Exclusive: WHO chief nurse urges governments to ‘listen to nurses’

The most senior nurse in the world has said that now is the time to change the historic undervaluing of the nursing profession.

The chief nursing officer (CNO) of the World Health Organization (WHO), Dr Amelia Latu Afuhaamango Tuipulotu, has called on national governments to listen to the voice of nurses, amid the pay disputes that are currently taking place across the globe.

In her first interview with Nursing Times, Dr Tuipulotu laid out her priorities and ambitions for her time in post. She explained that now was the right time “for empowerment, recognition, value and respect for nurses and midwives”.

Dr Tuipulotu said: “We must care for them, the nurses and midwives. We must make sure they have decent pay and working conditions, we must enable them to work to the full extent of their scopes of practice, and we must have more nurses in senior health positions.

"These are key [parts] of the solutions for the issues that nurses are facing.”

"We really have to see the whole picture, the ripple impact of decisions we make"

- Amelia Latu Afuhaamango Tuipulotu

A key issue in nursing across the globe is the “historical undervaluing of the profession” through things like poor pay, she argued.

“For me this is the right time that we must come together to change that,” she said.

She urged governments “to listen to the nurses’ and midwives’ voices and perspectives”, arguing that they are the people on the front lines delivering the care, while experiencing overwork, long hours and burnout.

Dr Tuipulotu said: “Leaders must come to fully understand [the conditions in which nurses are working]… and the impact of the decisions for fair pay and fair working conditions for nurses and midwives.

“If the profession feels [it is] undervalued [and] disrespected – historically and after the pandemic – how will that impact the nurses themselves, their confidence and the way they value their work? We really have to see the whole picture, the ripple impact of decisions we make.”

Now seven months into the CNO role, Dr Tuipulotu described her time so far as “a major step up” in her career.

Previously, she was the CNO for her native Tonga – a country made up of around 170 islands in the southern Pacific Ocean – between 2014 and 2019.

After that, she became the first female health minister in Tonga, a post she held for two years, when she led the country’s coronavirus pandemic response, before joining the WHO.

She said: “I had been working for one country and now [I am] having to work for 194 member states, and the billions[-strong] population of the world.”

Dr Tuipulotu acknowledged that another key issue facing the nursing workforce right now is the growing reliance on international recruitment to plug staffing gaps.

“International recruitment has been really challenging, particularly after the emergency phase of the pandemic,” she said.

Currently, the WHO has a red list comprising 55 countries that have been identified as facing the most pressing workforce shortages and should, therefore, not be targeted for systematic recruitment by international employers.

Dr Tuipulotu explained that 37 of these countries were in the WHO’s Africa region, while the remaining were in its Eastern Mediterranean, Southeast Asia, Western Pacific, and the Americas regions.

International recruitment in the Western Pacific region had become “particularly difficult” as it hosts many small islands and developing states, said Dr Tuipulotu.

In some cases, she said, there may be only one nurse or midwife caring for a population of 200-1,000 people so, when they are pulled elsewhere, “it is very challenging”. She added: “It just means a lack of access to care for the vulnerable population.”

Despite the WHO’s warnings, many high-income countries, including the UK, continue to fill vacancies with nurses from countries on the red list.

The CNO noted that it was important to “see the perspectives [of] the healthcare professionals” who are migrating to other countries, and said: “Of course, there are the issues with regards to healthcare professionals and nurses, [and] their own rights to be able to migrate. So, we must all come together and see the picture very clearly, as we will be called to be accountable into the future.”

When asked whether the WHO’s red list was fit for purpose, Dr Tuipulotu said the organisation only “issues guidelines” so it was, ultimately, up to individual countries to take note of the recommendations and adhere to them.

However, she added: “If our actions are unethical, which may solve a short-term problem for now, it will not be the best solution for us in the long term.”

In addition, Dr Tuipulotu called on nurses, nursing associations and governments from all countries, “to discuss openly international recruitment and the need for ethical recruitment”.

She said: “It’s always very important that we look at [a] situation, map it out carefully, see the potential impact on the population of our decisions and our actions – and I think we will come up with the right solutions and strategies.”

High-income countries that continue to benefit from international recruitment could be encouraged to invest back into source countries, to support them to maintain their domestic workforce, suggested Dr Tuipulotu.

“We have to think outside the box [about] some other options that can be done so there is a fair contribution back to the source country,” she said.

However, she stressed that every country needed to invest in their nursing workforce.

She said: “Investment must be done globally, everywhere around the world. We must be able to do it together as one team. The whole world must work together in solidarity.”

Similarly, Dr Tuipulotu said she wanted to use her time in post to help the WHO’s Office of the Chief Nurse to become “a trusted global leader to strengthen nursing and midwifery”.

These comments come as the WHO recently launched a new emergency care training initiative, titled ‘25x25x25’, to mark its 75th birthday.

The scheme, which was designed to address a “critical skills gap”, aims to provide training in basic emergency care to 25% of nurses and midwives in 25 countries by the end of 2025.

Dr Tuipulotu said: “It’s an ambitious campaign, initiative and target, but we are working slowly and diligently in partnership with the regions and the member states and all relevant key partners to move forward.”

The scheme was launched because nurses and midwives are dealing with emergencies that “are happening everywhere and every day”, said Dr Tuipulotu.

“It is very important that they have the knowledge [and] the skills to care for the population during emergencies,” she added.

One of the biggest emergencies nurses have had to face in recent years has been the coronavirus pandemic.

Dr Tuipulotu noted that, although the WHO declared back in May that Covid-19 was no longer an international public health emergency, the virus was “still killing and still changing”.

In addition, she described how the pandemic had affected nurses’ mental health by causing “burnout and fear” that was still being felt today.

“Nurses were at the front line and, for me, I was [seeing] that they were [in] the firing line,” she said.

To spotlight how the pandemic has affected the nursing profession, the WHO, in collaboration with the International Council of Nurses, will publish a second State of the World’s Nursing Report in 2025.

Dr Tuipulotu noted that Covid-19 deeply affected the world and the nursing profession.

She said: “There is a need to better understand the impact of Covid-19 and, specifically, its impact on nurses and midwives.”

She added that she hoped the report would “raise the value, the profile, and the recognition and the respect to the profession”.

Looking forward to the rest of her time in post, Dr Tuipulotu said there were a lot of opportunities, but also a lot of challenges as CNO.

She said that she was most excited about how the Office of the Chief Nurse could “enhance and strengthen nursing and midwifery engagement with the WHO”.

Notably, Dr Tuipulotu said she would like to see nurses engage further in some of the programmes that are being launched in the coming months, as they themselves would be the ones to “deliver them on the ground”.

Dr Tuipulotu added: “I think we have the power in our hands together – nurses, midwives, associations, member states, [ministries of health] and governments – to change the future for tomorrow, for the profession [and] for universal health coverage for the population to ensure safe and quality care. That’s why we have to do it.”