“I genuinely think this is a unique period of time and of opportunity for the profession,” said Howard Catton in his first full interview with Nursing Times since taking the helm of the ICN in February. The ICN is a membership federation of more than 130 national nurse associations around the world.
Mr Catton explained how a combination of world health priorities aligning with the role of nurses, support for nursing from influential leaders, and growing momentum behind the global campaign Nursing Now, had helped push nursing up the agenda.
On top of this, he noted that 2020 had been earmarked as the international Year of the Nurse, to coincide with the bicentenary of the birth of the founder of modern nursing, Florence Nightingale.
Mr Catton said: “I’m not aware that we’ve had these sorts of factors, these sorts of forces, which have come together at the same time to provide this platform.”
“For me it is about maximising every opportunity that this window that we have will afford us”
This opportunity in the spotlight should be utilised to not only celebrate nursing, but also to tackle some of the key issues facing the profession, said Mr Catton.
“There’s a huge global platform to raise the profile of nursing, yes to celebrate nursing, but I think to really importantly to address what needs to be done to support nursing,” he told Nursing Times.
He said the “obvious things” to tackle would be educating more nurses and addressing workforce gaps, but also supporting nurses to develop advanced and extended roles, and improving nurse leadership.
“For me it is about maximising every opportunity that this window that we have will afford us,” said Mr Catton, who was head of policy and international affairs at the Royal College of Nursing for 10 years before relocating to Geneva in 2016 as ICN director of nursing, policy and programmes.
“The point is this is putting nurses into overstretched and under-resourced work environments”
He highlighted that world health priorities including achieving universal health coverage, fighting non-communicable and infectious diseases, addressing humanitarian crises and uplifting primary care were “at the core of what nursing is about”.
Mr Catton, who has been appointed ICN chief executive initially for 12 months, also said nursing had been buoyed by support from World Health Organization director general Dr Tedros Adhanom Ghebreyesus.
Under his leadership, the WHO has partnered with the ICN to launch Nursing Now, aiming to raise the profile and status of nursing worldwide. Running from 2018 to 2020, the campaign has so far been adopted by more than 80 countries and received the patronage of the Duchess of Cambridge.
In addition, Dr Tedros reinstated the role of a WHO chief nursing officer after a seven-year absence. Mr Catton said he wanted to see health providers and governments following this lead and ensuring they had nurses in leadership positions.
Acknowledging that the limelight “won’t last forever”, Mr Catton said he wanted to use this time to build a “legacy” and reframe nursing as an “investment not a cost”.
His ambitions come at a time when the global shortage of nurses is predicted to hit nine million by 2030 if nothing changes.
Mr Catton said international nurse recruitment had become much more competitive, revealing that even countries such as India and the Philippines, on which the UK has traditionally depended to fill nurse gaps, were beginning to struggle to meet their own demand.
“India and the Philippines have been up there in terms of being suppliers of nursing to the world to a number of other countries [but] their circumstances, their situations, may be changing as well,” he said.
Mr Catton reiterated the ICN’s message that countries should endeavour to become self-sufficient in their nurse supply, describing reliance on international recruitment as “uncertain” and associated with risks.
“I sometimes had the sense in the past that people may not have seriously connected when I have been talking about staffing issues”
In addition, he said it was unethical to take nurses from countries that needed them for their own health services and that had invested money in training them.
“I have been [at the ICN] for two or three years now and each year at a WHO meeting I have heard a country raise an issue… about the recruitment of staff from their countries where they say that they cannot afford to lose those staff,” he said.
“The ethics is of course a fundamental issue, but there’s also an economic issue that you sometimes hear as well in terms of ‘well if you are going to recruit nurses from us that we can ill afford to lose, that we’ve paid for to train, then there should be some cost associated with that as well’,” he added.
The WHO was “rightfully” reviewing how countries were complying with the global code of practice on international recruitment, Mr Catton noted. It comes after NHS England announced plans in January to increase international nurse recruitment by “several thousand” a year to plug gaps in the short-term.
Turning to safe nurse staffing levels, a topic which he described as “close to my heart”, Mr Catton said the ICN was working to reframe this issue as critical to patient safety in order to catch the attention of policymakers.
