The International Council of Nurses (ICN) has adopted the theme Our Nurses. Our Future. The economic power of care, for International Nurses Day in 2024.

For a world still recovering from the effects of the COVID-19 pandemic, increasing geopolitical instability, climate change, and with wealth and income inequality rising to unprecedented levels across the globe, what is the significance of this theme to nurses globally, and in Australia specifically?

According to ICN President, Dr Pamela Cipriano, despite being the core of the health system, nurses are often subject to financial constraints in their work and societal undervaluation of what they do (ICN, 2024).

The International Labour Organization (ILO) succinctly summarises the situation by stating that nurses are overworked, underpaid, and undervalued (ILO, 2023).

Dr Cipriano goes on to state that it’s time to shift perceptions of nursing as a cost in economic terms, to one which recognises the value and positive impact of nursing on economic, social and health at the individual and societal level.

The economy must be made to serve the wellbeing of the people, not the opposite as is often sadly the case (Sax Institute, 2023).

But why do we need this paradigm shift and how do we drive the shift from the current situation to one where an investment in nursing, rather than a focus on costs and expenditure, achieves the health, economic and social gains identified by the ICN?

How do we turn undervaluing and cost into worth and recognition?

The simplest answer is that the current system isn’t working effectively and operates far too slowly for nurses for a number of reasons, and we must force change.

For example, despite the universal acknowledgement of the essential role that nurses played in the COVID-19 pandemic, this recognition has not translated well into tangible outcomes.

Nurses continue to suffer burnout and stress (Mannix, 2021) with many expressing an intention to leave the profession (Berlin et al., 2022). This is unacceptable.

As another indicator of the long-term underinvestment in nursing – significant workforce shortages – are being experienced across all sectors and are expected to continue into the future.

The message must be that building the nursing workforce is an investment in the future, not a cost to be minimised and something to be neglected.

Anything less is simply a false economy and a case of short-term gain at the cost of long-term pain.

Kicking the can down the road no longer works… if it ever did.

However, changing perspectives isn’t easy and there are a range of factors that must be considered as we reflect on how nursing and nurses can be repositioned to be acknowledged as a core asset of health care.

Across those services that constitute the care economy (childcare, elder care, health care, social care, and education), both paid and unpaid, are provided by predominately by women.

According to the World Health Organisation (WHO), 67% of the global health and social care workforce are women.

The following examples show how important, but unacknowledged, this contribution is.

• Globally, women provide essential health care to five billion, out of a world population of approximately eight billion.

• The financial value of this contribution is US$3 trillion annually (WHO, 2024).

This contribution is also undervalued, with these caring roles often grouped in lower status, lower paid (or often unpaid) work (WHO, 2024).

As a result, women often have limited power to improve their work, economic, social and health conditions and thus influence decision making and shift thinking and attitudes (WHO, 2011).

A similar pattern emerges in Australia. Within the health and social assistance industries (the care economy) women constitute 76.2% of workers.

According to the Department of Prime Minister and Cabinet, women:

• are more likely to be in low-paid, insecure work

• work fewer hours than men

• do the majority of care type work

• provide more unpaid care and domestic work

• continue to suffer from a gender pay gap where on average, an Australian woman is likely to earn $1 million less than an Australian man over their career lifetime. If allowed to continue this gap could increase to $2 million over time (Department of the Prime Minister and Cabinet, 2023).

Little wonder that despite being the largest, and an essential, part of health and aged care, nurses still don’t have the recognition, influence, and visibility commensurate with their numbers and criticality to the functioning of health and aged care.

What can be done to address these systemic inequalities, and turn unacknowledged nursing care and work into a visible and important contribution to health, economic and social wellbeing?

A starting point is, and must be, the collective action of nurses.

There are several considerations.

First, being a member of a union means better wages (Jericho, 2022) and the greater economic power, both individually and collectively that flows from that.

Second, the demographics of union membership have shifted. The stereotypical male-dominated blue-collar union member has given way to female dominated unions representing occupational groups such as nursing and teaching.

