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International Council of Nurses

Biennial report

Patient and public safety matter:

nurses on the front line
Patient and public safety matter: nurses on the front line

ICN mission: Through the ICN Girl

To represent nursing worldwide, Child Education Fund
advancing the profession the orphaned daughters
and influencing health policy. of nurses in developing
countries are getting
back to school.
For more information see page 13.

Biennial report 2004-2006

The International Council of Nurses (ICN) is a federation of

129 national nurses associations representing the millions of
nurses worldwide. Operated by nurses, ICN is the international
voice of nursing and works to ensure quality care for all and
sound health policies globally.

ICN’s scope of work

is housed within
three main pillars:
professional practice,
nursing regulation and
the socio-economic
welfare of nurses.
We are pleased to
ICN Board of Members:
share this account Edith Allwood Anderson
of our work from (Jamaica)
2005-2009 Dulce Dirclair Huf Bais
2004 to 2006 with (Brazil)
all our stakeholders, Officers:
Beatriz Carvallo Suarez
Hiroko Minami
colleagues and President (Japan)
collaborators. Rudolph Cini
Franz Wagner
First Vice-President (Germany) Anna Karin Eklund
Rosemary Bryant William Holzemer
Second Vice-President (USA)
(Australia) Euisook Kim
Philda Nzimande Yves Mengal
Third Vice-President (Belgium)
(South Africa) Veronika Pretnar Kunstek
Julita Sansoni
Teresa J. C. Yin

ICN organisational chart

Council of National
ICN Board of Directors
Representatives ICN Secretariat
4 officers
1 voting member from each Located in Geneva
11 members
of the member associations

Patient and public safety matter: nurses on the front line

New ICN initiatives


The Wellness Centres for Health Care Workers

Offering a holistic complement of services, including stress management, training
in HIV/AIDS and TB care, a knowledge resource training centre, antenatal expertise,
testing, counselling and treatment for HIV and TB, and occupational health and
safety services. See page 12.

Training a critical mass of nurses in TB prevention, care and treatment, and tackling
the issues of stigma and discrimination related to TB. See page 12.

Refugee library
Providing nurses and other health workers with access to the latest nursing/health
information and accompanying training to better meet refugee health priorities,
improve patient safety and the quality of care. See page 13.

The International Centre for Human Resources in Nursing

Strengthening the nursing workforce globally through the development, ongoing
monitoring and dissemination of comprehensive information, standards and tools
on nursing human resources policy, management, research and practice.
See page 23.

The International Centre on Nurse Migration

Facilitating collaboration and knowledge sharing among global organisations
involved with migrating nurse professionals and contributing to patient and public
safety and improved health care. See page 23.

Global Nursing Workforce Review

Clarifying the extent of the global nursing shortage; providing an analysis of key
nursing workforce issues globally; identifying priorities for policy intervention; and
developing recommendations to address issues. See page 23.

Regulation Observatory
Anticipating and responding to international regulatory development, and
facilitating a regulatory framework which promotes patient and public safety.
See page 20.

Biennial report 2004-2006


Patient safety: nurses working on the front line

for quality health and nursing care
Message from ICN’s President and Chief Executive Officer 7

Pillar 1 Professional nursing practice

Working for improved health and safe care across settings,
communities and challenges. 8

Tackling the Millennium Development Goals 12

ICNP®, creating a universal nursing language 16

Pillar 2 Nursing regulation, ensuring public safety

Providing and enabling environment for public and patient safety 18

Pillar 3 Socio-economic welfare of nurses

Strengthening and protecting the health workforce 22

Bringing nursing together worldwide 25

ICN nursing networks 28

ICN Awards 29

Florence Nightingale International Foundation 29

Patient and public safety matter: nurses on the front line

Facts & figures

30,000 children die each 60 percent of children Children living in poverty are
day globally because of missing out on formal five times more likely to die
preventable diseases. education are girls. before reaching the age of five.
ICN is working to make ICN’s Girl Child project Nurses’ work for poverty
vaccinations against childhood promotes the healthy alleviation is enabled with ICN
diseases safer. development of urban girls advocacy and education tools.
ages 10-14.

Biennial report 2004-2006

Patient safety: nurses working

on the front line for quality health
and nursing care

Message from ICN’s President and Chief Executive Officer

Whether increasing access to safer water, with the Commission on Graduates of Foreign
identifying counterfeit medicines, providing Nursing Schools, the Centre on Nurse Migration
disaster relief or coordinating critical care, the (ICNM). As well we initiated the Health Worker
goal and role of nursing is to ensure that patients Wellness Centre programme in sub-Saharan
and communities have safe, quality care when Africa, aimed at addressing the well being of all
they require it. The more than 13 million nurses health workers. We believe addressing the global
providing care in hospitals, rural health centres, nursing shortage addresses the most serious
schools, refugee camps, workplaces and war threat to the safety of patients, the quality of
zones have patient safety upper most on their care and the health of nurses.
minds, as does ICN. This biennial report also highlights ICN’s
We have addressed many pressing health activities in the three programme areas that we
issues over this past biennial, including the believe are crucial to the strengthening of patient
HIV/AIDS pandemic, tuberculosis and malaria, and public safety: Professional Nursing Practice,
chronic health conditions, women’s health and Nursing Regulation and Socio-economic Welfare
the needs of girl children. A common theme cuts of Nurses. Whether working with our member
across all of these issues — the critical shortage associations, affiliates, UN partners, industry or
of nurses. Today’s reality is that the number the NGO community, our policy, advocacy and
of staff has fallen, and the ‘acuity’ of patients activities are aimed at bettering the health and
has risen. Fewer nurses are taking care of health care of people everywhere.
sicker people without the time, resources and
mechanisms they need.
Evidence indicates that inadequate institutional
staffing levels are correlated with increase in
adverse events such as patient falls, bed sores,
medication errors, nosocomial infections and Dr Hiroko Minami
readmission rates that can lead to longer hospital President,
stays and increased hospital mortality rates. International Council of Nurses
In short, inadequate human resources present
a serious threat to the safety and quality of
health care. As a profession, we are facing our
greatest challenge.
How has ICN taken up this challenge? Judith A. Oulton
In the last biennial we undertook a multifaceted Chief Executive Officer,
programme of work in health human resources International Council of Nurses
aimed at: 1) clarifying the extent of the global
nursing shortage; 2) analyzing key nursing workforce
issues globally and; 3) identifying priorities for
policy intervention and recommendations to
address issues. We have established the Centre
for Human Resources in Nursing (ICHRN) and,

