Interview with Howard Catton

Last summer, I had the privilege of sitting down with Howard Catton, the Chief Executive Officer of the International Council of Nurses (ICN). As the largest and most influential organization representing the nursing profession globally, the ICN plays a pivotal role in advocating for nurses worldwide. I was eager to learn from Howard about how the ICN amplifies the global voice of nursing, delivers invaluable leadership, and provides actionable insights that drive national and international healthcare improvements. In addition, we discussed his thinking about innovation and the evolving global direction of the profession. JNSPP: While we were communicating about getting this interview set up, you mentioned in an email that you just came out of the World Health Assembly and Midwifery Partners meeting. Perhaps we could start our conversation by you sharing some highlights on what emerged from those meetings, that you believe is important for nurses and midwives across the world and particularly in the Middle East region to know? HC: The annual World Health Assembly is attended by delegations from all member states of the World Health Organization (WHO), making it a crucial event for global health. It is important to recognize the significance of this gathering, as decisions made by WHO are based on the consensus of participating countries, similar to the relationship between the ICN and the WHO. The ICN, being the first international professional organization to establish formal relations with WHO post-World War II, has the privilege of participating in the World Health Assembly and contributing to discussions and interventions. In addition, WHO frequently seeks input from ICN on various health policy matters, reflecting a strong collaborative partnership beyond the Assembly. Despite skepticism from some individuals who believe global issues are beyond the scope of nursing, it is clear that nurses are intimately familiar with and affected by these challenges in their daily practice. By actively participating in discussions and interventions at events such as the World Health Assembly, nurses contribute valuable perspectives and insights to shaping the global health agenda. The Challenges We Face… In last year’s World Health Assembly (2024), we received important messages from the WHO regarding the state of global health. It is widely known that the sustainable development goals (SDG) include a focus on health, specifically SDG3. The WHO has placed a significant emphasis on ensuring universal access to health care globally, with clear warnings to Member States that we are falling behind on achieving the SDGs. While progress is being made toward Universal Health Coverage, the pandemic and other challenges such as economic instability, conflicts, and natural disasters have diverted attention from this goal. The numerous global crises, including climate change, present formidable obstacles to improving global health. However, amid competing priorities such as cost of living pressures, defense concerns, and unexpected events like pandemics, health issues can often be sidelined. It is important to recognize the complexities faced by policymakers in navigating these challenges and making difficult decisions. The global health agenda directly impacts nursing practice, as nurses observe and address the implications of these global issues on a daily basis. Nurses play a crucial role in responding to and finding solutions to these complex challenges, possessing a legitimate voice in shaping the global health agenda. The engagements and interventions of nursing professionals go beyond the formal agendas of such events, encompassing side events and bilateral meetings that provide opportunities to address key issues, and advocate for meaningful change. Impactful Global Collaborations… There is also a biennial global partners meeting which is a collaborative effort between ICN and the International Confederation of Midwives. This gathering brings together association leaders, chief nursing and midwifery officers, senior nursing leaders, regulatory authorities, education leaders, and representatives from international organizations to discuss pressing issues in the nursing and midwifery fields. Topics include migration, climate change, workforce shortages, and noncommunicable diseases (NCDs). The meeting provides a valuable opportunity for knowledge exchange, sharing of best practices, and influencing policy at the WHO and the World Health Assembly. The discussions before the World Health Assembly are strategic and impactful. Strategic and Policy Directions… First, it is important to note that the first-ever State of the World’s Nursing Report (SOWN) was released in 2020. It served as the foundation for the global Strategic Directions for Nursing and Midwifery, which were approved by the World Health Assembly. The data and evidence presented in the report were approved by the assembly, along with the strategies to address the identified issues. This work was completed before the onset of the pandemic. Recognizing the urgency of the situation, the ICN lobbied for a second SOWN Report, which has now commenced, with the support of Dr. Tedros Adhanom Ghebreyesus, Director General of the WHO. This report will inform the next iteration of the global strategic direction for the nursing workforce. Evidence-based Actionable Insights… It is essential to emphasize the significance of the evidence-based approach taken by the WHO in producing global reports and strategies. The data and conclusions presented are grounded in solid evidence, which is fundamental for informed policy development. Research plays a vital role in shaping these policies, as it provides the necessary evidence for advocacy and implementation of changes in the nursing profession. Furthermore, while each country may adapt the global strategy to suit its specific context, it is essential for them to align with and support the overarching global strategy. The global strategy acts as a catalyst for discussions, advocacy, and policy changes at the country level, guiding countries on areas where improvement is needed. By aligning national strategies with the global framework, countries can address specific areas of concern while staying accountable to the global standards set by WHO. It is crucial for the nursing profession to utilize the global strategy as a tool for continuous improvement and development, adapting it to address specific challenges faced in each country. Some countries may excel in this area more than others, but having a unified global strategy serves as a valuable resource for all stakeholders involved. There is a wealth of information to consider in shaping the future of nursing. JNSPP: You mentioned the importance of advocacy. It sounds to me that a big part of the ICNs work is to empower Chief Nursing Officers (CNOs) and Nurse Leaders to take these global policy and strategy directions and datasets, situate them in their national context, and advocate for what they need in their national context relative to that bigger strategy. Is that an accurate summary? HC: It is important to understand that ICN does not aim to exert control or provide a manual to chief nurses or nurse leaders, dictating specific actions they must take. Instead, ICN seeks to offer evidence and resources regarding global