Feature| Volume 21, ISSUE 1, P56-60, February 2023

What Is Your Global Nurse Leadership Policy Literacy?

Published:November 09, 2022DOI:


      The primary aim and objective of this article is twofold. Firstly, to advance strategic nursing policy and leadership awareness, and secondly to issue an action challenge to urge nurses to proactively assess their professional global nurse leadership literacy levels. By harnessing our individual and collaborative foundational policy competencies, our confidence is bolstered, and through collective leadership, we can advance our profession’s influence and impact, and further contribute to global health. My top 10 key global resources that I leverage in my capacity as chief nurse with the International Council of Nurses is shared strategically to inform, enable, and empower nurses as policy leaders locally to globally, from the bedsides to classrooms, and from the boardrooms to governments nationally, internationally, and beyond. Nurse leaders across health, social, and academic systems can strengthen and leverage their global leadership and policy competencies for the health of our world and profession.
      Key Points
      • Nurses are leaders regardless of their informal or formal role titles.
      • Lead with intention to catapult your nursing leadership policy competence and confidence locally to globally.
      • Personalize your continuing professional development nursing leadership policy action plan to advance global investments and sustainability.
      In my intentional effort to lead by example, I am excited to share my International Council of Nurses (ICN) chief nurse (CN) top pocket, go-to, foundational global nursing leadership and policy resources with nurses who lead both formally and informally. My effort is intentional, deliberate, and purposeful to power-up knowledge and disseminate relevant resources to guide and support you. Assess and advance your professional leadership policy literacy competence and confidence to maximize strategic professional nursing influence and impact locally to globally. Policy acumen is learning of knowledge as in every other field. Each nurse has their professional domain of knowledge, but transforming it into the policy domain requires the knowledge of the science and art of the policy discipline.
      I sought leadership enhancement opportunities to assess and validate my competency and expertise level, and boost my confidence globally. I was privileged to be in the first cohort of Miller Fellows in 2021 at the Shaughnessy Nurse Leadership Academy, Case Western Reserve University in Cleveland, Ohio, United States. This innovative post-doctorate nurse executive leadership program with international reach catapulted my global transformation and pivoted my career trajectory. I was appointed as the inaugural CN of the ICN in May 2021.
      • Acorn M.
      Reflections from a system chief nursing executive: intention to lead.
      My leadership professional development is evolving further with the 2022 cohort of Coldiron Fellows at Case Western, in partnership with the American Nurses Association, American Organization for Nursing Leadership, and the Health Care Financial Management Association.
      My top 10 CN resources with aligned rationales that have amplified my global nursing leadership and policy literacy, utilized in my personal discovery journey and professional utilization to support you locally to globally while advancing your competence and confidence will follow thematically.

      Personal Nursing Certification Agenda

      Certified Global Nurse Consultant

      I voluntarily applied for the ICN and CGFNS International Global Nurse Consultant Certification, designed to capture nurses’ credentials across our careers. My desire to validate my knowledge and expertise during my post-doc leadership journey and expand my professional opportunities occurred in advance of contemplating my role shift.
      Certification can provide consultant opportunities for nurses to contribute to various ICN initiatives, and consult with governments, health care institutions, and nongovernment organizations.
      International Council of Nurses
      I found value in certification, advancing my global legitimacy, credibility, and visibility as a nursing expert in the specialty of leadership. We must build capacity and a pipeline of global nurse experts across diverse specialties and sectors to amplify our value and knowledge contributions locally to globally for sustainability.

