More than ever, we need nurses / Hiroshi Nakajima

World Health • September-october 1992 3 Editorial More than ever, we need· nurses M ost people's image of the nurse is that of a unifonned lady caring for patients in a hospital ward. This stereotype gives a very false impression. In fact, many nurses work, and always have worked, outside hospital- in people's homes, in health centres and dispensaries, schools, factories and elsewhere. Most people are also unaware that many nurses work as senior managers and as educators and researchers. In many countries there are also male nurses. Thus, the number and diversity of persons working under the title 'nurse' makes generalization dangerous and, more practically, poses enonnous problems of definition and categorization, as well as legislation and professional preparation. While a nurse in one country may be a highly educated practitioner with several qualifications and responsibility for her own actions, her counterpart elsewhere or even in her own country -sometimes called auxiliaries or nurse-aides- may have had only minimal training and have no autonomy. The answer to the question "what is a nurse?" is therefore not self-evident. Promoting health, preventing illness, and caring for the sick are age- old human concerns, and certainly not the prerogative of any occupation. In · fact, the bulk of nursing and healing is carried out not by professional nurses and their support staff, but by families and friends. Traditionally, caring and nursing in families and communities have been carried out by mothers, grandmothers, young girls or female neighbours. This is unlikely to change, and is now fully recognized by health workers everywhere. Nurses increasingly see themselves not just as active providers of care, meeting the professionally defined needs of Nurses increasingly see themselves not iust as active providers of care, meeting the professionally defined needs of passive patients, but more as facilitators who help people to take charge of their own health. passive patients, but more as facilitators who help people to take charge of their own health. She- or he - infonns, educates, and supports the work carried out in families and communities. The work of nursing staff and their training must therefore be geared to these situations and provide responses to local - and changing - needs. It must also be seen in relation to the other caring professions that have proliferated during recent decades. In many countries, the nursing profession is in a state of crisis, resulting in lack of interest among the young to take up nursing. Until society values caring work and women's work more highly, and rewards them accordingly, measures taken to attract new recruits will not succeed; well- educated, motivated women will continue to seek careers in occupations that have a higher social standing and higher remuneration. The social consequences of this for the health and well-being of populations will be disastrous. In developing and Or Hiroshi Nakajima, Oirector·Generol of the World Health Organization. developed countries alike we need excellent nursing and midwifery services. More than ever it is essential to clarify and agree on fundamental issues: the who, what, why, and how of nursing. Nurses, other health workers, and the communities they serve must move beyond the traditional stereotype and be flexible and forward-looking. This may sometimes be painful and difficult, but it will enable us to create nursing and midwifery services that are appropriate for the third millennium. • Hiroshi Nakajima, M. D., Ph. D.