health and the intersections between nursing and global health delivery. Through reports and strategies outlining the global context, ICN opens opportunities for nurse leaders to advance the nursing profession in their respective countries, utilizing global advocacy and resources. When discussing advocacy, the goal is to be effective rather than to simply issue press releases. Communicating challenges in a compelling and credible manner, supported by evidence, is key. It is essential to not only identify problems but also present viable solutions. For instance, in recent years, ICN has highlighted the role of nursing in addressing global health challenges, showcasing examples of nurses leading innovations and advancing practice to underscore the profession’s potential in solving healthcare issues. Nurse leaders play a crucial role not only in the nursing workforce but also in ensuring quality and safety in healthcare organizations. By advocating for solutions, ICN aims to support countries in improving their healthcare systems. Sharing success stories and case studies can inspire and guide countries to invest in nursing, leading to tangible improvements that are recognized globally. The goal is to foster a collaborative and mutually beneficial relationship between global and local healthcare stakeholders, promoting collective progress. An overarching question that emerges is whether the current medical model of health care is ideal for the future, or whether there is merit in exploring alternative approaches that could be championed by nursing professionals. It is crucial to raise awareness among policymakers about the vast potential of nursing in shaping the future of healthcare systems worldwide. Politicians often use global platforms to showcase their country’s achievements and commit to further progress, and it is important for us to use these opportunities to advocate for nursing and prompt collaboration toward shared goals. JNSPP: Nurses often want to understand what is the line of sight between what I do and what they do. Nurses definitely get the cost of living issues because they’re feeling those pressures every single day, but it’s not always so easy for them to understand why they should be concerned about climate change, or political instability, or about what is happening in Sudan. And perhaps organizations like the ICN or the WHO seem so far removed from their reality. But how would you explain to a nurse who was in clinical practice, an RN, an advanced practice nurse, a nurse in a clinic, the impact of the work of the ICN that you guys do actually have or could have on their practice? HC: This is a longstanding concern for me, as I am always mindful of the need for us to be perceived as engaged and connected, rather than distant and detached, having been a critic myself in the past, questioning the relevance of discussions held in air-conditioned rooms in Geneva. Making the Connection… I understand the skepticism surrounding the real impact of global issues on individuals’ lives. It is essential to consider how issues such as climate change and cost of living affect people directly, particularly vulnerable populations like the elderly or those with NCDs who struggle with extreme temperature changes. These challenges can exacerbate existing health conditions, leading to social isolation and mental health issues. Furthermore, conflicts, famines, and natural disasters often result in population movements and increased healthcare demands, which must be addressed without compromising healthcare access for local populations. Addressing the root causes of health issues through early intervention and prevention is crucial, as doing so can alleviate pressure on healthcare systems, and reduce the need for hospitalization. It is essential to humanize these global challenges and demonstrate their impact on everyday practice in order to resonate with a wider audience. Nurses play a key role in identifying social determinants of health, such as inadequate housing, financial constraints, and lack of transportation, which impact individuals’ well-being and access to healthcare services. By highlighting these challenges in a nursing practice context, we can emphasize the importance of investing in healthcare systems and supporting healthcare workers with advanced skills. Through a bottom-up approach, we aim to raise awareness and advocate for solutions that address these complex issues in a more tangible and relatable manner than just presenting data. The final point to consider is the interconnected nature of global issues, particularly highlighted by the COVID-19 pandemic. In order to address these complex challenges, it is imperative for individuals to work together collaboratively. Nurses recognize the importance of teamwork in their clinical practice and can use this understanding through partnership and cooperation in addressing larger issues at a global scale. The role of nurses extends beyond individual actions to encompass a broader team dynamic, reflecting the collaborative approach needed to tackle global health challenges effectively. Despite being often characterized as soft skills, the leadership and managerial aspects of nursing should be acknowledged. JNSPP: Does the ICN have a stance on nurse innovation? If so, could you describe what this sounds and looks like for our readers? Nurses are adept at identifying issues and devising solutions. I believe there is a sense of ownership that nurses must maintain. Too often, I have observed successful innovations being presented by individuals other than nurses at events or meetings. The origin of these ideas often stems from the observations made by nurses in their practice and the subsequent actions they take to address them. During a conference, a speaker made a profound statement about the complexity of nursing and how nurses have the unique ability to simplify intricate matters. While I acknowledged the truth in their words, I also emphasized the importance of highlighting the complexity of our profession and the intricate role we play in managing various factors. It is not innate for us to be innovative; rather, it is part of our professional duty. It is crucial for the nursing profession to exude confidence and assertiveness when articulating problems and taking ownership of initiatives or ideas. Nursing leaders play a pivotal role in ensuring that innovations are not relinquished prematurely. Following the identification of an issue, it is essential to undergo testing, research, product development, and market testing. Nurses should be actively involved at every stage of this process. A clinical nurse might not always be the one to see an innovation through to completion. However, the responsibility for driving forward these practice changes rests with nursing leadership. It is important to involve nurses and other healthcare professionals from the onset of an idea’s development to ensure successful implementation. The industry employs healthcare professionals who operate within it, and it is essential to consider career pathways for nurses transitioning from research to innovation. This challenge of diversifying career opportunities for nurses must be addressed more thoroughly, as it is currently an area, in which we are not as strong compared to other issues. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.