      Global Agenda

      Global Strategic Directions for Nursing and Midwifery

      Adopted at the 74th World Health Assembly, the Strategic Directions for Nursing and Midwifery (SDNM) highlights 4 key interrelated key evidence-driven policy priorities from a labor market lens for population health for 2021 to 2025.
      World Health Organization
      Targets are educating enough midwives and nurses with competencies to meet population health needs; creating jobs, managing migration, recruiting and retaining midwives and nurses where they are most needed; strengthening nursing and midwifery leadership throughout health and academic systems; and ensuring support, respected, protected, motivated, and equipped nurses and midwives to contribute to their service delivery settings safely and optimally.
      World Health Organization
      The summary priorities graphic,
      World Health Organization
      (p.6) with the 12 policy priorities is a must to bookmark for quick reference and utilization. Implementation, monitoring, and accountability focuses on data, dialogue, and decision-making. Member states use National Health Workforce Accounts (NHWA) indicators to share data to inform the State of the Worlds’ Nursing Report (SOWN)
      World Health Organization
      and for annual country reporting on policy priorities progress towards countries’ policy action. These impacts could fully enable the contributions of nurses and drive investments towards strengthening access, primary health care, universal health coverage (UHC), sustainable development goals, pandemic response; mitigating the health effects of climate change; and managing international migration.
      World Health Organization
      The global need for skilled nurses and investments for education, jobs, leadership, and service delivery settings is urgent. The need for nurses to articulate and align the global SDNM (GSDNM) pillars towards a common policy approach is required internationally.

      State of the World’s Nursing Report

      This first landmark 2020 report provides evidence and policy options for investing in the global nursing workforce. 2020 was the International Year of the Nurse and the Midwife, providing an opportunity to leverage the evidence in the SOWN report
      World Health Organization
      and commit to action to drive and sustain progress towards 2030 by urging governments and stakeholders to invest in the massive acceleration of nursing education—faculty, infrastructure, and students—to address global needs; create 6 million new nursing jobs by 2030, primarily in low and middle income countries, to offset the shortages and inequitable distribution of nurses; and strengthen nurse leadership to ensure that nurses have an influential role in health policy formulation and decision-making, and that they contribute to the effectiveness of health and social care systems.
      World Health Organization
      Nearly 28 million nurses account for 60% of the health professionals. Country profiles on nursing workforce are located in the report. Ageing health workforce patterns threaten the stability of nursing. One nurse out of every 8 practices in a country other than the one where they were born or trained. Nearly 90% of the nursing workforce is female, but few leadership positions are held by women. A total of 71% of responding countries have a national nursing leadership position with responsibility for providing input into nursing and health policy. The presence of a government chief nursing officer position is associated with stronger regulatory environments for nursing. Investment in nurses will contribute to health-related sustainable development goals (SDG) targets, education (SDG 4), gender (SDG 5), and decent work and economic growth (SDG 8).
      World Health Organization
      It will be crucial that we advocate and insist on a future SOWN report that reflects our post-COVID world realities to accurately capture country-level nursing NHWA progress.

      TRIAD Statement

      Nursing and midwifery leaders representing World Health Organization (WHO) Member States, national nursing associations, and national midwifery associations met virtually for the 9th Triad Meeting of the WHO,
      World Health Organization. (2022). 9th TRIAD Statement.
      the ICN, and the International Confederation of Midwives (ICM). Leaders from 165 countries committed in 2022 to:
      • 1)
        Accelerate the GSDNM to achieve UHC, specifically to drive data use for implementing and monitoring needs-based workforce planning supported through sustainable funding.
      • 2)
        Adopt innovative approaches to strengthen the capacity of health teams, accelerating telehealth, digital education, and interprofessional collaboration to optimize scopes of practice and competencies of health workers.
      • 3)
        Adopt the WHO’s Global Health and Care Worker Compact and Charter on Health Worker Safety to protect and safeguard their rights and to ensure decent work, free from discrimination, with safe and enabling practice environments.
      • 4)
        Support the WHO Global Code of Practice on the International Recruitment of Health Personnel for ethically growing our workforces, and
      • 5)
        Reinforce the International Labour Organization Nursing Personnel Convention.
        • Buchan J.
        • Catton H.
        • Shaffer F.
        Reporting on the TRIAD policy action plan for the 2024 Meeting needs to be proactive and intentional as we move forward.

