Reflection on Nursing Leadership: Shadowing experience with WHO Chief Nurse Elizabeth Iro at WHO Headquarter Geneva.
The Florence Nightingale Foundation (FNF) is a charitable organisation in the United Kingdom that provides scholarships to nurses, midwives and other health professionals and serves as a living tribute to the work of Florence Nightingale. The shadowing attachment at WHO headquarters with Chief Nurse Elizabeth Iro was arranged as part of my Florence Nightingale Foundation (FNF) Aspiring Nurse Director Leadership Scholarship 2018/2019. It was pre-arranged with advice from my FNF mentor Catherine Hannaway who is a global Nursing Now campaign leader. WHO Chief Nurse carefully planned my attachment to be during the week preceding WHA 2019. This was confirmed through email correspondence despite her busy schedules. It was a proud moment to be able to represent FNF as a scholar in this world-leading event to promote global nursing and midwifery initiatives. The Nursing Now Campaign, a collaboration between the World Health Organization and the International Council of Nurses, is run as a program of the Burdett Trust for Nursing, an independent charitable trust based in the United Kingdom. I also have the honour to be part of the Nursing Now which was launched in England on 10 December 2018 while I was preparing my itinerary for WHO headquarters.
My flight from London Heathrow touched down at Geneva, a beautiful city, on 13th May 2019 in the afternoon. I had the opportunity to visit Geneva that evening before my very busy first day at WHO headquarters meeting with Chief Nurse and her colleagues.
The next day, 14th May 2019 marked my ultimate global nursing leadership journey at WHO. It started with an introductory meeting with Elizabeth Iro in person. I was humbled to meet our global Chief Nurse who always has a smile on her face with frangipani flower at the side of her head. After the quick introduction, she got me security badge for an official visiting member to the WHO headquarters for a week. Passed the security door and I went to the WHO Headquarters with flags from different countries above me! Amazing atmosphere and unbelievable reflection of where I had come from since FNF residential event in May 2018. A proud Florence scholar walking down WHO headquarters with our WHO Chief Nurse.
We walked past a little cafe down the stairs leading to a library with big crowds gathering having their global professional dialogues full of enthusiasm and friendly smiles. We walked into the library past a small walkway and into the Chief Nurse’s office. A humble office with a reception desk and chairs and her office desk with two large computer screens and a telephone and flowers reminding Chief Nurse of her roots where she came from-Cook Islands. I admire Elizabeth’s dedication and commitment to global nursing and midwifery agendas to influence positive change. She has made a lot of decisions from this small humble office where she spent time meeting with her technical team members. Proactive engagement, discussion and collaborative decision making all happened at the table where I spent the remaining few days working and learning in her office.
Pre-WHA seeks to promote health advocacy by young people pursuing careers in health and social care. It precedes the convening of the World Health Assembly annual gathering of the highest decision-making body of the World Health Organization (WHO). A select group of nurses and midwives meets in Switzerland to become more effective health policy advocates. I also had the opportunity to attend the Youth Pre-World Health Assembly cocktail evening sponsored by Shenandoah University, International Society of Telemedicine and eHealth where I met young enthusiastic nurses and allied healthcare professionals. WHO Chief Nurse Elizabeth Iro, Lisa Darsch (Program Director Patient Navigation, Adjunct Faculty International Nursing Shenandoah University) and Elizabeth Rosser (Director at Large (2015-19) on the board of directors of Sigma Theta Tau International Honour Society of Nursing (Sigma), who is emeritus professor at Bournemouth University in Dorset, United Kingdom) were a few of the nursing leaders who I had the honour to share our leadership experience. The highpoint of that evening was the opportunity to listen to the young leaders share their nursing and professional aspirations in this challenging women leadership environment. Elizabeth Iro shared her story with all whenever she met with young leaders which is an inspiration to all of us, nursing leaders. This special pre-WHA event seeks to promote health advocacy by young people pursuing careers in healthcare from Shenandoah University in the United States and included a nurse, physician assistants, and pharmacy students. I am proud to represent both as FNF Scholar and a member of Sigma Nursing during this Pre WHA met with Elizabeth Rosser Director of Sigma Nursing.
