The future is ours to shape: Nursing emerging from the pandemic with insight, optimism and courage

The theme for International Nurses Day 2023 is ‘our nurses, our future’, and in contemplating the future, it is necessary to reflect on where we are now. The COVID-19 pandemic has changed the world, particularly the world of health care and has provided a platform for radical change in health and social care sectors. As we emerge from the pandemic, nursing and nurses are left with much to reflect on and consider. Nurse researchers and scholars all over the world have literally spent many thousands of hours interrogating and scrutinizing aspects of the pandemic (Jackson, 2022). At the Journal of Advanced Nursing alone, in the past 2 years, we have published more than 300 papers focussed on the pandemic. Other nursing journals have also published volumes of work about multiple aspects of the pandemic. These accounts compel us to interrogate the world we have left behind and consider where we are headed. Aside from the many issues in in-patient and community care including the initial lack of effective treatments, the critical need for a vaccine and disparities and racism (Chan et al., 2022; Kang & Barcelona, 2022; Okoye et al., 2023), the pandemic exposed weaknesses and flaws in pandemic preparedness and response, health communication and communicating risk, supply chains, redefined work practices and highlighted the need for rapid redeployment in direct health care and at multiple points along the health and social care continuum. Volunteering across all sectors of health and social care, education and food supply chains was needed on a scale not previously seen. The pandemic was a catalyst for digital transformation, and in nursing we saw that clearly through rapid increases in telehealth (Searby & Burr, 2021; Walthall et al., 2022), changed practices in relation to hospital visiting (Altman et al., 2021; Bloemberg et al., 2022; Lim et al., 2022) and in teaching and learning practices in nurse education (Iradukunda & Canty, 2023; Kimani, 2023; Usher et al., 2023). The pandemic highlighted the need for an agile and responsive nursing workforce and meeting this need involved extensive redeployment, rapid upskilling and reskilling, expeditious design and implementation of new services and adjustments to usual ways of working (Endacott et al., 2022; Gardiner & MacLellan, 2022). Nurses who no longer worked in the health sector were encouraged to return to support the collective good, and if appropriate to return to practice, were provided a rapid access route to re-register. Nurses also came out of retirement to offer their services either as re-registered nurses or volunteers. Outside of the formal health sector, volunteer nurses organized foodbanks, community welfare groups, food deliveries and initiatives to combat loneliness and isolation of people staying home. These new pressures created by the pandemic occurred against a backdrop of quite longstanding global chronic and acute workforce issues. In lower- and middle-income countries particularly, health systems were already stretched with an acute shortage of doctors and nurses before the pandemic hit. In addition to the challenges raised by the pandemic, there are many other complex issues facing nursing as we look ahead to the future—issues associated with health care and human rights for refugees, migrants, displaced persons (Commodore-Mensah et al., 2021; Wilson et al., 2022). The ongoing severe humanitarian crises affecting millions of people across the globe impacts us all. Failing to assist vulnerable populations experiencing persistent conflict, poverty and disease places us all at risk of poor health outcomes. As we look ahead, we also need to address complex challenges such as missed nursing care, which the literature suggests is a widespread matter of concern, and raises issues about current staffing, skill mix, patient acuity and the utility of current models and frameworks of care (Dutra & Guirardello, 2021; Griffiths et al., 2018; Jackson, 2023). Nursing will also take a more active role in environmental issues including those surrounding climate changes. Some countries will need to address challenges around an ageing nursing workforce and difficulties in recruiting and retaining nurses (Lokmic-Tomkins et al., 2022). During the pandemic, nurses worked with unparalleled levels of resilience and versatility. Nurses practised in a time of instability, disruption, uncertainty and fear for themselves and their own families, the multi-disciplinary teams they worked with and for their patients. They witnessed a high death rate of patients who were separated from their families, and in some settings, nurses themselves moved out of their family homes and leave behind their partners and children for fear of infecting them with the virus at a time when there were no effective treatments and vaccination was not available. However, effective and responsive support systems to address the nurses' psychological needs during the healthcare crises, such as COVID-19-related trauma, appeared to be lacking in many nurse working environments worldwide. It is essential that learning from what worked to support the mental health of nurses during and after the pandemic is used to develop effective easy to access interventions for use in future health emergencies. The effects of the pandemic are likely to be felt for some time yet, and the extent and duration of the effects underlines the need for preparedness for future events and to take the many lessons from this COVID-19 pandemic into future healthcare planning. The global nature of the pandemic highlights the need for nursing and nurses to work together across professional disciplines, sectors, regions and countries and diverse populations to develop our collective resilience and ability to respond to future similar events. As nations switch off from the doom and gloom of pandemic reporting there has been a rapid influx of hate speech, misogyny and health misinformation. As nurses face unremitting pressure and shrinking attention, hard-fought professional gains are at risk. For example, in the United Kingdom there was a surge of interest from those wanting to enter the nursing profession during the pandemic, which has subsequently disappeared, and some Universities are currently finding it difficult to recruit to undergraduate nursing courses. As we write this editorial, nurses in England are in dispute with the Government over working conditions and pay during the post-pandemic economic crisis, and a lack of recognition of their contribution to the pandemic response and as a consequence have been participating in unprecedented strike action. The post-pandemic recovery period heralds an important opportunity to disrupt the current narrative and amplify the voices of nurses globally, including those employed in lower-resource settings. Health emergencies that require a rapid nursing response are common occurrences globally. The nursing profession must use the collective knowledge and experience from the recent pandemic to be better prepared for the next health emergency crisis. Health emergency preparedness and response is its own practice and academic discipline, to which more nurses need to sign up to and influence. We must also continue to engage in scholarly publication and media (including social media) to shine a light on lesser known, yet essential clinical and humanitarian nursing activity. We need to invite journalists into our work settings and help them to understand modifiable sources of deprivation and poor health outcomes for our patient populations. Even in the most challenging of places there is commonly a novel news story that amplifies the positive role and contribution of nurses. We need nurse researchers and educators to continue to invent and report on innovation. Nurses have the power to quickly spread awareness and reliable health information to huge numbers of people globally. Much remains untapped in our ability to engage and inspire the future of health care. We need nurses to boldly advocate for policies that disrupt structural racism and social inequity which drives disparities in health outcomes among marginalized populations across the globe. As we reflect on International Nurses Day 2023 and consider the theme ‘our nurses, our future’, we know that the future of nursing is ours to shape with courage. As we move into a post-pandemic world, we need to be proactive in shaping our future; to actively take the lead in promoting public understandings of nursing, and to take leadership roles in cultural, diversity, equity, inclusion (Morley et al., 2020; Sharps et al., 2023) innovations and strategies that promote adaptive clinical and organizational change in health care. If we take our power and work collaboratively, we have every reason to look ahead to a bright future in which nurses lead the way in important health and social care reforms. The authors have no conflicts of interest to declare.

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