Patient and public safety matter: nurses on the front line

ICN Pillar 1
Professional nursing practice

Professional nursing practice ICN Pillar 1

Patient safety is fundamental to quality health and nursing care. ICN believes that the
enhancement of patient safety involves a wide range of actions in the recruitment, education
and retention of skilled health care professionals in a safe and sufficiently resourced
health care setting. ICN is deeply concerned about the serious threat to the safety of
patients and quality of health care resulting from insufficient numbers of appropriately
prepared human resources. The current global nursing shortage as well as access to
continuing education, are key aspects of this threat.
We are pleased to give a brief overview of ICN initiatives addressing patient and public
safety in the realm of professional nursing practice including: safe staffing; safe medicines;
teaming-up with other health professionals; informing patients; and strengthening the
nursing profession through education and leadership training.

Working for improved health and safe care across

settings, communities and challenges
Safe staffing saves lives Campaign against counterfeit
Nurses worldwide called for legislators and policy medicines
makers to address the need for sufficient and Nurses have a key role in educating the public
suitable human resources in health care settings. about the dangers of counterfeit medicines.
ICN initiated the global campaign by selecting Globally counterfeit medicines pose a serious
Safe Staffing Saves Lives as the theme for threat to patient safety and the quality of health
International Nurses Day (IND) 2006. Since 1965, care. It is estimated that 10 percent of medicines
IND has been celebrated around the world sold worldwide are counterfeit and do not
every May 12 on the anniversary of Florence provide any medical benefits. Worse, they can
Nightingale’s birth. result in poisoning, disability and death.
Inadequate staffing in health care settings is International Nurses
To inform nurses and to provide them with Day 2006.
reaching crisis proportions in all regions. Evidence tools to tackle this growing problem, ICN selected
indicates that it results in a critical increase in Nurses for Patient Safety: Targeting Counterfeit
length of hospital stays, patient morbidity and and Substandard Medicines as the theme for
mortality and preventable adverse events. High International Nurses Day 2005. The 2005
patient-to-nurse ratios not only have a negative International Nurses Day kit can be downloaded
impact on patient outcomes but also affect from
nurses who are at risk of emotional exhaustion, Also in 2005 ICN launched a new initiative
stress, job dissatisfaction and burnout. against counterfeit medicines in partnership with
To help nurses, hospital administrators, the International Federation of Pharmaceutical
government and the public in general to understand Manufacturers & Associations (IFPMA). The
this complex and critical subject, ICN prepared a initiative utilises the two organisations’ worldwide
toolkit, Safe Staffing Saves Lives. It is available on member networks, as well as the research-based
the ICN website pharmaceutical industry’s anti-counterfeiting International Nurses
The tool kit supports professional nursing body, the Pharmaceutical Security Institute. Day 2005.
associations and nurses in their work to advance Central to the initiative is the IND kit, Counterfeits
the argument for appropriate staffing levels, kill: Nurses target counterfeit medicines,
and educate policy makers about the positive developed by ICN. The multi-sector campaign
relationship between nurse staffing and overall involves other health professions, patient groups,
patient care outcome. The tool kit also addresses industry and regulators. The International
the importance of skill mix and the clarification Alliance of Patients’ Organisations distributes
of roles and issues, such as healthy work the ICN kit to its members to further broaden
environments and nurses’ health. the fight against counterfeits and to protect
patient safety.

Patient and public safety matter: nurses on the front line

Leadership for Change (LFC)

Health systems and patients benefit when
nurses have strong leadership skills. The
Leadership for Change™ (LFC) programme is an
action-learning initiative that develops nurses as
effective leaders and managers in a constantly
changing health environment. The specific aim
is to enhance nurses’ contribution to health
services, and to promote patient safety and
quality care, through appropriate and proactive
leadership strategies.
Since its inception in 1996, the LFC programme
has been implemented in more than 60 countries
in all regions. Many of these countries are now
implementing LFC programmes led by trainers ICN/MSD Mobile Nursing Library
certified by ICN through its Training of Trainers
Nurses can provide better and safer patient care
(TOT) programme. To date ICN has certified 209
when they have access to current health care
trainers. New LFC programmes will begin in 2007
information. The ICN/MSD Mobile Nursing Library
in China, Grenada, Portugal and South Africa.
is an innovative resource bringing up-to-date
Participants of the ICN LFC programme work
health information to nurses working in remote
with partners to address health policies at local
areas of developing countries. Initiated in 2001
and national levels. They develop strategic
to help close the gap between nurses’ need for
directions for strengthening health care services
current information and its availability, the
and workforce issues that best meet their
project now encompasses 140 mobile libraries
country and local needs.
in 16 African countries.
Country programme evaluations indicate
These mobile libraries and related training
that LFC graduates build sustainable partnerships
are now serving nurses and their patients in more
and help develop new models to improve patient
than 300 communities in Botswana, Ethiopia,
safety and care. This has been particularly evident
Ghana, India, Kenya, Liberia, Malawi, Mauritius,
in maternal and child health, primary and
Mongolia, Seychelles, Somalia, Sudan, Swaziland,
community health, and elder care. Nurse leaders
Tanzania, Uganda, Zambia and Zimbabwe. Thanks
also are tackling global challenges in HIV and
to information from mobile libraries, nurses and
AIDS prevention and treatment, and malaria in
health workers provide better care for tens of
countries such as Kenya, Uganda, and Tanzania.
thousands of the world’s most vulnerable people.
LFC graduates are addressing human resources
A team of industry and nursing partners
development strategies in Guyana, Tanzania,
work together to make this initiative possible.
Mauritius, and Barbados.
ICN and its member national nursing associations
ICN works with key partners to implement
manage the project. Merck Sharp & Dohme (MSD)
the LFC programme worldwide. Partners have
provide funding and the donation of the Merck
provided valuable learning experiences for
Manual. Elsevier publishing handles the packing
the LFC participants, financial assistance for
and shipping of the libraries.
programme implementation and sustainability,
Many nursing organisations and some
and supportive networking. Partners include:
individuals have donated the US$2000 required
WHO, PAHO, national and regional governments,
to stock, ship and manage each mobile library
development agencies, educational institutions
unit. Any individual or organisation interested in
and national nurses’ associations.
sponsoring a mobile library may contact Linda
Carrier-Walker at

