Co-Contributor – ENUNU Henry, BScN, RN, MPH, PhD

A Story to Begin

On a sweltering afternoon in a rural community of Turkana County, Kenya, I (EH) sat with a mother who had walked nearly three hours, hoping to find a midwife at the nearest health post. When she arrived, there was no nurse or midwife available. Her face reflected silence and strength—a story of resilience, but also of inequity. She returned home without receiving care, a reality repeated in villages across Africa, Asia, and Latin America, where fragile health systems leave women without essential services.

Meanwhile, in Helsinki, Finland, I (DL) joined thousands of nurses at the International Council of Nurses (ICN) Congress, where the 2025 State of the World’s Nursing Report (SoWN) was discussed. The halls were filled with evidence, policy dialogue, and global solidarity.

The contrast between a mother’s unmet needs in Turkana and global conversations in Helsinki captures nursing’s reality: local struggles and global dialogues are inseparably linked. SoWN is more than data—it is a moral and professional call to action. Nursing knowledge can help bridge the lived realities and the policy agendas.

SoWN Report: Overview of Findings and Recommendations

SoWN, authored by the World Health Organization (WHO) and ICN, is a follow-up to the landmark 2020 first edition. It was prepared by a Global Steering Committee with input from the WHO and all ICN regions. At 163 pages and 439 references, SoWN is the most comprehensive assessment of the global nursing workforce to date (p.3). An overview is provided here. Refer to the link below to read SoWN in more depth.

Three themes stand out across the SoWN’s categories of jobs/employment, education, service, delivery, and leadership: progress achieved, inequities persist, and very slow movement toward the United Nations’ (UN) Sustainable Development Goals (SDGs).

1. Global Progress in Nursing
The last five years have seen growth in the nursing workforce (increasingly professional and employed in the public sector) as well as investments in nursing education, expanded roles in service delivery, and modest growth in leadership positions.

2. Persistent Inequities
Yet, there is a shortage of 5.8 million nurses and distribution gaps in region, gender, age, mobility and migration remain stark (p.viii-x). By example:

• 78% of the world’s nurses serve countries covering only 49% of the global population.
• High-income countries, home to just 17% of people, employ nearly half (46%) of nurses.
• By 2030, projections suggest a global workforce of 36 million nurses, but with shortages concentrated in Lower Middle-Income Countries (LMIC) (p. x). This imbalance denies millions of citizens access to essential health care services, reinforcing cycles of inequity.

In Kenya, the nurse-to-people ratio is 22.7 to 10000, about ¼ of the European Region’s 76.9 to 10000 (Kenya Country data & p. 32). In Turkana County, Kenya, with a population of 1.3 million, in 2023, there were only 590 nurses and midwives (4.5 nurses per 10,000 people), many deployed in hard-to-reach dispensaries (County Government of Turkana). Inequities extend beyond numbers to “distribution, diversity, education, capacity, wages, working conditions, and existing and future shortages of nurses” (p. xviii). Nurses practice in environments with geopolitical tensions, unsafe travel, delayed pay, poor housing and burnout—yet they remain the backbone of service delivery. Gains risk being reversed without deliberate investment, particularly in fragile and conflict-affected regions.

3. Slow Movement Toward the SDGs
The UN’s SDG report for 2025 notes: “The SDGs have improved millions of lives globally. However, the pace of change remains insufficient to meet the Goals by 2030 as escalating conflicts, climate change, rising inequality, and inadequate financing are holding back further progress”. Nurses are essential to achieving health-related SDGs and good health is foundational to all the SDGs. Without adequate investment in nursing capacity, the SDGs risk remain aspirational rather than achievable (p.iv).

Policy Priorities for Nursing and Midwifery

SoWN reaffirms that the WHO Global Strategic Directions for Nursing and Midwifery (2021–2025) remain relevant through 2030. However, focus areas were identified for the remaining years of the SDGs and five emerging policy priorities were identified (pp. xiv-xvi).
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• Jobs & Employment: Equitable workforce planning and creation of decent jobs are central. In LMICs, contract terms are often insecure, salaries are delayed, and rural deployment is unattractive. Without fair employment, retention will remain poor.
• Education: Priorities include faculty development, modern teaching tools (e.g., simulation labs), and rigorous quality assurance.
• Service Delivery: Nurses require safe, supportive, and enabling work environments. This includes strong regulatory protections, regular supportive supervision, and access to mental health resources.
• Leadership: Nurses must be integrated into policy and governance structures. While high-income countries have created senior nursing roles, many LMICs still exclude nurses from national decision-making. Establishing chief nursing officer positions and investing in leadership training will amplify nursing voices.
• Emerging Policy Areas – Nursing agendas must address new and cross-cutting priorities:
  • • …develop advanced practice nursing roles to improve access
  • •Address gender-related bias…
  • Harness the potential of digital tools and technologies…
  • Empower nurses to contribute to the climate agenda…
  • … “support for nursing education, employment, working conditions in fragile, conflict-affected and vulnerable settings” (p. xvi)

SoWN and Nursing Knowledge

Nursing’s disciplinary knowledge offers a lens by which nurses can make sense of the SoWN report and envision how to support its recommendations.