      Sustain and Retain Report in 2022 and Beyond

      This document highlights the global nursing workforce shortage prepandemic of almost 6 million nurses, who are highly concentrated in low-income and lower middle-income countries from 2019 to early 2020. The pandemic has significantly impacted nurse retention, burnout, and high turnover. An Action Agenda Plan targets country-level and international-level goals.

      Country level

      Support for safe staffing levels with the necessary resource allocations, early access to vaccinations for nurses; regular nurse workforce impact assessments, capacity review of the domestic nurse education system from a national labor market analysis; improving retention of nurses and the attractiveness as a career by fair pay and employment conditions including career opportunities and access to continuing education; supporting advanced practice and specialist nursing roles, and appropriate technology, and monitoring nurse self-sufficiency indicator levels of reliance on foreign-born or trained nurses.

      International level

      Support an updated SOWN analysis for accurate national and global profiles of the nursing workforce, international co-operation is required to protect nursing workforces in all countries; ethical management of our international supply of nurses through a collective approach with fair and transparent recruitment and employment practices; and commitment to investing in nurse workforce sustainability impacted by the pandemic, and by building UN High Level Commission on Health Employment and Economic Growth and the WHO SDNM, which demonstrate the long-term economic, social, and population health benefits of investing in the nursing workforce.
      World Health Organization
      Sustaining and retaining the nursing workforce is paramount from a holistic and global perspective to ensure the health and longevity of nursing contributions across our career trajectories.

      Nursing and Midwifery Global Community of Practice

      If you have not already registered and are not engaging, I urge you to become an active nurse participant. By joining the WHO Community of Practice (COP), you can connect, discuss, and join events with nurses globally, as well as with regional hubs and collaborating centers. The SDNM and the 9th Triad Meeting was hosted here, and accessible recordings are available to review at your convenience. There are 15 groups to date and climbing. The COP groups provide nurses opportunities to connect virtually with WHO Twinning Partnerships for Improvement, Pandemic Resources, Future Leaders, Patient Safety, Climate and Health, Live Learning Labs, Emergency and Critical Care, plus others.
      World Health Organization
      I encourage you to explore the ICN policy and program resources highlighted in the COP Library Resources that align with the SDNM leadership, education, service delivery, and jobs pillars for additional knowledge building.

      The 2030 Agenda for SDGs

      Adopted by all United Nations Member States in 2015, the agenda provides a blueprint for peace and prosperity for people and the planet. The 17 SDGs require urgent calls for action by all countries in a global partnership effort. Specifically, the SDGs are:
      • 1)
        End poverty in all forms
      • 2)
        End hunger, achieve food security, improve nutrition and sustainable agriculture
      • 3)
        Ensure healthy lives, and promote well-being for all
      • 4)
        Ensure inclusive and equitable quality education and lifelong learning opportunities
      • 5)
        Achieve gender equality and empower all women and girls
      • 6)
        Ensure sustainable management of water and sanitation
      • 7)
        Ensure access to affordable, reliable, and sustainable energy
      • 8)
        Promote sustained, inclusive, economic growth, productive employment, and decent work
      • 9)
        Build resilient infrastructure, promote inclusive and sustainable industrialization, and foster innovation
      • 10)
        Reduce inequality within and among countries
      • 11)
        Make cities and human settlements inclusive, safe, resilient, and sustainable
      • 12)
        Ensure sustainable consumption and production patterns
      • 13)
        Take urgent action to combat climate change and its impacts
      • 14)
        Conserve and sustain oceans, seas and marine resources
      • 15)
        Protect, restore and promote sustainable use of ecosystems, forests, combat desertification, halt and reverse land degradation and biodiversity loss,
      • 16)
        Promote peaceful and inclusive societies, provide access to justice and build effective, accountable institutions at all levels
      • 17)
        Strengthen implementation and revitalize the global partnership for sustainable development
      • Nurses need to be aware and versed, and advocate and harness our abilities to advance the SDGs locally to globally for our population and profession.