Professional nursing practice ICN Pillar 1

World Health Professions headache and migraine management, obesity,

osteoporosis, sexually transmitted infections,
Alliance: a unique partnership stroke and tuberculosis, among others. National
for world health nurses associations and consumer groups are
One way that ICN works for patient safety and encouraged to link directly to Patient Talk.
cost effective, quality health care is through The website also contains position statements
collaboration with our colleagues in medicine, on topics of relevance to patient safety such as
pharmacy and dentistry in the World Health counterfeit medicines, tobacco use and protecting
Professions Alliance (WHPA). The WHPA was patient rights. The Patient Talk site holds a
founded in 1999 by ICN, the International HONcode certificate from the Health on the Net
Pharmaceutical Federation and the World Medical Foundation Code of Conduct.
Association and expanded to include the World
Dental Federation in 2005. Vaccines, older persons
That same year, WHPA granted official
and the nurse
partnership status to the International Alliance
of Patients’ Organizations (IAPO), representing ICN undertook to consult its Bank of Experts,
patients of all nationalities across all disease a select group of national nurses’ associations
areas. This partnership provides an important from industrialised and developing countries,
mechanism for health professionals and patients educational institutions and the available
to work together towards safe and high quality literature to create an informed understanding
patient-centred healthcare. of the use of vaccines by nurses as a health
In 2004 nurses, pharmacists and physicians promotion strategy with older persons. The
from more than 60 countries gathered in Geneva result is a comprehensive situation analysis,
for the inaugural WHPA leadership symposium, which will identify vaccine drivers and barriers
focusing on inter-professional and international of health professionals and consumers, improve
collaboration on health issues. nursing care of older populations, and guide
Patient safety was the primary focus of the future research, policymaking and strategies.
second WHPA Leaders’ Forum, held in Geneva
in 2006. National and global leaders of the
New database for Nursing
four health professions brought forward the
critical discussion on blame-free reporting Innovations
of adverse events in health care and examined Worldwide nurses are engaged in innovative
the role of the health professions in combating activities on a daily basis. Many of their initiatives
counterfeit medicines. significantly improve patient safety and care,
and result in cost savings for health systems.
Patient Talk In 2005 ICN created a globally accessible
A key strategy in promoting patient safety is to database to facilitate the dissemination of
encourage patients to be well-informed. The nursing innovations.
Patient Talk website, created by ICN and Johnson The first of its kind, the ICN Innovations
& Johnson, offers high-quality health information Database is a web-based resource which fosters
to assist patients in making good decisions about nursing innovation and promotes knowledge
their health. The information can help consumers sharing. Nurses can contribute their innovations
prevent disease, obtain correct diagnoses, make to the database, and/or use it to search for new
good treatment choices and get the best clinical ideas. Of interest to anyone wanting to learn
care. The series of “informed patient” fact sheets about innovative nursing practices and concepts
now covers 25 health issues such as antimicrobial from around the world, the database can be
resistance, depression, nutrition, dementia, accessed at

Patient and public safety matter: nurses on the front line

Tackling the Millennium Development Goals

Wellness Centres for Health Care Responding to the
Workers in sub-Saharan Africa TB crisis

ICN launched a programme of Comprehensive Nurses are in the forefront of the global fight
Wellness Centres for Health Care Workers and against tuberculosis (TB). ICN works with a
their families in 2006, with the first Centre number of partners in developing nursing capacity
opened in Swaziland. Others to follow quickly will on the ground for TB prevention, care and
be opened in Lesotho, Zambia and Malawi. The treatment. As a key player in the Eli Lilly MDR-TB
Swazi Centre, managed by the Swaziland Nurses Partnership, ICN collaborates with its member
Association (SNA), addresses the severe health national nurses associations, Eli Lilly and
worker crisis in Swaziland through attention to Company, the International Hospital Federation,
the health, wellbeing and capacity of the health the World Medical Associations, WHO Stop TB,
work force. the International Federation of the Red Cross,
The Centre is the result of an innovative Partners in Health and the UNION to battle
partnership between the SNA, ICN, the Danish the growing threat of multi-drug resistant
Nurses Organization, the Stephen Lewis tuberculosis (MDR-TB).
Foundation and BD Corporation. The first of its Although it is curable, TB kills approximately
kind, the Centre is considered a model of good two million people every year. An estimated 8.8
practice by many global organizations, including million new cases of TB occur annually, of which
WHO and Physicians for Human Rights. ICN approximately 400,000 are multi-drug resistant
and its partners are committed to seeing TB (MDR-TB). An even more resistant form of
Wellness Centres established in all countries TB – XDR-TB – surged in some regions in 2006,
in sub-Saharan Africa. causing particularly high death rates among
The Swaziland Centre delivers health and HIV/AIDS patients. TB accounts for one-third of
other professional services to all Swazi health AIDS deaths worldwide.
workers and their immediate families. By offering In 2005 ICN and partners launched a Training
quality, confidential health care services responsive of Trainers (TOT) programme, targeting nurses
to health care workers’ needs, the Centre helps working in primary health care settings in TB
address the severe health human resources high-burden countries. Approximately three million
crisis affecting Swaziland and much of sub-Saharan nurses work in the 22 TB high burden countries
Africa. One of the factors pushing health care which account for 80% of TB cases. In most
workers out of the country is that they are of these countries nurses are the primary health
over-stressed, under-valued and face many barriers care provider. The programme aims to train a
to health and wellness services. The Centre critical mass of nurses in TB prevention, care and
facilitates a strengthened health care workforce treatment. Training also tackles the issues of
which is better able to meet the country’s stigma and discrimination related to TB.
enormous health challenges. In collaboration with its member associations,
Housed in a new, accredited clinic, the ICN conducted TOT workshops in South Africa,
Centre provides a holistic complement of services, Swaziland, Malawi, Russia and the Philippines in
including stress management, a knowledge 2005-2006 and will continue to roll out the
resource and training centre for continuous TOT programme to other high burden countries
professional development, antenatal expertise, during the next biennium.
testing, counselling and treatment for HIV
and TB, and occupational health and safety
services such as post exposure prophylaxis and
needlestick injury surveillance.

