World Health Day: the essential role of nursing

At first blush, it wouldn't seem like Mercedes Gascueña’s typical work day has changed very much over the past month. Mercedes is a nurse in the intensive care unit at Hospital Universitario Infanta Leonor de Vallecas in Madrid where she starts her shift like always. She reviews the patient files handed over to her from her colleagues on the previous shift. Work is divided up between other nurses; schedules are coordinated with the doctors; and Mercedes gets busy dealing with the tasks at hand. She won't leave until the next shift is ready to start, approximately seven hours later.

But some things have changed. Some things are more formalized with stricter protocols, like a painstaking approach to protective measures and using personal protective equipment (PPE), which wasn't required before —  and which inevitably impacts how fast she can act, in a unit where response time is fundamental. Other changes go much deeper. “There's something that causes us a lot of pain: the fact that family members can't be here. Some patients die, and their families can't be with them. It is extremely hard.” Lourdes Muñoz Abril, a doctor specializing in family and community medicine in an emergency room in Madrid agrees:  “The role you assume in this kind of situation is very difficult because you can’t provide the help that you would want to under normal circumstances.”

COVID-19 is proving to be a challenge for all health care professionals, but particularly for nursing staff, which at 36 percent of the total represents the largest group of certified health care professionals in Spain. Each year since 1948, World Health Day has been celebrated on April 7th in commemoration of the founding of the World Health Organization (WHO), and a topic of specific and timely significance to the organization is chosen as a theme. This year the spotlight is focused on the fundamental role nurses and midwives play in the health system, and an appeal is being made to reinforce the importance of these positions.

Nursing is a profession heavily dominated by women. According to a 2018 report on the registered health care professionals in Spain, only 15.8 percent of certified nurses were men, compared to 84.2 percent women. These percentages are not likely to change significantly in coming years: the latest official data available from Spain's Ministry of Science, Innovation and Universities reveals that men make up only 20 percent of the total number of university students enrolled in nursing and care for the infirm.

A woman’s name also permeates the historical origins of modern nursing: Florence Nightingale.  Born into an affluent family during the Victorian age, there was nothing about her early years that foretold a future of caring for the injured in the Crimean War and thereafter making nursing a fashionable vocation among women of her time.The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, which she founded upon her return from the war, is still in operation 150 years later.

"Nurses and nursing assistants play an essential role in healthcare; they are a crucial part of the successful operation of health care centers. They have the closest day-to-day contact with patients and are responsible for their follow-up care, at least in hospital settings,” Lourdes states. Mercedes agrees: “It gets to a point that you even know what shoe size they wear,” she laughs. "We don't leave the unit. We are always there. We’re the ones who have the most contact with them, and while you're administering an IV, you talk to them; you know how they're doing. My job as a nurse in the ICU is to know my patients as thoroughly as possible, to know if they have a mole today that they didn't have yesterday, for example.”

Neither Lourdes nor Mercedes hesitates to say what the best part of their job is, especially in these trying times. “To see, even in a situation like the one we’re in, that there are people who get better, who recover, and knowing that you had something to do with it,” Lourdes says.

“We are successful at our jobs when we are able to release patients from the ICU, when patients go home, when they go home feeling better. When a patient leaves the ICU, it's an occasion for celebration," agrees Mercedes.

In the face of the current trying situation, Mercedes has a single, overriding recommendation: “Stay home. My colleagues and I hear the applause that you give us and the words of encouragement that you send, but I applaud all those others: for all those gas stations and supermarket workers, our suppliers, the police force, firemen. There are a lot of people giving their all, for all of us. And also for the people who are staying home, because they are doing what needs to be done. We are all part of a chain and each link is as important as the other.” Lourdes also expresses a wish for the future: “From now on, let's be responsible and provide education about health care. I think it's a subject that goes overlooked, in the sense of understanding when you should see a doctor and being able to put yourself in the shoes of health care workers.”