ARTICLE IN PRESS

0020-7489/$ - se

doi:10.1016/j.ijn

International Journal of Nursing Studies 45 (2008) 1115–1117

Guest Editorial

The Global Alliance for Nursing Education and Scholarship:Delivering a vision for nursing education

Keywords: Nurse education; Nursing workforce; Nurse migration; Nurse shortage

www.elsevier.com/ijns

Nurses represent a vital component of the global

health workforce, and nursing education plays a key role

in procuring the future-nursing workforce and in

developing the existing workforce. Globalization has

created many new challenges, issues and opportunities

for nursing and health care (Davidson et al., 2003). One

of the most pressing issues confronting global health is a

shortage of health workers (WHO, 2006). This has been

deemed a ‘crisis’ by the former Director-General of

WHO, Dr. Lee Jong-Wook. In the Working together for

health: the World Health Organization Report 2006

he states:

‘There is a chronic shortage of well-trained health

workers. The shortage is global, but most acutely felt in

the countries that need them most. For a variety of

reasons, such as migration, illness or death of health

workers, countries are unable to educate or sustain the

health workforce that would improve people’s chances

of survival and their well being. People are a vital

ingredient in the strengthening of health systems. But it

takes a considerable investment of time and money to

train health workers. (That investment comes both from

the individuals and from institutional subsidies or

grants. Countries need their skilled workforce to stay

so that their professional expertise can benefit the

population. When health workers leave to work else-

where, there is a loss of hope and a loss of years of

investment. The solution is not straightforward, and

there is no consensus on how to proceed. Redressing the

shortages in each individual country involves a chain of

cooperation and shared intent between public and

private sector parties which fund and direct educational

establishments; between those who plan and influence

health service staffing; and between those able to make

financial commitments to sustain or support the condi-

tions of service of health workers)’ (WHO, 2006, p. xiii).

e front matter r 2007 Elsevier Ltd. All rights reserve

urstu.2007.08.002

Nursing workforce sustainability is a critical issue

globally and many areas of the world are currently

confronting an undersupply of registered nurses at a

time when there is increasing demand for nursing

services. Predictions are that this situation may worsen

in the next decade because of an ageing workforce in

some countries (WHO, 2006). Other factors which

can influence health workforce sustainability globally

include: ‘migration, risk of violence, illness and

death, occupational change and retirement’ (WHO,

2006, p. 112).

Given that nurses form by far the largest group of

health workers across the globe, these issues are

particularly pertinent to the profession. It is argued that

‘a shortage of human resources has replaced financial

issues as the most serious obstacle to implementing

national treatment plans’ (WHO, 2006, p. 20). This has

grave implications for provision of health care services

and hence global health. According to WHO data the

current global health workforce profile ‘shows that there

are more than 59 million health workers in the world

distributed unequally between and within countries.

They are found predominantly in richer areas where

health needs are less severe. Their numbers remain

woefully insufficient to meet health needs, with the total

shortage being in the order of 4.3 million workers’ (2006,

p.15).

Nursing shortages and the need to meet health needs

of populations worldwide is high on many government

agendas. However, these shortages cannot be addressed

unless there are sufficient appropriate nurse education

programs in place. Global migration of nurses around

the world is not solving the nursing shortage (McEl-

murray et al., 2006). On the contrary, it is exacerbating

the problem and increasing the unequal distribution

(Cowan and Wilson-Barnett, 2006; Lu et al., 2005;

d.

ARTICLE IN PRESSGuest Editorial / International Journal of Nursing Studies 45 (2008) 1115–11171116

WHO, 2006). Importantly, many health issues are global

and no longer isolated to individual countries (e.g.

SARS, pandemic flu, HIV/AIDS, tuberculosis) creating

the need to establish common nursing educational

approaches. These approaches need to be respectful of

both unique cultural needs within a country, and

preparing nurses to provide care across multi-cultural

groups (Davidson et al., 2003).

Global nursing workforce shortages have created an

environment in which leaders in health care are crisis

managing and seeking short-term solutions to health

service staffing needs (Hayes et al., 2006). Examples of

this include: a rush to create lower levels of health

workers with limited educational preparation to provide

what is considered basic care (which can compromise

quality of care and safety), and pressure to create new

ways of preparing registered nurses more rapidly within

existing infrastructure which is already stretched to

capacity in many instances.

A key goal of nurse education must be the preparation

of well-educated registered nurses to meet global work-

force needs with the capacity to make scientifically sound

contributions to health outcomes for recipients of

nursing care through provision of quality health care.

The discipline and profession of nursing has a growing

evidence base which shows that a well-educated profes-

sional nursing workforce has a critical, positive impact

on patient survival and recovery from a range of illnesses

(Aiken et al., 2002, 2003; Rafferty et al., 2007).

Development in nursing roles should target the growth

of the nursing contribution to care, rather than dilute the

profession. An added nursing crisis is developing as the

age profile of nurse educators change and fewer younger

people move into faculty positions simultaneous with

significant numbers of nurse educators retiring. This

issue must be addressed if the continued worldwide

demand for registered nurses is to be met.

When considered from a global perspective nurse

education faces many challenges including:

�

Securing and maintaining adequate investment in

development of high-quality undergraduate nursing

education programs.

�

Achieving consistency in standards for nursing role

development and basic undergraduate course curri-

cula given the mobility of the registered nurse

workforce.

�

Responding effectively to nursing workforce demand

and supply challenges.

�

Addressing the international shortage of well-pre-

pared nurses for research and/or teaching roles in the

higher education sector.

�

Lobbying governments and health policy decision

makers and increasing awareness of the vital contribu-

tion that nursing as a profession makes to health care.