Professional nursing practice ICN Pillar 1

The Global TB Resource Centre workers who work alongside UNHCR staff in the
field rarely have up-to-date health care information
On World TB Day 2005, ICN launched an online and are far from well furnished hospitals for
Global TB Resource Centre ( expert advice on critical health issues. The
The Centre provides multiple tools for nurses: access to current health information provided
TB guidelines; fact sheets on TB and HIV/AIDS; by the ICN/MSD Nursing Libraries, and the
positions statements; a toolkit on stigma; and the related training, help to fill a serious gap in refugee
opportunity to exchange experiences through health care.
two interactive forums. It was made possible by The partners are building on success of the
an educational grant from Eli Lilly and Company. classic ICN/MSD Mobile Library, launched in
ICN is a member of the WHO Stop TB 2001 and now present in more than 140 African
Partnership, and is part of a Nursing TB Task communities. Each library unit, consisting of a
Force involving WHO and the International Union transportable trunk resistant to moisture, insects
against TB and Lung Diseases. and hard knocks, contains about 80 titles,
covering topics from malaria case management,
The Nursing Library reproductive health and gender violence to
disease prevention, health promotion, surgery
for Refugee Health and anaesthesia.

Girl Child Education Fund

Nurses are helping to educate the orphan
daughters of lost colleagues by contributing to a
fund created by ICN and its sister organisation,
the Florence Nightingale International Foundation
(FNIF). The Girl Child Education Fund supports
the schooling of girls whose nurse parent or
parents have died. The Fund, established in 2005,
is part of the ICN/FNIF Girl Child Initiative and is
currently schooling orphaned girls in Kenya,
Swaziland, Uganda and Zambia.
A new collaboration launched in 2006 by the
The Fund presently concentrates on sub-Saharan
United Nations High Commissioner for Refugees
Africa, where the need is greatest. Education
(UNHCR), Merck Sharp & Dohme (MSD) and ICN,
contributes directly to the economic independence
is delivering nursing knowledge and training for
of women. It is an important tool for reducing the
health workers in refugee populations in Africa.
social and economic vulnerability that exposes
Last year 50 ICN/MSD Nursing Libraries for
girls and orphans to a high risk of HIV/AIDS.
Refugee Health hit the ground in Tanzania and
Through the Fund, ICN and nurses are contributing
Zambia, where more than 770,000 refugees
to the achievement of the UN Millennium
are currently living in numerous camps and
Development Goals of universal primary education
communities. The libraries provide access to
and the promotion of gender equality. Donations
the latest nursing/health information and
can be made on the following secure online site:
accompanying training to better meet refugee
health priorities, improve patient safety and
the quality of care. The goal is to expand the
programme over the next five years to reach
nurses and other health personnel in refugee
settings across Africa, improving the quality of
health care provided to the continent’s almost
three million refugees. Elsevier publishing is
also partnering with MSD, ICN and UNHCR to
produce and ship the mobile libraries, bringing
valuable health information to more than 50
remote refugee camps.
Refugees are among the world’s most
vulnerable and excluded populations, and constantly
face serious risks to their health. The health

Patient and public safety matter: nurses on the front line

Safer water for children Girl Child Policy

and families and Research Project
The Girl Child Policy and Research Project
mobilises nurses to promote the healthy
development of girls between the ages of 10 and
14 living in large cities. The project has brought
together leaders in government, health, education,
and social welfare agencies to address the needs
of young girls. The Swedish Association of Health
Professionals and the Nurses Association of
Botswana piloted the project. In 2005, ICN’s
member nursing associations in Portugal and
Swaziland joined.
In Sweden, the results were put into action
through a government sponsored project called
FLICKA which focuses on the same target group
and aims to boost girls’ self-confidence. In
Botswana, results of focus group research were
presented at a conference in Gabarone attended
by community and government leaders. The
In developing countries, diarrhoea is a major work in Portugal and Swaziland is ongoing.
cause of illness and death in children under five.
Children living in orphan centres are particularly Meeting the challenge
vulnerable as their access to safe, clean water is
far from guaranteed. Orphaned and vulnerable of malaria in Zambia
children in 5 centres in Uganda, Kenya and In the past three decades, the incidence of
Malawi are getting that access now, thanks to a malaria in Zambia has tripled, making it the
safe water programme launched in 2004. The country’s greatest public health problem. ICN
initiative, involving a partnership between ICN, works with nurses in Zambia to address this
the Ugandan, Kenyan and Malawi national nurses challenge, and in collaboration with Novartis,
associations and the Procter & Gamble Health on a programme to build malaria case
Sciences Institute delivers access to safe drinking management capacity and expertise related to
water and has seen diarrhoea rates drop by as new artemisinin-based combination therapies
much as 90% where the programme has been for malaria. The programme, led by the
implemented. In Malawi, the Norwegian Nurses Zambian Nurses Association, delivers capacity
Association is also a key partner. building for nurses and other health care workers
The project involves the donation of a point midwives in the nine provinces of Zambia.
of use water purification product, PuR, to AIDS
orphanages in Uganda, Kenya and Malawi and a
nurse-led sanitation and hygiene education and
monitoring programme. This is supplemented by
research on the impact of the intervention on the
children’s health. A further component is outreach
and education for nurses and midwives so that
they, in turn, can educate
other health providers and
their local communities.
ICN and the P&G Health
Sciences Institute have
worked together since
2003 to improve access to
safe household water in
developing countries.

