Former Chief Nursing Officer for Wales says nurse leadership must help shape a more just and equitable health-care system

“We nurses and midwives must insert ourselves in every level of decision-making and shape what the future holds for us as professionals and not let others speak for us. We must advocate both for our role and for how we can best meet the needs of our patients.” This is the message that recently retired Chief Nursing Officer for Wales, Jean White, has for her colleagues.

“During my 10-year tenure, I was proud to lead and oversee many developments in policy and legislation, including the Nurse Staffing Levels (Wales) Act. Most recently, I witnessed and contributed to important changes in the way we deliver care during the COVID-19 pandemic.”

Embracing digital technologies while retaining the human element of care

“We have reduced the amount of face-to-face interaction during the pandemic by embracing digital technologies. We now hold digital consultations to monitor people’s chronic conditions and discuss symptoms and treatment, which means patients can receive care in the comfort and safety of their homes.

“For nurses to be able to adapt to this new way of working, I advocated for investments in nurse digital leaders’ training. It is important to acknowledge, however, that not everything can be done in a human way over technology, like having to break bad news, hold someone’s hand or simply be there for them when they are at the end of life. We cannot afford to lose the human element of care.”

Inequality has worsened during the COVID-19 pandemic

“We found that people from minority ethnic communities, who often coincided with the poorest ones, were doing worst in the pandemic – they were dying at a greater rate and many were suffering from long-term health conditions.

“We also realized that people with intellectual disabilities and mental health conditions were at far greater risk of death than the general population; this spurred me on to ensure they and their carers were in a priority group to be vaccinated in Wales.

“Inequality has worsened significantly during the pandemic and waiting lists for hospital treatment have grown significantly, which will take years to address. Nurses have a lot to contribute to building back a more just and equitable health-care system.”

Nurses are needed everywhere, from cradle to grave

“One of the issues we discussed during a recent meeting of nursing and midwifery representatives in the WHO European Region, is the shortage of nurses, which the pandemic exposed even further.

“Not only do countries need more nurses, but nurses with the right qualifications. We are needed everywhere, in every type of health and care service.

“As it takes years to educate a nurse, governments may increasingly resort to hiring nurses internationally, which can pose a risk in terms of depletion of a ‘source’ country’s nursing workforce. We should instead be developing a sustainable self-sufficient domestic workforce.

“In Wales, we have been investing in nursing recruitment and diversifying education opportunities to enable a wide range of people of all ages to enter the profession, which is helping provide staff in rural areas.”

Investing in nurses and ensuring their well-being

“Retention of the workforce, exacerbated by the recent physical and mental health challenges, also poses a significant problem for governments striving to build back strengthened and more resilient health systems.

“I fear a lot of nurses will leave the profession, due to insufficient resources, burnout and stress related to the pandemic response. They require and deserve our support.

“Part of improving the retention policies must involve addressing the ageing workforce. Older nurses may not be able to work long shifts like young graduates, but they can still contribute significantly in teaching or mentoring roles or by working more flexible hours.”

No limits to what can be achieved

“I have participated in many mentorships, both as a mentor and a mentee in so-called reverse mentorships. They are a great way for nurse leaders to hear what the situation is like on the frontline of delivering care or learn about the lived realities of ethnic minority people working in health care.

“I have also taken on mentees to show them what it’s like to be working at the heart of government. I’ve always wanted to help nurses be the best they can be, to go as far as they want to go and not be held back by anything.

“Sometimes all they’ve needed to pursue new opportunities is a little push, someone to say, ‘go on, you can do it! There is no limit to what you can achieve – make your voice heard’.”