      Eastern, Central, and Southern Africa Education and Labor Markets for Nurses

      This collaborative report by the World Bank, ICN, East, Central, and Southern Africa College of Nursing (ECSACON), and Jhpiego presents a comprehensive assessment of the education and labor markets for nurses in the Eastern, Central, and Southern African (ECSA) region. More than 80% of the population in low-income countries cannot access health services because of the lack of sufficiently trained health workers. Wide recognition that nurses are essential to achieving universal health coverage through primary health care exists. The Governance and Regulatory Capacity (5.3) specifically illuminated the QUAD concept uniquely, but suboptimally leveraged regionally. The nursing Quad was a formally constituted mechanism in the ECSA region while implementing the African Health Professions Regulatory Collaborative project, to ensure that the nursing and midwifery agenda was addressed comprehensively to improve practice, regulatory governance, and advocacy mechanisms to embrace change, as well as strengthen education aspects to ensure sustainability.
      The Quad included 4 nursing pillars representatives: One, nursing educators (professors, educators, and preceptors); two, regulators (councils or regulators); three, government (chief nursing officer/director of nursing and midwifery services or ministry nurse leaders); and four, professional association leadership. The Quad arrangement in the ECSACON member countries has served as a permanent mechanism to support nursing and midwifery strengthening through meetings, advocacy and common supportive supervision from the national level to the lowest levels of care.
      Leveraging the QUADS unity from local to global as a best practice could strengthen relationships, investments, and action in countries to drive investments, implementation, data, dialogue, and decision-making. Future collaboration with the Word Bank and valued integral partners to conduct more post-COVID regional assessments are needed globally from a nursing workforce lens.

      Social Justice

      Violence Against Health Care

      This important collective work conducted in 2022 by 4 international umbrella organizations and members of the global community of concern for the Health Care in Danger initiative include ICN, International Committee of Red Cross, International Hospital Federation, and the World Medical Associations. A joint survey to evaluate the perceptions of violence against health care during the early stages of the pandemic and to identify good practices to prevent, reduce, or mitigate incidents was undertaken. The WHO defines attacks against health care as any act of verbal or physical violence, or obstruction, or threat of violence that interferes with the availability, access, and delivery of health services during emergencies. Types of attacks vary and can range from violence with heavy weapons to psychosocial threats and intimidation.
      Country survey results demonstrate the persistence of violence against health personnel, with a higher frequency of incidents after the coronavirus pandemic started. The incidents impacted negatively on a from emergency care to preventive health care services. Close to 80% of reported violence against health care is perpetrated by family members accompanying patients. The document provides practical solutions to tackle violence at a community level in the areas of security, promoting safer work environments, caring for staff’s mental health and well-being, and addressing gaps in communication and coordination. The pandemic has worsened violence against health care and with higher frequency of violent events. Frequent underreporting of incidents indicates that awareness raising is required. A robust system for reporting, monitoring, and analyzing data is needed. The importance of improving relationships between health personnel, patients, and their family is evident. Education in communication skills for de-escalating potentially violent situations is required, as well as legal support and health facility security. Lastly, the Ethical Principles of Health Care, endorsed in 2015 by civilian and military health care organizations, aim to guide health personnel when providing health care.
      The physical and emotional safety and protection of the nursing, professional, and other health personal are essential for respecting and sustaining rights and global health.