Professional nursing practice ICN Pillar 1

Making every child count Working with the poor

– campaign for birth registration against poverty
Every year 48 million newborns are not officially Recognising poverty as the greatest misery we
registered. Unregistered children are extremely face today, ICN chose this theme for International
vulnerable to exploitation of every kind. Because Nurses Day in 2004. Poverty and poor health go
there is no official recognition of their existence, hand-in-hand, with the poor sharing an unequal
they may be excluded from education and health burden of ill health. As the most trusted of health
care services, and may never have a passport or professions, nurses can work effectively with and
the right to work. While most unregistered births on behalf of poor people to ensure that their
take place in South Asia and sub-Saharan Africa, voices are heard. Nurses can advocate so that the
the problem exists in every country. poor are included in decisions concerning them,
ICN and the International Confederation of and that the inequalities of access, employment,
Midwives (ICM) have developed a birth registration services, gender, ethnicity and race are addressed.
toolkit, to raise awareness among nurses and
midwives of the importance of birth registration Reducing mother-to-child
and spur action to address the issue in their
country. ICN, ICM and Plan, the international transmission
child’s rights organisation, are working together In an important first step in ICN’s efforts to
to promote birth registration, and call for strengthen health care infrastructure by securing
governments everywhere to encourage and access to antiretroviral therapy for health care
improve the birth registration process. workers in countries with a high burden of
HIV/AIDS, pregnant health sector employees in
Zambia benefited from a new programme of HIV
testing, counselling and treatment, delivered by
the Zambian Nurses Association in 2003 and
2004. Supplementing ministry of health efforts
at a time when access to antiretroviral medicines
was limited, the initiative ensured free access to
the antiretroviral drug nevirapine, effective in
reducing mother-to-child HIV transmission.
The initiative was collaboratively developed by
ICN, the Zambia Nurses Association and the
Norwegian Nurses Association.

Patient and public safety matter: nurses on the front line

ICNP®: creating a universal nursing language

The International Classification The development of the ICNP® requires the
collective involvement of national associations,
of Nursing Practice (ICNP®) individuals and nursing opinion-makers. More
than 160 nurses, representing 47 different countries,
serve as nursing practice expert reviewers.
They provide their knowledge and expertise to
evaluate terms and definitions in the ICNP®.
In 2005, Version 1 of the International
Classification for Nursing Practice (ICNP®) was
launched, providing the concepts or values for
the International Standards Organization (ISO)
standard for a reference terminology model
for nursing diagnoses and nursing actions.
A major advancement of ICNP® Version 1 is that
it is computer-based, with the advantages of
description logic and associated software tools
and therefore easier to implement and maintain.

ICN Research and Development

The first ICN Accredited Research & Development
Centre: Deutschsprachige ICNP® Nutzergruppe
(German-Speaking ICNP® User Group) was
established in 2005. An ICN Centre is an
institution, organisation, department, national
association, or other group which, through
The ICNP® is a unified nursing language system information, research, training and other services,
that provides terminology to represent nursing advances ICNP® and its use in patient care.
diagnoses, interventions, and outcomes. As such, The Deutschsprachige ICNP® Nutzergruppe
it facilitates the cross mapping of local terms and consists of three national nurses’ associations,
existing vocabularies and classifications, allowing Austria (OeGKV), Germany (DBfK) and Switzerland
comparisons across various systems and health (SBK/ASI) and the three national ICNP® User Groups
care delivery settings. The ICNP® can provide of these countries. Currently there are also Centres
regional, national, and international solutions to in: the Department of Nursing at the University
standardizing nursing terminology, enhancing of Concepción, Chile; Canberra Hospital/University
nurses’ efforts to provide safe and high quality of Canberra, Australia; and, the University of
patient care. Wisconsin, College of Nursing, USA.

Patient and public safety matter: nurses on the front line

ICN Pillar 2
Nursing regulation, ensuring
public safety

Nursing regulation, ensuring public safety ICN Pillar 2

Nursing regulation includes all of those legitimate and appropriate

means – governmental, professional, private, and individual – whereby
order, consistency, identity and control are brought to the profession.

Providing and enabling environment for

public and patient safety
For more than a century, ICN has played a Regulators’ Forum
leadership role in nursing regulation, working to
ensure that the regulation of the profession With increased mobility of staff and patients, the
provides a framework within which patient safety environment within which competent authorities
can be assured, and nurses can respond rapidly operate is becoming more dynamic and complex.
and flexibly to changing health needs. Recognising this fact, ICN and the International
Confederation of Midwives furthered their
longstanding commitment to regulation and
Credentialing Forum patient safety by creating the Regulators Forum.
Eleven associations currently actively involved The forum facilitates global networking and
in credentialing activities, or with well-advanced exchange among regulators in many countries.
plans to become involved in this field, attended The first annual forum was hosted by the Spanish
the first meeting of the Forum in December General Nurses Association in Madrid in 2005.
2006. The Credentialing Forum aims to: Nursing and midwifery regulators from North
l Serve as a vehicle for countries with dynamic America, the Caribbean, Africa, Asia, Australia
credentialing programs to communicate, and Europe gathered to address issues affecting
consult, and collaborate with one another on safe patient care.
trends, problems, solutions, etc. In 2006, the Regulation Forum met in
l Promote and enable nursing’s role at the Geneva, attended by 60 regulators from around
forefront of healthcare and professional the world, including developed and developing
credentialing and quality assurance. regions. The regulators focused on the assessment
l Advise ICN on developments and needs in of continuing competence and the opportunities
the field of regulation, credentialing, and and threats related to the assessment of
quality assurance. overseas applicants for a country’s register.

Patient and public safety matter: nurses on the front line

The ICN Observatory New Regulation web page

on Licensure and Regulation Additional information about ICN’s activities
in the field of regulation is available at ICN Position
Statements and regulation publications are posted
on the web page. It also provides links to the
Regulation Network, the Credentialing Forum,
and the ICN Registry of Credentialing Research.