The energy from the Pre-WHA ‘Walk the Talk’ event was striking with participants from different countries and from different leadership backgrounds. Dr Tedros WHO DG addressed us at the opening of ‘Walk the Talk’ at Place des Nations or Nations Square, a large park situated in the heart of Geneva’s international district. Located near the European headquarters of the United Nations the square is famous for ‘Broken Chair’, a monumental wooden sculpture that commemorates victims of mine disasters. A great leader in a great event venue with inspiring stories for all the young leaders especially with 22 young leaders who took part in the Nursing Now Campaign representing countries in Africa, Asia, Europe, the Americas, the Middle East, and Oceania. I was impressed as FNF Scholar with the current leadership and future leadership in the nursing movement towards 2020 and beyond.
Year of The Nurse and The Midwife 2020
I met with WHO Chief Nurse taskforce working on The Nursing and Midwifery Strategy, Women Deliver agendas and on the Nursing Workforce Strategy during my first two days of attachment at WHO Headquarters. There were many discussions on midwife-led care model through technical taskforce review during my first day of working with Chief Nurse. The framework on midwife-led care model with a framework on quality education were few of the subjects that have impacted on my leadership experience on how to influence policymaking through collaboration and evidence-based data. It was an experience having these opportunities to listen and observe WHO Chief Nurse’s leadership influencing policy making through collaboration with her teams and wider nursing and midwifery teams globally. Her leadership entails dedication, compassion and authenticity. Elizabeth Iro has a great deal of the world leadership capacity which I learnt in the very brief period including the following:
- Leadership is about others, not us; it is about growing others.
- There is no hierarchical leadership not just by authority and title. Followers need to be inspired and cared for by a manager/leader.
- Leadership is about serving others.
- Creating a high-performance culture through getting the team together—best person for the job!
- Give straight feedback on how to help the person without demolishing the person
- Have a strategy on how to achieve safety culture and best outcome to achieve strategic objectives.
- There should be room for joy when a team is doing well! Celebrate because it makes the team stronger.
- High-performance culture extremely visible with strong leadership through collaboration and acknowledge the success of the team members.
WHO Chief Nurse would always remind me of her leadership motto which is a leader is about vision, passion big picture. Great leadership is about credibility to lead and not just charisma. I fully understood this in my few days attachment with the world nursing leader who has inspired me to be an authentic leader in whatever I want to achieve. It takes courage to be in the spotlight to lead, and I need to have a strong vision and not just plan to articulate with clarity to team members and decision-makers in order to reach consensus for meeting the organisation and unit strategic goals. The vision must start with ‘WHY’. A leader must be optimistic-must believe things will get better no matter how bad they are. Great leaders think big and they have to believe that what they think is right. It has to be the organisation they achieve for and not own ego! Channel the ego into good for the organisation and nursing is one aspect which I will always reflect back from my attachment at the WHO headquarters. Telling stories is one aspect which I have harnessed to be an authentic leader. Every leader has a story to tell in their leadership journey and one that is truly inspiring will take root wherever the story lands.
WHO Chief Nurse shared her experiences as a nurse and a midwife during her career in Cook Islands prior to her appointment as WHO Chief Nurse and how policy and regulation were managed. I could hear Chief Nurse’s compassion in her work as a nurse and as a midwife. One important aspect which Chief Nurse has in common with my nursing aspiration is to deliver safe care to patients with the best outcome to patient and family. Chief Nurse’s vision of 2030 Universal Health Coverage is aligned very much with the WHO mission and her passion showed through during our professional exchanges around local, regional, national and international healthcare inequality and poor access to health in some developing countries. I am very proud to have such a strong passionate WHO CNO who has dedicated her energy for better health care to all with a strong degree of leadership guiding the success of the midwifery report and promoting stronger global nursing with the upcoming nursing strategy workforce report 2020.
It is instructive to have the first-hand experience to learn from our World Chief Nurse with her subject matters always aligned with UHC and the nursing/midwifery strategy with policy priority in influencing in accordance with the respective priority locally when referring to world health issues. Co-production with a strategic focus on local agenda is the theme which I took away to be applied in my own leadership role within the NHS setting.