      The Gender Pay Gap in the Health and Care sector: A Global Analysis

      There is a heightened need to eradicate gender inequalities and social injustices. Countries and the international communities have taken steps such as the 1995 Beijing Declaration agreed upon during the 4th World Conference on Women, and the target of reducing the gender gap in labor force by 25% in 2025 by the G20 leaders at the 2014 Summit. The SDG (8) calls for equal pay for work of equal value.
      This 2022 document co-developed by International Labour Organization and WHO, is the first global sectoral gender pay gap report.
      World Health Organization
      The health sector, with 67% of wage employees being women, has a key role to play in women’s economic empowerment and the broader SDG5 agenda. Using this evidence to achieve equal pay for equal work across the sector is a critical step to attracting, retaining, and addressing the global shortfall of health and care workers to achieve UHC. The high degree of feminization in the sector is a key factor behind the lower earnings for both women and men. Globally women face a 24-percentage point pay gap compared to men across the health and care sector, greatly unexplained by labor market attributes that should be the sole factors determining wages. Evidence indicates that the employment impact of COVID-19 in the sector disproportionately affected women. Significant variation across countries is evident.
      Targeted action to close gender pay gaps in a path forward includes: improving the collection and analysis of targeted gender-disaggregated wage data for the health and care sector; Investing in decent jobs in the sector; social dialogue; promoting science, technology, engineering and mathematics careers for women; attracting more men into middle occupation categories and more women to the top; pay transparency and legal instruments against discrimination; policies to redress the motherhood pay gap; and facilitating the transition of workers from the informal to the formal economy.
      The value and respect of nurses as a highly gendered profession must be addressed for the health workforce pandemic faces and the sustained nursing profession.


      I hope you have found my top 10 chief nurse global nursing leadership policy resources informative and comprehensive as you assess, reflect, plan, and shape your global leadership policy journey discovery and growth. This article consolidates more than ten important policy papers. Annual nursing global agenda updating is recommended. The importance of engagement of individuals at the local and global level, and back again locally is key. You can bolster both your individual knowledge while catapulting our collective professional knowledge and leadership impacts to lead and power the nursing profession resulting in momentum and transformational change.
      Intentionally commit to increase your global nurse leadership policy acumen, confidence, and competence. Nurses have the power to strengthen quality care and influence meaningful and impactful change across all sectors, locally and globally. Gaining policy acumen is important for nurses. The call for policy enhancement through investments, education, and professional and personal efforts is essential for momentum and transformation.


        • Acorn M.
        Reflections from a system chief nursing executive: intention to lead.
        I Int Nurs Rev. 2021; 68: 437-440
        • International Council of Nurses
        Certification for Global Nurse Consultants. 2020 (Available at:)
        • World Health Organization
        Global Strategic Directions for Nursing and Midwifery 2021-2025. 2021 (Available at:)
        • World Health Organization
        State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership. 2020 (Available at:)
      1. World Health Organization. (2022). 9th TRIAD Statement.
        (Available at:)
        • Buchan J.
        • Catton H.
        • Shaffer F.
        Sustain and Retain in 2022 and Beyond. International Centre on Nurse Migration, 2022 (Available at:)
        • World Health Organization
        Nursing and Midwifery Global Community of Practice. 2022 (Available at:)
        Date accessed: October 1, 2022
      2. The United Nations. 2030 Agenda for Sustainable Development. 2015 (Available at:)
      3. Eastern, Central, and Southern Africa. ECSA: Education and Labor Market for Nurses; Challenges and Opportunities. 2021 (Available at:)
      4. Health Care in Danger. Violence Against Health Care: Current Practices to Prevent, Reduce or Mitigate Violence Against Health Care. 2022 (Available at:)
        • World Health Organization
        The Gender Pay Gap in the Health and Care Sector: A Global Analysis in the Time of COVID-19. 2022 (Available at:)


      Michelle Acorn, DNP, NP PHC/Adult, CGNC, FCAN, FAAN, is a Coldiron Fellow with the Marian K. Shaughnessy Nurse Leadership Academy, Frances Payne Bolton School of Nursing, Case Western Reserve University, in Cleveland, Ohio, and adjunct professor at the Faculty of Nursing, University of Toronto, in Toronto, Ontario, Canada. Dr. Acorn was a Coldiron Fellow in 2022 and a Miller Fellow in 2021. She can be reached at [email protected]