“I sometimes had the sense in the past that people may not have seriously connected or interacted with me when I have been talking about staffing issues, because they think [my] motivation is purely about the working life of a nurse, as to whether the nurse is having to work particularly hard one day or not,” he said.
“When you move in that direction you better understand why errors, why faults, why harm, happen”
In addition, he reflected on how the relationship between care errors or delays and staff pressure and burnout were moving “more to the forefront”.
As well as the harm caused to patients, Mr Catton said the emotional toll these events took on nurses needed to be considered, which is increasingly and controversially being labelled the “second victim phenomenon”.
Mr Catton said he was aware of some “tragic” cases in which nurses in these situations had ended their lives.
“I know that some patient groups would disagree with me calling it the second victim phenomenon or syndrome – and I can understand that perhaps that isn’t the right phrase – but the point is this is putting nurses into overstretched and under-resourced work environments,” he noted.
They try to do their best but when there are failures as well the impact on the individual and their family, we shouldn’t ignore the impact that there is on the nurse or on the health worker,” he said.
He praised the move by the UK’s Nursing and Midwifery Council to take greater account of the context in which mistakes happen when nurses had their fitness to practise questioned. He noted how some regulators in other countries were going down a similar path.
“When you move in that direction, you start to move away from simplistic blaming of individuals when things go wrong,” he said. “When you move in that direction you better understand why errors, why faults, why harm, happen.
“I have a combination of pinch me moments and moments of feeling overwhelmed by the sense of responsibility”
He noted: “It gives you a better understanding, so it’s actually a way to drive quality improvement because you are looking at individuals within systems, within environments that they work. And to prevent that happening again, you are more likely to come up with solutions and changes to practice which are sustainable.”
Mr Catton shrugged off concerns about Brexit, stating that nurses understood that their cause was too important to be blocked by politics. “Healthcare is right at the forefront of being genuinely international in terms of the challenges we are facing and the approaches that we need to adopt,” he said.
“It’s a time where around the world I see nurses and their organisations looking outwards, looking across borders, and building new relationships with individuals and with organisations,” he said. “Not motivated by ‘it’s a nice thing to do’, but motivated by ‘it’s actually necessary to find the solutions and the best ways of dealing with some of these cross-border issues’.”
On a similar note, Mr Catton was aware that RCN members had recently signalled a desire to reconnect with the wider international nursing community. During the college’s annual congress in Liverpool this month, a debate will be held over whether the RCN would be “more influential for nursing and health globally” if it re-joined the ICN.
He stressed it must be a decision led by RCN members, but admitted that he would personally “love” for the college to return to the ICN. He said the world was now a different place to the one it was when the RCN controversially voted to leave in 2013.
“Hand on heart, I would love for RCN to come back in, I think they have a huge amount to give but I think they could also get a lot from being part of the international community as well,” he said. “But it is for their members, it’s their decision and I respect those people when I was working with them and I respect them exactly the same now.”
Mr Catton qualified as a registered nurse in 1988 and said even today he saw himself as a nurse first and foremost – “because that’s the starting point for me”. He said he had never envisaged at the beginning of his career that he would attain the heights of his current role.
“I have a combination of pinch me moments and moments of feeling overwhelmed by the sense of responsibility and the work that there is to do on behalf of the nursing profession globally,” he told Nursing Times.
Mr Catton said he had stuck by his nursing principles at every step of the ladder and his core motivation was making life better for the 20 million nurses worldwide. “Everything that ICN does, the test for me is always how does it help that nurse, that practitioner, in their work today,” he said.
Howard Catton: Biography
Howard Catton qualified as a registered nurse in 1988 and held nursing posts in England and the US.
He completed a stint at the New Zealand Nurses Organisation and also worked as a manager in the UK NHS.
For 10 years he was head of policy and international affairs at the Royal College of Nursing in the UK. He also worked closely with government on policy and legislative issues.
He served as an elected local government councillor in England and for five years was a cabinet member with lead responsibility for corporate and customer services.
In April 2016, he relocated to Geneva in Switzerland to join the International Council of Nurses as its director of nursing, policy and programmes, before being appointed to his current role of chief executive in February 2019.