On my last attachment day, I had the most exciting experience travelling to Basel with Chief Nurse and attended Swiss Nurses Conference. The Nursing Now for Swiss Nurses was launched at the Conference hall in Basel Convention Hall on 17 May 2019. It was an amazing experience witnessing all the young Swiss nurses and students who are so eager to be part of the Nursing Now 2020 and to develop into future nursing leaders. The experience was humbling yet motivating to my aspiration to lead change in areas of my professional interest around developing strong nursing leadership in a technologically advanced healthcare environment. Elizabeth delivered her guest speech with her story and linking to her aspiration as WHO Chief Nurse to assist WHO DG Dr Tedros to meet the UHC target for all. It was a motivating story from the Cook Islands to Geneva which impressed the Swiss Nurses and Students and Nursing leaders with a big ovation at the end of the closing speech.
My ambition to develop a new system of work focusing on the fast introduction of advanced technology and artificial Intelligence while maintaining strong leadership on patient safety has become stronger knowing my responsibility for future young leaders and patients. Nurses and Midwives are taking up 50% of the global workforce delivering frontline healthcare and services across the health spectrum. WHO Chief Nurse has her vision and focus remains on strengthening and expanding the role of the nurse and the midwife which requires investments in quality health education, competencies, regulation and professional standards.
There must always be time out at work to reflect and often important decisions made need not be at the office desk! This came about when I had the opportunity to walk with Chief Nurse and a Professor Midwife who was having her research attachment at WHO Headquarter one afternoon at the surrounding park areas. We spent 40 minutes walking in the park absorbing the beautiful greenery, listened to the birds singing and water flowing from the stream with the occasional sound of engines from passing vehicles. The park overlooked Geneva Lake with The Jet d-Eau fountain – the famous landmark of Geneva city. We walked past a > 100-year-old tree trunk which has been overgrown with new trees from the core of the trunk forming a new life and branching upwards to the sky.
We had shared our leadership story at this point referring to the Nursing Now and how younger leaders are shaping the world of nursing and midwifery with the pioneer leaderships supporting these millennials with a strong foundation of leadership principles and role model. At this point, I was able to have a conversation with Chief Nurse Elizabeth Iro listening to her wisdom and plan around global collaboration with CNOs and getting the regulatory system to be aligned to fit in with the WHO Charter. Amazing energy and assertion has been demonstrated by Chief Nurse during the brief moment walking in the park. She has never failed to emphasise getting local issues right before venturing out globally with constant reference to WHO Nursing and Midwifery Taskforce report on patient safety, staffing, health for all, education and task force planning etc. The time spent walking in the park is a form of catching up with her technical taskforce where new ideas emerged. It is also a moment of sharing and mentoring. Getting out of the office desk provides a form of calm and reflective opportunity for both persons to acknowledge each others contribution which is powerful yet effective to develop a good working relationship at all levels.
Meet with global health experts
On my third day at the WHO Headquarters, I had the opportunity to walk with Chief Nurse to meet with WHO Technical experts in the area of patient safety, Technology and Digital Health. My meeting with Dr Neelam Dhingra-Kumar who is passionate about patient safety at the global scale was an experience. I had the opportunity to share with Dr Neelam my work around patient safety in the NHS and also locally at the Royal Marsden Hospital NHS Foundation Trust. I also got to introduce to Dr Neelam brief insight of Singapore Healthcare system and the National Health Care System in the UK. The fundamental value of patient safety remains the core of every healthcare professional regardless of which part of the globe they practise. Patient safety and the quality outcome remains critical and it is one major aspect in the delivery of Universal Health Coverage (UHC). There was a lot of transferable knowledge and technical skills which I had shared with Dr Neelam and Chief Nurse Elizabeth Iro. I am confident that we will continue our good work in the years to come to achieve UHC.
My aspiration of leading nursing in the advanced technological era has inspired Chief Nurse who has found my topic of discussion interesting and inspiring. Chief Nurse followed up our conversation by personally introducing me to one of her highly technical expert teams in global technology and digital health. This has linked up my next line of commitment to work towards stronger nursing contribution in the work of artificial intelligence (AI) and advanced nursing practice in the era of high tech and AI.