Seventh international
Regulation conference
Globalisation and Regulation was the central theme
In 2005, ICN established the ICN Observatory of the 7th International Regulation conference, held
on Licensure and Registration. The small in Taipei, Taiwan in 2005 and co-hosted by Taiwan
cross-sectional expert group advises ICN on key National Nurses Association, the Taiwan Department
issues and offers insights into emerging and of Health and ICN. Representatives from 63
future trends in regulation. It enables ICN and countries addressed professional self-regulation,
the nursing profession to anticipate and respond issues related to the General Agreement on Trade
in a timely, appropriate manner to international and Services (GATS), as well as migration and
regulatory developments, and to facilitate a future perspectives on professional regulation.
regulatory framework which promotes patient
and public safety. In addition it provides leadership Inaugural Triad Meeting
in influencing policy on global regulatory matters.
Government chief nursing and midwifery officers,
The inaugural meeting of the ICN Observatory
representatives of national nursing and midwifery
took place in Madrid in 2005.
associations and regulatory bodies from 101
In 2006, the Danish Nurses Organisation
countries came together in Geneva in May 2006,
hosted the Observatory event, focusing on
for the inaugural ‘Triad Meeting’ of the
future work in the following areas: principles of
International Confederation of Midwives, the
regulation and the associated ICN framework;
International Council of Nurses and the World
potential for developing the competencies
Health Organisation. The trilateral group
associated with the continuum of nursing care;
addressed issues critical to the provision of safe,
a potential major research proposal to map
quality nursing and midwifery care and professional
legislation from countries across the world
regulation. A resolution on nursing and midwifery
and conduct a comparative analysis; and,
was issued, urging the World Health Assembly
consideration of policy statements.
to address the global nursing and midwifery crisis,
with a commitment to health as a basic human
ICN/WHO Futures Perspective right providing for equal access to equitable
Nursing Regulation: A Futures Perspective was health care based on need rather than the ability
published by ICN and WHO in 2005, exploring the to pay. ICM, ICN and WHO, together with the
intent, scope and nature of professional regulation participants of this inaugural triad meeting,
for nursing. It discusses new challenges to agreed to work locally, regionally and globally to
professional regulation such as increased mobility meet the commitments in the resolution and
of professionals, growing trade in the health to continue to address issues that advance
services, health sector reform and a greater nursing and midwifery in pursuit of global public
public interest in the quality of health services. safety and better health.

Patient and public safety matter: nurses on the front line

ICN Pillar 3
Socio-economic welfare of nurses

Socio-economic welfare of nurses ICN Pillar 3

The nursing shortage occurring in health systems around the world is bringing in its
wake a serious crisis in terms of adverse impacts on the health and well-being of
populations. It poses unprecedented challenges for policy makers and planners in both
high and low income countries alike.

Socio-economic welfare of nurses: strengthening and

protecting the nursing workforce
ICN is deeply concerned about the serious The International Centre on
threat to the safety of patients and quality of
health care resulting from insufficient numbers Nurse Migration (ICNM)
of appropriately trained nurses. The global nursing Responding to growing concerns about migration
shortage occurring in health systems around the and the health human resources crisis, ICN and
world is the result in many cases of insufficient the Commission on Graduates of Foreign Nursing
attention to the health, safety and well-being of Schools launched a much needed, new global
the nursing workforce. ICN works in a multi-faceted resource – The International Centre on Nurse
way to address the many forces and issues Migration. Established in 2005, the Centre facilitates
impacting the health care workforce. collaboration and knowledge sharing among
global organizations involved with migrating
The International Centre nurse professionals and contributes to patient
and public safety and improved health care.
for Human Resources in Nursing The Centre is an important asset in
(ICHRN) understanding and acting on the needs of
migrating nurses, employers and policy makers
throughout the global community. It addresses
gaps in policy, research and information regarding
the migrant nurse workforce. The centre’s web
site,, acts as a portal
for policy, research studies and other information
regarding migration trends and statistics.

A global picture of the

nursing shortage
In 2004, ICN and the Florence Nightingale
International Foundation, supported by the
To inform policy making and to build capacity in Burdett Trust for Nursing, undertook a two-year
nursing human resources, ICN and its premier analysis of the world’s nursing workforce – the
foundation, the Florence Nightingale International Global Nursing Review Initiative: Policy Options
Foundation (FNIF), established the International and Solutions. The results of this detailed
Centre for Human Resources in Nursing (ICHRN). investigation highlighted three critical challenges
Inaugurated in 2006, the Centre provides open related to nursing shortages: HIV/AIDS in
access to nursing HR knowledge, practice and policy. sub-Saharan Africa; internal and international
It allows nurses and others to remain up to date migration, and international recruitment of
with national, regional and global issues and trends. nurses; and the effects of health sector reform
ICHRN is a gateway to information, tools, and restructuring.
standards and training in nursing HR policy, As part of the Initiative, seven ‘issue papers’
management, research and practise. The Centre informed a high level consultation of health
tracks and develops nursing HR policy and human resource experts, feeding into an ICN
standards. The Centre’s web site,, plan of action presented to nursing leaders
enables open access to its Knowledge Library for input and validation at the Global Nursing
which offers a web based, interactive and fully Summit convened by ICN in 2005. Project
searchable database. The database holds a activities culminated with the publication of a
comprehensive range of information and final report, The Global Nursing Shortage:
documents covering all aspects of nursing HR, Priority Areas for Intervention. The reports and
including innovative work published by ICHRN. issue papers are available in English, Spanish
The Centre is supported through funding and French on the ICN Global Nursing Workforce
from the Burdett Trust for Nursing and ICN. Project website