Putting Concepts, Theories and Models into Action
Community, caring, and community-as-partner exemplify concepts relevant to putting SoWN into action. Nurses care for communities (ICN, 2025, p. 12). However, they often view “community” as their local area. Nurses are called to think of communities and health (including the social determinants) with a global lens.

How do nurses “care” for communities? Though DL and EH practice community health in widely different settings, both apply Swanson’s caring processes and Anderson & McFarlane’s concept of “community as partner” (Swanson, 2025; Anderson & McFarlane, 2018). We view communities as having assets as well as concerns and that social determinants are integral to assessing a community’s health. We seek out and value members’ perspectives and collaboration in interventions to improve the health and well-being (Swanson’s outcome) of individuals, families, and their communities.
Patterns of Knowing in Nursing (Lindell & Chinn, 2022)

• Empirical Knowing – The SoWN is rooted in robust evidence reported as global, regional and country data. Nurses must use such data for advocacy, influencing health policy, and designing evidence-based interventions.
• Ethical Knowing – The WHO Code of Practice on International Recruitment questions whether high-income countries that recruit LMIC nurses should contribute to training replacements. What responsibility do nurses in high-resource countries (and the countries themselves) have to support health in disadvantaged communities of their own country and LMICs and protect the health of our fragile planet?
• •Aesthetic Knowing – The nurse goes beyond empirical knowing to “seek the deep meanings in a situation… and facilitate the capacity of the individual, family or community to move through their health experience in ways that heal, comfort and transform”. (ref) As EH notes, in Turkana, Women walk for hours only to find no midwife or choose home births despite risks. These are not statistics—they are human lives.
• Personal Knowing – Relationships are central to nursing practice with individuals, groups, families and communities. Building on aesthetic knowing to foster healing relationships and build trust and partnerships with communities sets the stage for behavior change. Globally, relationships among nurses from different countries facilitate understanding our shared commonalities, honoring our differences, and collaborative action to advance nursing and promote health globally.
• Emancipatory and Sociopolitical Knowing – This pattern integrates the other four and could not align more closely with SoWN. “Nurses who engage in emancipatory and sociopolitical knowing recognize the interdependence of humans, health, and the environment as well as the critical impact of the social determinants on health of individuals, families, communities, and the world” (Lindell & Chinn, 2024) “…Nurses are called to act to “transform lives and systems toward human flourishing” (Walter, 2025).

While “think globally, act locally” is more relevant than ever; the ICN’s Global Nursing Leadership Institute (2025) challenges us to go beyond to “think locally; act globally.

How can you act globally? Most hospital systems and educational institutions have global or international programs. In nursing, The National League for Nursing and SIGMA have initiatives. The US government has programs such as the Peace Corps and Fulbright Program with opportunities to participate and/or support continued funding.

EH supports the SDGs through his efforts to improve care of child-bearing women in Turkana. DL was a Fulbright Scholar in Kenya 2021-2022, and acts globally through teaching, mentorship, co-authorship, linking local researchers with NGOs and policy networks, and preparing nurse leaders with a global lens.

Conclusion

Whether in a remote village or an international conference hall, the work of nurses is interconnected. Local innovations and global solidarity reinforce each other—from mothers meeting under a tree in Turkana to nurses gathered in a Helsinki conference hall, all are part of the same story. SoWN is both a mirror and a map—reflecting deep inequities while also charting the way forward. Nursing knowledge serves as a bridge between lived realities and health for all.

Appreciation to Dr. Joyce Fitzpatrick for her perspectives on global nursing and conceptualizing community.

About the contributors

Deborah Lindell, DNP, MSN, RN, CNE, CGNC, ANEF, FAAN is the Marvin E. and Ruth Durr Denekas Professor at the Frances Payne Bolton School of Nursing (FPB), Case Western Reserve University, Cleveland, OH. She has been a member of the Nursology.net Advisory Team since the website founding. Dr. Lindell has over 40 years’ experience in nursing education where she has held administrative roles and has taught nursing theory, community/public health nursing, and quality improvement. Dr. Lindell has a strong commitment to global health nursing. Since 2005, she consulted and taught in Vietnam, China, Kenya, Nepal, Ghana and Israel, and was a Fulbright Faculty Scholar in Kenya, Sept 2021- May 2022. Since 2024 Dr. Lindell has been Education Director for the Marian K. Shaughnessy Nurse Leadership Academy’s Hong Kong Nurse Leadership Development Fellowship Program. Dr. Lindell holds certification as a Global Nurse Consultant and Certified Nurse Educator. She is a fellow in the NLN’s Academy of Nursing Education and in the American Academy of Nursing. In November 2025 Dr. Lindell will receive SIGMA’s Elizabeth Russell Belford Award for Excellence in Education.

ENUNU Henry, BScN, RN, MPH, PhD candidate , is the County Policy, Planning, Research, and Development Coordinator in Turkana, Kenya. With over two decades in nursing, midwifery, and public health, he advances equitable maternal health services. His PhD research at Kenya Methodist University focuses on enhancing the implementation of the WHO’s Eight-Contact Antenatal Care model through Group Antenatal Care, community innovations, and health system integration. Henry bridges research, policy, and practice to strengthen health equity and ensure that mothers and children in Turkana County have access to safe, dignified, and quality care.