The pre-WHA cocktail reception on my last attachment day with WHO Chief Nurse provided an opportunity for global health decision-makers and students from various healthcare professions to come together to broaden understanding of issues addressed by the World Health Assembly. It was an informal environment fostering effective student and professional interaction to further explore global health issues. I had the experience of staying by the side of WHO Chief Nurse who was a real role model to my nursing leadership journey. Here I met with Elizabeth Rosser who represented Sigma and the Nursing Now team; S. Yunkap Kwankum, PhD, chief executive officer of Global eHealth Consultants and executive director of the society, and Shenandoah University professors Michelle Gamber, DrPH, and Lisa Darsch, MSN, RN. In just one evening I had met with so many experts in nursing leadership and technology through the shadowing opportunity with WHO Chief Nurse. I have learnt so much from her direct personal story and experience from the young leaders who are aspiring to be leaders in the area of their professional interest.
Reflection and looking onwards on personal nursing leadership
Visit to WHO Headquarters shadowing WHO Chief Nurse, attending the launch of Nursing Now at the Swiss Nurses Conference where Chief Nurse addressed to young Swiss nurses and students, participating in pre-WHA event, meeting with nursing leaders and experts in healthcare technology and participating in the ‘Walk the Talk’ event preceding the WHA have been remarkable for this FNF scholar who just started to have the introduction to global nursing and how global policymakers impact on the delivering of UHC at the higher level and the movement of Nursing Now to promote nursing towards 2020 which is the year of the nurse and the midwife. I have been fortunate to have this experience to work closely with WHO Chief Nurse and under her leadership, I have learned from the insight of our first global CNO with a strong vision for nursing and midwifery. Her calm, passionate and collective approach in decision making has inspired my next path towards reaching my nursing leadership goal. I have been able to draw closer to the art and science of the nursing profession and continue the legacy of Florence Nightingale to be the very best in nursing, applying science, critical thinking and caring to change the life of people. I hope to maintain my dedication to nursing and continue to strive for the best with strong research evidence-based practice with autonomous leadership to impact nursing practice locally, nationally and internationally.
Nursing Now 2020 is about nursing with emphasis on developing younger leaders to lead the next generation workforce from the millennials. We are leading the way for the millennials who are eager to get their voice out to be listened to and to be engaged in decision making influencing policy for the best of healthcare and UHC. ICN and WHO collaboration are leading this movement of nursing towards 2020 and onwards which has created a surge of energy globally. It takes courage and assertion with a strong voice which I have learned from my shadowing opportunity at the WHO CN office and also through my personal correspondence with the WHO technical experts workforce around patient safety, professional strategy development and Health Technology. The year 2020 and beyond will be the decade for nursing and midwifery to strengthen global collaboration with a united front to deliver UHC and global strategy on human resources for health 2030.
WHO Chief Nurse Elizabeth Iro’s has commended my strength with a strong focus on my nursing leadership aspiration and she recognised my capability as an individual who articulates with clarity my vision of uniqueness of nursing and of patient-centred care even with the emerging technologies and artificial intelligence in the Operating Room. My thanks to our Global Chief Nurse who believes in me and my nursing vision to achieve the highest possible goal to promote nursing in the millennium when Technologies and AI are converging to impact on how nursing is to be delivered as an art and science along with other healthcare professionals. To drive change the leader needs to align vision and passion with clear articulation, through positive behaviour with a clear strategy about how an organisation operates in terms of processes, budgets and policies. This is important advice from my leadership shadowing journey. To deliver impact on healthcare service for the best patient outcome requires a leader with clarity. The leader needs to recognise the culture of empowerment and foster leadership from all levels to achieve the best outcomes for patients, organisation and staff.
My gratitude to mentor Catherine Hannaway who has linked in with WHO Chief Nurse Elizabeth Iro for this opportunity, to WHO Chief Nurse Elizabeth Iro for her generosity and time with wisdom shared during my attachment at WHO Headquarters, to Florence Nightingale Foundation for the opportunity be part of the Florence Scholar taking up nursing leadership onwards and upwards and to my organisation The Royal Marsden Hospitals NHS Trust who supported me in my FNF application. This shadowing experience was an opportunity to represent FNF as Florence Scholar a step towards my nursing aspiration to reach to global nursing. It was a privilege to experience such an amazing group of nursing and midwifery leaders and young people who are keen to take leadership roles in raising the profile of nursing and midwifery and improve global health.
Matron (The Royal Marsden Hospitals NHS FT, UK)
Florence Nightingale Foundation Scholar
Registered Nurse (RN)
MSc Leadership and Critical Care Practice Education
Advanced Diploma Operating Theatre (OT) Nursing