�

Securing adequate resources for capacity building for

research to grow nursing science, including a robust

evidence base for practice.

�

Accumulating data through quality research on

outcomes of education programs particularly in

relation to clinical practice.

�

Ensuring co-ordinated, informed strategic leadership

to address issues of global concern.

The Global Alliance for Nursing Education and

Scholarship (GANES) was created in 2005 in response

to the shared concerns of a group of Deans’ organiza-

tions from UK, Canada, Australia, New Zealand and

USA. The inaugural meeting of Deans was held in

the UK in December 2005 with representatives from

the Council of Deans in the UK, Canada, US and

Australia/New Zealand in order to create a collabora-

tive means for working together to pursue global

priorities and agendas in nursing education and scholar-

ship. It was recognized that education is pivotal to

addressing future-nursing workforce challenges. It

was also acknowledged that maximum impact and

influence would only be achieved through a collabora-

tive approach. As a result of this GANES was created.

GANES is a body that will engage leaders in nursing

education from around the world. Its core vision

is to provide an informed global voice for nursing

education in order to improve health and health care

through nursing education and scholarship. It will offer

a forum for nursing education leaders to collaborate in

and share nursing knowledge and best practices, learn

from one another, and work as an international group

to influence policy and health care in respective

countries.

GANES acts as an international strategic resource

and vehicle for addressing these challenges of delivering

quality nursing care and influencing policy and political

processes to strengthen the global position of nursing

education and scholarship and its contributions to

quality health care. It constitutes the only international

body providing strategic level expertise in the education

and professional development of nurses worldwide. It

has a mandate to work in partnership with key global

and national organizations in order to:

(a)

raise awareness of the key role of nursing education

in the improvement of global health and quality of

care;

(b)

inform the debate about the global migration of

nurses;

(c)

advocate for global investment in nursing education

to ensure adequate capacity building and the

sustainability of the nursing workforce globally; and

(d)

provide information and advice on education pro-

cesses and standards for nursing role development

ARTICLE IN PRESSGuest Editorial / International Journal of Nursing Studies 45 (2008) 1115–1117 1117

worldwide in order to:

(i) provide accurate and contemporary data and

advice to global policy organizations, govern-

ments and NGOs on issues related to the

education and professional development of

nurses;

(ii) provide the infrastructure for a new interna-

tional network of nurse education leaders;

(iii) provide collegial support, advice and mentor-

ship to those responsible for developing nurse

education worldwide;

(iv) promote the development of a robust evidence

base for nursing practice through rigorous

research.

In summary the GANES’ focus is on education and

scholarship as the means for improving the health status

of citizens of our respective countries and other

countries which will join with us. One of our key

messages is that we believe that all nations security

require the most highly educated and skilled nursing

workforce to deliver high-quality care. We see a clear

link between a strong educational infrastructure and

strong scholarship activities in nursing and the ability of

a society to be healthy and prosperous. GANES’ focus is

on education and scholarship and that makes it unique

from other international nursing groups. We invite

eligible groups to join us. Information on GANES,

including membership eligibility criteria can be located

at: www.GANES.info

Acknowledgement

The authors thank Professors Jan Duke, Pauline

Nugent, Kim Usher, Lynnette Stamler and Lise Talbot

for helpful comments on draft versions of this paper.

References

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., Silber,

J.H., 2002. Hospital nurse staffing and patient mortality,

nurse burnout, and job dissatisfaction. Journal of the

American Medical Association 288, 1987–1993.

Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., Siber,

J.H., 2003. Educational levels of hospital nurses and

surgical patient mortality. Journal of the American Medical

Association 290 (12), 1617–1623.

Cowan, D., Wilson-Barnett, J., 2006. European Healthcare

Training and Accreditation Network (EHTAN) project.

International Journal of Nursing Studies 43, 265–267.

Davidson, P.M., Meleis, A.I., Daly, J., Douglas, M., 2003.

Globalization as we enter the 21st century: challenges for

nursing research, science and practice. Contemporary Nurse

15 (3), 162–174.

Hayes, L.J., O’Brien-Pallas, L., Duffield, C., Shamian, J.,

Buchan, J., Hughes, F., Spence Laschinger, H.K., North,

N., Stone, P.W., 2006. Nurse turnover: a literature review.

International Journal of Nursing Studies 43, 237–263.

Lu, H., While, A.E., Barriball, K.L., 2005. Job satisfaction

among nurses: a literature review. International Journal of

Nursing Studies 42, 211–227.

McElmurray, B.J., Solheim, K., Kishi, R., Coffia, M.A.,

Woith, W., Janepanish, P., 2006. Ethical concerns in

nurse migration. Journal of Professional Nursing 22 (4),

226–235.

Rafferty, AM., Clarke, S.P., Coles, J., Ball, J., James, P.,

McKee, M., Aiken, L.H., 2007. Outcomes of variation in

hospital nurse staffing in English hospitals: cross-sectional

analysis of survey data and discharge records. International

Journal of Nursing Studies 44 (2), 175–182.

World Health Organization, 2006. Working together for health:

The World Health Organization Report 2006. WHO:

Geneva.

John Daly, RN PhD FRCNA

Chair, Council of Deans of Nursing and Midwifery

(Australia & New Zealand)

E-mail address: j.daly@uws.edu.au

Dame Jill Macleod Clark, RN PhD

Past Chair, Council of Deans and Heads of United

Kingdom University Faculties for Nursing and Health

Professionals, UK

Jeanette Lancaster, RN PhD FAAN

President, American Association of Colleges of Nursing,

USA

Geraldine (Polly) Bednash, RN PhD FAAN

Executive Director, American Association of Colleges of

Nursing, USA

Carole Orchard, RN EdD

Canadian Association of Schools of Nursing, Canada