Patient and public safety matter: nurses on the front line

Dealing with violence in the issues and the work environment on the safety
and delivery of patient care.
health care workplace In recent years LIN has been financially
Violence in the health care workplace has been a supported through the Danish Nurses Organisation
topic of concern for ICN for many years, as we and the LO/FTF Council for International
see the incidence and severity of violence against Development Co-operation with funds from the
nurses in particular on the rise. While nurses are Danish International Development Agency and by
not trained to handle violence a global shortage the Swedish Association of Health Professionals
of 4 million health care workers has worsened and LO/TCO Secretariat of International Trade
the situation. In Africa, the HIV/AIDS pandemic is Union Development Cooperation with funds from
also a contributing factor, as long queues of the Swedish International Development Agency.
patients requiring time-consuming treatment
often engender frustration, despair and anger. Safe injections for nurses
In cooperation with the Norwegian Nurses
Association, and the SADC AIDS Network of and patients
Nurses and Midwives (SANNAM), ICN supports
an initiative in five African countries, aimed at
reducing violence in the health care sector.
Through workshops and follow-up activities in
Botswana, Lesotho, Mauritius, Swaziland and
Tanzania (Zanzibar), a new consciousness is
being created. The goal is to provide nurses with
workable techniques to handle and reduce
workplace violence.
ICN also undertook work with WHO, the
International Labour Organization and Public
Services International to reduce workplace
violence in the health sector. The four organisations Nurses and health workers experience an average
have commissioned research on workplace of one to four needlestick injuries per year,
violence in the health sector internationally, potentially exposing them to serious or fatal
developed framework guidelines and piloted a infections. In fact, accidental needlestick injuries
training programme manual. The guidelines, account for 86% of all occupationally related
related training manual and other materials are infectious disease transmission.
available at In 2005, ICN and the World Health Organization
(WHO) implemented a Needlestick Prevention
Leadership in Negotiation Project in Vietnam, South Africa and Tanzania
The Leadership in Negotiation (LIN) initiative and developed a new tool kit, Preventing
teaches nurses skills to promote patient and Needlestick Injuries and Occupational Exposure
public safety, achieve safer working environments to HIV/AIDS. The goal is to reduce needlestick
and just compensation, and influence health and injuries and occupational exposure to blood-
nursing legislation. borne pathogens.
Introduced in 1982 in Africa, this action-learning Addressing this same issue in Europe, ICN
project has since been adapted to the needs of joined forces with the Standing Committee
nurses in the Caribbean, Eastern Europe, Latin of Nurses in the EU to demand immediate EU
America, South East Asia, the Pacific Rim and action to provide safer needles to protect health
the South Pacific and has been delivered in more workers from the threat of HIV/AIDS and other
than 40 countries. It facilitates the training of blood-borne diseases. It is estimated that health
nurse leaders in problem solving, negotiation, care workers in Europe suffer one million
communication, human resources development, needle stick injuries each year, of which 40%
occupational health and safety, association relates to nurses.
management, and marketing. At the same time,
it sensitises participants to the impact of labour

Bringing nursing together

23rd Quadrennial

Congress highlights included inspirational words

from Gretta Styles, as she accepted nursing’s
highest honour – the Christiane Reimann Prize
and a moving address by Stephen Lewis, UN
Special Envoy for HIV/AIDS in Africa, recipient
of ICN’s Health and Human Rights Award.

More than 4,500 nurses from 148

countries and every region of the
world participated in ICN’s 23rd
Quadrennial Congress held in Taipei,
Taiwan, 21-27 May 2005. Participants
joined in an international summit
Hiroko Minami, an outstanding nursing leader
on the global nursing workforce, in Japan and internationally, was elected and
installed as the 25th ICN President. Since its
which continued critical work by founding in 1899, ICN has had a tradition that
ICN and the FNIF in addressing the each President choose a watchword as a theme
for her presidency. Dr Minami chose the word
global nursing shortage. “Harmony”. She follows Christine Hancock
who served as ICN President from 2001-2005.

In an impressive celebration of nursing innovation

and knowledge, the programme offered more
than 1500 scientific presentations and 29 main
sessions given by international health care
experts. Participants discussed health challenges
such as HIV/AIDS, malaria, TB and SARS.


Samoan nurse Pelanetete Stowers delivered

a keynote address on the impact of knowledge,
innovation and vitality on nursing and
health care. Frances Hughes of New Zealand
led a discussion of nursing at the forefront
of innovation.

Women’s health advocate, Dr Afaf Meleis,

was the guest speaker at the FNIF Celebratory

Nursing on the move:

Knowledge, innovation and vitality
Patient and public safety matter: nurses on the front line

ICN nursing networks

Further information ICN creates forums for the international Nurse politicians around the
about these and exchange of ideas, experience and expertise.
other ICN Networks Such exchanges help nurses improve patient world caucus via ICN
is available at safety and the quality of care by exposing The Network offers nurse politicians, often working them to new ideas, and supporting them in their in isolation, a vehicle to share knowledge and
work. Established networks include Advanced experience and exchange and test ideas. As well
Practice, Regulation, Research and Leadership. it provides new and experienced politicians with
Over the recent biennium ICN created three the opportunity to develop mentoring relationships.
new networks: HIV/AIDS; Nurse Politicians; and In addition to being a vehicle of support to current
Remote and Rural Nursing. politicians, the Network members are invited to:
share their expertise in policy and advocacy with
Supporting nurses who care global nursing; assist ICN in identifying and
monitoring political trends and issues affecting
for HIV/AIDS patients health care, nursing and society in general; serve
as a political opinion resource to ICN.

Networking nurses in rural

and remote areas
Nearly half of the world’s population lives in rural
or remote areas. ICN has established a new network
to improve the health of rural populations, and to
support nurses who work in remote areas.
The ICN HIV/AIDS Network provides opportunities By providing a global forum, the ICN Rural
for exchange of HIV/AIDS-related knowledge and and Remote Nurses Network promotes sound
experience. Members also help identify trends in rural nursing practice and research by creating
HIV/AIDS prevention, care, support and treatment. opportunities for the exchange of knowledge
Over 100 nurses working in HIV/AIDS care and and experience. Network members and others
prevention have joined the network to date. The communicate in a variety of ways including via
network is moving forward as linkages are established the ICN web site, an online bulletin board, a
with its members and other groups. Plans are network bulletin, and meetings and conferences,
underway to organise meetings and conferences. the first of which was held in 2005.

