimately affected patient care. Nurses and other healthcare workers faced the daunting task of comforting patients during crises when resources like oxygen, ventilators, and ICU beds were scarce. This reality has a profound effect on their mental health.

The perception of heroism in healthcare can inadvertently place the burden of resilience on individuals rather than addressing systemic issues. Strengthening the healthcare system as a whole is essential. Policies should be implemented to support individuals while also tackling the root causes of workplace violence. It is crucial to establish a zero-tolerance policy for abusive behavior. While it is understood that patients may be distressed due to their circumstances, this does not justify violence or abuse directed at nurses or caregivers.

On uniform and practical challenges
Question: How can hospital administrators be encouraged to adopt more practical uniforms for nurses while maintaining professionalism?

Howard: The primary purpose of nursing uniforms is to support nurses in performing their duties comfortably and safely. Back in the 1990s, when I was a practicing nurse, hats were eliminated from uniforms because they hindered movement. Nurses were frequently required to bend and lift patients, and balancing a hat during these tasks was impractical. A functional uniform allows nurses to move freely, which is essential not only for patient care but also for protecting the health of the nurses themselves.

Back injuries remain a significant concern for healthcare systems, as they often lead to nurses taking time off work. Employers have a vested interest in reducing absenteeism and sickness rates, making it crucial to provide uniforms that are conducive to nurses' work. Additionally, uniforms must be easy to wash to minimize the risk of infections, necessitating materials that can withstand frequent laundering.

Uniforms also play a vital role in helping patients identify healthcare professionals. Complicated designs with various colors or patterns can confuse patients, making it difficult for them to know who they are interacting with. For many nurses, a well-designed uniform instills a sense of pride in their profession.

Therefore, getting the design, material, and color of uniforms right is essential. However, many hospitals make these decisions without consulting the nurses themselves. To effectively address uniform issues, it is imperative to engage with nurses and understand their needs. By listening to their feedback on what works best for them in their roles, hospitals can foster better relationships between nurses and patients. When guided by nurses' insights, hospitals are likely to make decisions that meet the needs of both the staff and the patients.

On policy and advocacy
Question: What role does advocacy play in bringing about systemic changes for nursing welfare and working conditions? How can international organizations like ICN partner with Nursing Board Malaysia to push for these necessary reforms? What actions should the Malaysian Nurses Association (MNA) and the Nursing Board Malaysia take to address these issues?

Howard: The Malaysian Nurses Association (MNA) is a proud member of the International Council of Nurses (ICN), which comprises over 130 national nursing associations from around the globe. The MNA is a highly respected association, and its participation in hosting this meeting highlights the esteem in which it is held. The associations attending this event collectively represent 10 million nurses worldwide. This gathering provides an opportunity for participants to learn about the nursing landscape in Malaysia while sharing their own experiences. The insights gained from neighboring countries regarding the challenges and demands they face can be invaluable for Malaysia.

The MNA's role within the ICN is significant, as it facilitates major congresses every two years. This membership not only enhances the visibility of Malaysian nursing on the international stage but also showcases Malaysian society as a whole.

One challenge I observe within the nursing profession globally is our tendency to work in silos rather than collaboratively. It is essential for various stakeholders—such as associations, regulators, nurse leaders, government nurses, administrators, researchers, and academic institutions—to engage in meaningful discussions related to their areas of expertise.

To achieve meaningful progress, we must unite as a profession, particularly on critical issues. Engaging in open debates, even when opinions differ, allows us to present a coherent and consistent voice to decision-makers. When we fail to do this, it becomes easier for leaders to dismiss our concerns by citing internal disagreements among nursing groups. The association plays a crucial convening role in bringing together diverse voices, and the Malaysian Board of Nurses is a key group of leaders in this effort.

While differences of opinion will always exist on certain matters, it is vital that we present a unified stance on significant issues. By doing so, we can ensure that the interests of the nursing profession are effectively represented and heard loud and clear.

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