As identified by Lori-Anne Sharpe, Assistant Federal Secretary of the ANMF, “the average union member in Australia is now a 36 year old nurse and the largest union is her union, the ANMF” (Marin-Guzman, 2023). This represents a significant shift in political power and influence and must continue to be built on by growing nursing and midwifery industrial and professional power.

We all know that politicians and employers don’t always do things because it’s the right thing to do. Sometimes power must be used to demand and achieve change.

Third, stronger unions, and the collective voice that goes with that, improve economic performance resulting from better worker engagement, a more satisfied and productive workforce, better wages and conditions, and a range of wider social and economic benefits, e.g., better workplace health and safety and wellbeing outcomes and reduced inequality, including decreased gender inequality (Wright, 2023).

The recent 15% wage increase for direct care workers in aged care is a good example of how union power can drive change. This national work value case has been driven by the need to rectify the significant undervaluation of nurses and carers in this sector by highlighting the historical lack of acknowledgement of the real value of hard-working aged care workers.

Australia is currently experiencing significant nursing workforce issues across all sectors, with the aged care sector predominating, and off the back of the COVID pandemic, there’s no better time to focus politicians, policy makers and society more generally on just how essential nursing and nurses are to economic and social wellbeing, and the better health of the nation.

The ICN theme of Our Nurses. Our Future. The economic power of care couldn’t come at a more important time.

Start preparing for International Nurses Day in May 2024 and claim the day.

 

References:

International Council of Nurses. (2024). International Nurses Day 2024 theme announced! Our Nurses. Our Future. The economic power of care [Web article]. www.icn.ch/news/international-nurses-day-2024-theme-announced-our-nurses-our-future-economic-power-care

International Labour Organisation. (2023). Nurses and midwives: Overworked, underpaid, undervalued? [Web article]. ILOSTAT. https://ilostat.ilo.org/nurses-and-midwives-overworked-underpaid-undervalued/

Sax Institute. (July 5, 2023). Not just window dressing: How a true ‘wellbeing economy’ can tackle urgent social and environmental challenges. www.phrp.com.au/media/media-releases/wellbeing-economy/

Mannix, K. (2021). The future of Australia’s nursing workforce: COVID-19 and burnout among nurses. University of Melbourne. www.unimelb.edu.au/__data/assets/pdf_file/0004/4085194/katelyn_mannix_report.pdf

Berlin, G., Bruce, D., Luthra, K., Lapointe, M., & Maud, M. (2022)  Should I stay, or should I go? Australia’s nurse retention dilemma [Web article]. McKinsey & Company. www.mckinsey.com/industries/healthcare/our-insights/should-i-stay-or-should-i-go-australias-nurse-retention-dilemma#/

World Health Organisation. (2024). Value gender and equity in the global health workforce [Web article]. www.who.int/activities/value-gender-and-equity-in-the-global-health-workforce

World Health Organisation. (2011). Gender, Work and Health. WHO. https://iris.who.int/bitstream/handle/10665/97940/9789241501729_eng.pdf?sequence=1

Department of the Prime Minister and Cabinet. (2023).  A 10-year-plan to unleash the full capacity and contribution of women to the Australian economy 2023 – 2033.  Australian Government. https://www.pmc.gov.au/resources/10-year-plan/current-state#:~:text=Despite%20women's%20increasing%20labour%20force,'construction%20industry'%20are%20male

Jericho, G. l. (December 14, 2022). ABS data shows being in a union delivers better wages [Web article].  The Australia Institute. https://australiainstitute.org.au/post/abs-data-shows-being-in-a-union-delivers-better-wages/

Marin-Guzman, D. (January 16, 2023). New face of unions a formidable political force. Australian Financial Review. www.afr.com/work-and-careers/workplace/new-face-of-unions-a-formidable-political-force-20230116-p5ccqn

Wright, C. F. (July 17. 2023). Stronger union rights can mean more productive, sustainable workplaces [Web article]. The University of Sydney. www.sydney.edu.au/news-opinion/news/2023/07/17/stronger-union-rights-can-mean-more-productive--sustainable-work.html