ICN Awards and FNIF

ICN Awards Florence Nightingale

International Foundation
Christiane Reimann Prize
Margretta Madden Styles, As ICN’s premier foundation, Florence
a past president of ICN, Nightingale International Foundation (FNIF)
was awarded the 2005 supports and complements the work and
Christiane Reimann objectives of ICN, including the advancement
Prize for her remarkable of nursing education, research and services for
achievements and the public good. FNIF’s research projects aim
contributions to the nursing to advance health issues internationally and
profession internationally. increase nursing knowledge.
A nurse scholar
renowned globally as an international leader in The Girl Child Initiative
nursing education, regulation and credentialing,
Dr “Gretta” Styles was the architect of the first
comprehensive study of nursing credentialing in
the 1970s. In the 1980s, she spearheaded ICN’s
definitive work on nursing regulation, including
the publication of a guidebook on nursing regulation.
She was also a past president of the American
Nurses Association and the American Nurses
Credentialing Center. Known as nursing’s top
international award, the prize bears the name
of ICN’s first full-time Executive Secretary,
Christiane Reimann. ICN bestows the prize every
four years to a nurse who has had a significant
The Girl Child Initiative (GCI) provides a focus
impact upon the nursing profession. Margretta
for the global nursing community’s efforts on
Madden Styles died in November 2005.
behalf of girls.
Health and Human Rights Award The Girl Child Initiative consists of two related
Stephen Lewis, United
Nations Special Envoy for l The Girl Child Policy and Research Project aims
HIV/AIDS in Africa, was to review national programmes and policies
awarded the 2005 Health available to address the needs of girls between
and Human Rights Award. the ages of 10 and 14, interview girls with respect
ICN gives the award every to their needs, and lead an interdisciplinary team
four years in recognition of to determine gaps in policy and programming
outstanding humanitarian and advocate for changes nationally
contributions and achieve- The Girl Child Education Fund, a nursing initiative
ments in the domain of health and human rights. for orphaned girls, supports the primary and
It is ICN’s only award given to someone who is secondary schooling of the orphaned daughters
not a nurse. of nurses in developing countries, through the
Lewis is a passionate advocate for the world’s provision of school fees, uniforms and books.
most vulnerable people. He epitomises the goals Please see more on the GCEF on page 13.
and values of ICN and nursing in the promotion
of health and human rights. Lewis has focused
attention on the suffering and powerlessness of
women, and advocated relentlessly for women’s
rights and gender equality.

Patient and public safety matter: nurses on the front line

The International The Resource Nurse Volunteer

Achievement Award With funding from the Burdett Trust for Nursing,
Every two years, the Florence Nightingale ICN and FNIF conducted two feasibility studies:
International Foundation (FNIF) recognises a the first examined the demand for a volunteer
practising nurse’s contribution to nursing register of nurses to provide services in the
internationally. The 2007 recipient of this form of advice, consultation, mentorship and/or
International Achievement Award is Anneli training to organisations in English-speaking
Eriksson, RN and President of Médecins Sans Africa and the Caribbean; while the second
Frontières (MSF) in Sweden for her outstanding explored the level of interest among UK nurses
work helping endangered communities during (active and recently retired) in undertaking
catastrophes and for her leadership in short-term overseas volunteer assignments.
international nursing. The Award is given to a Results from both surveys indicate need and
mid-career practising nurse who is currently interest; however, findings highlight insufficient
influencing nursing internationally in two of financial resources as a major organisational
nursing’s four domains: direct care, education, constraint to the placement of nurse volunteers.
research and management. It accords worldwide
recognition of the recipient’s achievements More information about FNIF is available at
and contribution to nursing internationally.

Front cover: p. 4 Wellness Centre: Swaziland p. 11 Berry van Schaik p. 20 ICN

Photo credits Nurses Association
Top row, from left to right: p. 12 Swaziland Nurses Association p. 21 AKF/Jean-Luc Ray
AKF/Jean-Luc Ray; ICN; ICN p. 22 AKF/Amit Pasricha
Refugee library: ICN p. 12 AKF/Jean-Luc Ray
Second row, from left to right: ICHRN: WHO p. 24 AKF/Jean-Luc Ray
p. 13 ICN
ILO/P. Deloche; ICNM: WHO/Carlos Gaggero
Finnish Nurses Association Global Nursing Workforce: ICN p. 14 P&G/Greg Allwood p. 25 ICN

Third row : Regulation: ICN p. 15 AKF/Jean-Luc Ray & p. 26-27 ICN

both AKF/Jean-Luc Ray p. 6 Finnish Nurses Association AKF/Amit Pasricha p. 28 WHO & AKF/Jean-Luc Ray
Bottom row: WHO p. 7 ICN p. 17 WHO p. 29 ICN
Inside cover: ICN p. 8 AKF/Jean-Luc Ray p. 18 AKF/Jean-Luc Ray p. 30 Anneli Eriksson
p. 3 ICN p. 10 ICN p. 19 ICN p. 31 AKF/Jean-Luc Ray

ICN National Nurses Associations
Andorra Egypt Liberia Sao Tome & Principe
Angola Estonia Lithuania Serbia
Argentina Ethiopia Luxembourg Seychelles
Aruba Fiji Macao Sierra Leone
Australia Finland Malawi Singapore
Austria France Malaysia Slovak Republic
Bahamas FYR of Macedonia Malta Slovenia
Bahrain Gambia Mauritius Solomon Islands
Bangladesh Georgia Mexico South Africa
Barbados Germany Monaco Spain
Belgium Ghana Mongolia Sri Lanka
Belize Greece Morocco St. Lucia
Bermuda Grenada Mozambique St. Vincent
Bolivia Guatemala Myanmar & the Grenadines
Botswana Guyana Namibia Swaziland
Brazil Haiti Nepal Sweden
British Virgin Islands Honduras Netherlands Switzerland
Brunei Darussalam Hong Kong Netherlands Antilles Taiwan
Burkina Faso Hungary New Zealand Tanzania
Canada Iceland Nicaragua Thailand
Chile Indonesia Nigeria Togo
Colombia Ireland Norway Tonga
Congo Democratic Israel Pakistan Trinidad & Tobago
Republic Italy Panama Turkey
Cooks Islands Jamaica Paraguay Uganda
Costa Rica Japan Peru United Arab Emirates
Croatia Jordan Philippines United Kingdom
Cuba Kenya Poland United States of
Cyprus America
Korea Portugal
Czech Republic Uruguay
Kuwait Romania
Denmark Venezuela
Latvia Russia
Dominican Republic Zambia
Lebanon Salvador (El)
Ecuador Zimbabwe
Lesotho Samoa

International Council Editorial

of Nurses Linda Carrier-Walker
3, place Jean Marteau Lindsey Williamson
1201 Geneva
Switzerland Design & Production
Chamberlain Dunn Associates, London
Tel +41 22 908 0100 Tel +44 (0)20 8334 4500
Fax +41 22 908 0101