Strategic directions for strengthening nursing and midwifery: potentialities and connections in the complex perspective

doi:10.1590/1518-8345.4456.3380

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.4456.3380 copy

Strategic directions for strengthening nursing and midwifery: potentialities and connections in the complex perspective^* * The publication of this article in the Thematic Series “Human Resources in Health and Nursing” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.

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Objective:

to understand from the complex perspective the connections established between the Strategic Directions for Strengthening Nursing and Midwifery, delimited by the World Health Organization; to discuss the implications of these strategies for the investment of human resources in nursing and midwifery, with a view to strengthening the technical health capacity to face global health demands.

Method:

a documentary research, carried out from official WHO documents, from September to October 2019. A categorical analysis technique was performed, and the interpretation of the data was achieved based on the theoretical framework of Complexity.

Results:

three interdependent categories were defined, namely: challenges for the training of human resources in nursing and midwifery in order to meet the needs for global health; challenges for the development of the work of nursing and midwifery professionals in different contexts of practice; challenges for governments, leaders and health services to strengthen human resources in nursing and midwifery.

Conclusion:

the strategic directions corroborate the complex perspective because they value multidimensionality in the challenges for the professional practice of nurses and obstetricians. However, these challenges are also related to contextual, political, and leadership factors.

Descriptors:
Nursing; Global Health; Health Personnel; Staff Development; Education, Nursing; Education, Nursing, Continuing

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[1] Corresponding author: Ítalo Rodolfo Silva. E-mail: italoufrj@gmail.com

Strategic Direction 2002-2008	Action: Education of health personnel for nursing and midwifery services
	Related factors: the dynamics of the health services requires professionals with the necessary competences to meet their demands. The strengthening of professional competences in nursing and midwifery is a result of this need.
Strategic Direction 2011-2016	Action: Nursing and midwifery policy and practice
	Related factors: evidence bases for nursing and midwifery. It aims to build an evidence base for the nursing and midwifery practice by means of research, and to ensure that it is used to change the practice.
Strategic Direction 2011-2016	Action: Education, training and career development
	Related factors: provision of nursing and midwifery workforce. To this end, it aims to ensure pre-service and continuing education programs in all the levels of nursing and midwifery to produce an adequate supply of competent professionals. In addition, it aims to ensure that nursing and midwifery education/training programs are grouped into adequate teaching resources. Also to develop knowledge by means of post-basic education, guidance, and other career development activities.

Strategic Direction 2002-2008	Action: Management of health personnel for nursing and midwifery services
	Related factors: establishment of national employment policies that seek equity for the gender relations that permeate nursing and midwifery with healthy and safe working conditions, with salary dignity, recognition, and appreciation of the nursing and midwifery competences. Based on the above, in addition to hiring, it aims to retain the staff.
Strategic Direction 2002-2008	Action: Practice and health system improvement
	Related factors: given the dynamism of the health systems, nursing and midwifery need to increasingly base their decision-making and care/management models based on the best scientific evidence, with a view to the best care practices. From this context, improving access to efficient nursing and midwifery services to the individual, family, and community derives as an objective.
Strategic Direction 2011-2016	Action: Contribution to the strengthening of health systems and services
	Related factors: contribution to person-centered care. This way, it aims to enable nurses and midwives to play a greater role in ensuring that the design, delivery, and performance of the health systems meet people's needs.
Strategic Direction 2011-2016	Action: Nursing and midwifery policy and practice
	Related factors: improving the professional position of nursing and midwifery
Strategic Direction 2011-2016	Action: Nursing and midwifery workforce management
	Related factors: performance improvement. Thus, it aims to promote a positive work environment, with support supervision for the ideal performance of the nursing and midwifery workforce.
Strategic Direction 2011-2016	Action: Partnership for nursing and midwifery services
	Related factors: it is necessary to encourage active and systematic collaboration among nursing and midwifery organizations, in addition to community-based organizations, professional groups, and the government. Therefore, it aims at the following: implementation and monitoring of these strategic directions, and articulation and strengthening of effective networks and partnerships to improve nursing and midwifery services.
Strategic Direction 2016-2020	Action: Ensuring an educated, competent and motivated nursing and midwifery workforce within effective and responsive health systems at all levels and in different settings
	Related factors: educating, recruiting, implementing, and maintaining the adequate number of nursing and midwifery workers with the necessary competences, strengthened with resources favorable to the performance of work, governed by professional regulations. To this end, it establishes the following as a strategy: to align investments and to coordinate plans for the development of nursing and midwifery in the management of the workforce.
Strategic Direction 2016-2020	Action: Working together to maximize the capacities and potentials of nurses and midwives through intra- and inter-professional collaborative partnerships, education and continuing professional development
	Related factors: to optimize the impact of nursing and midwifery on the health systems, at all levels of health care, by means of inter- and intra-professional collaboration and partnership. For that, it is necessary to outline, monitor, and evaluate roles/responsibilities of the nursing and midwifery workforce to promote education and collaborative practice.

Strategic Direction 2002-2008	Action: Health planning, advocacy and political commitment
	Related factors: provision of counseling of the nursing and midwifery services adequate to the nation's health and development plans. Three objectives are defined: strengthening the mechanisms for planning and intervention in the field of human resources policy, in order to contribute to the efficient work process of nursing and midwifery; mobilization of different actors (normative bodies, civil society, and professionals, among others) to promote mechanisms that allow for the strengthening of nursing and midwifery services; political and leadership participation in all scopes.
Strategic Direction 2002-2008	Action: Stewardship and governance
	Related factors: the administration and governance of the nursing and midwifery services comprise government, civil society, and health professionals committed to the quality of people's health care. From the above, two objectives are listed: advising governments on the development of administration and governance of healthy health systems, with a focus on nursing and midwifery services; granting and authorizing nursing and midwifery professionals to their regulatory bodies to assume the responsibility for self-regulation and the quality of care.
Strategic Direction 2011-2016	Action: Contribution to the strengthening of health systems and services
	Related factors: leadership for health. It aims to train nurses and midwives to lead at all levels of care in the health system.
Strategic Direction	Action: Nursing and midwifery policy and practice
	Related factors: to ensure that nursing and midwifery policies are an integral part of the overall formulation of health policies.
Strategic Direction 2011-2016	Action: Nursing and midwifery workforce management
	Related factors: to ensure that the national development plans include appropriate health strategies and to the nursing and midwifery services.
Strategic Direction 2011-2016	Action: Partnership for nursing and midwifery services
	Related factors: administration and governance - in order to help governments support the strengthening of solid administration and governance, especially in nursing and midwifery services.
Strategic Direction 2016-2020	Action: Optimizing policy development, effective leadership, management and governance
	Related factors: entrance and active participation of nursing and midwifery leaders at all levels of policy formulation, planning, and program formulation, including the generation of evidence for decision-making. Therefore, it is necessary to prepare nursing leaders for the current health challenges, with the necessary competence, including in the formulation of policies, and in knowledge management based on evidence for the efficient work process.
Strategic Direction 2016-2020	Action: Mobilizing political will to invest in building effective evidence-based nursing and midwifery workforce development
	Related factors: to establish structures that allow nurses and midwives to be empowered, in order to achieve effective engagement and contribute to the development of health policies, so as to increase the quantity and quality of the health services. To this end, political support from the health systems and civil society must be built to ensure that the policies created to achieve universal health coverage and the Sustainable Development Goals involve people-centered nursing and midwifery services.