护理、承诺和领导力：更多护士，打造更好的医疗保健模式——成为领导者的护士

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For the celebration of International Nurses Day in 2022, the International Council of Nurses (ICN) has proposed the slogan “Nursing, a voice to lead: Invest in nurses and respect rights for global health” [1]. There can be no nobler goal for a modern and transformative health system, especially for transforming nurses, than to uphold the rights of citizens to improve global health, i.e., planetary health. For example, it is obvious and well-known that disease is not distributed randomly among people; therefore, getting sick is not totally a matter of bad luck but rather of where you were born, where you live, what habits you have acquired in your living environment, and what resources you have, and nurses are a valuable resource to combat health inequities [2]. Additionally, for this reason, in a globalized, rarefied, and warlike world, promoting a new, more agile, decisive, diverse, and sustainable health care model should be a priority. Moreover, in this changed model, nurses must be part of the solution and not spectators. Furthermore, for exactly this reason, nursing must be a voice to lead, and not a voice to accompany, because the change in the health care model will be accomplished by the nurses, or it will not be accomplished at all. There is thus a fascinating challenge that nurses face in order to continue to grow as professionals and to rise to the need and challenge. It is convenient to share our particular vision of the present and the future of nursing and of the need for more nursing leadership, greater proactivity towards the health system and the transformation of the care model, and more participation of nurses in all the essential forums, especially in the decision-making that affects not only nurses, but also the entire population. The World Health Organization has long insisted on the need for more nurses to participate in health policies, although this has been reaffirmed and made more visible since 2020 with the Nursing Now campaign [3]. Worldwide, more nurses are necessary in decision-making that translates into a true and more powerful use of advocacy for health. Empowerment and leadership are key: particularly with nurses in active decision-making, it has been found that certain nursing care circumstances are objectively excellent in influencing health outcomes, with decreased morbidity and mortality, increased quality and improvement of care, and cost containment, along with multiple other benefits for society, citizens, users and professionals., All of this is possible with the influence of health advocacy [4].

Advocacy for health will allow what we propose to be exercised. Health professionals are responsible for being guarantors for the advocacy for the population’s health and for watching over the interests of patients and their families and respecting their will [5]. Advocacy towards the nurses themselves is also needed, as health professionals must become guarantors and watch over their interests, since the interests of the nurses are those of the population itself. For example, according to “The triple impact” report, if more is promoted and invested in nursing, three direct results will undoubtedly be obtained: first, improvements in clinical care and in patient and population care; second, reduction and improvement in gender inequality, causing greater equity; and third, the promotion of the sustainability of health systems by improving the countries’ economies [6]. Leadership seems to be a key element in what the ICN proposes and the WHO endorses. In higher nursing curricula, conceptual understanding and competence in leadership have been intensively worked on for years. It is also common to find postgraduate courses focused on leadership and management. We are training future nurses to encourage proactive attitudes. However, more recently, the concept of Political Competence has been incorporated, from very different perspectives, when working with nursing students. As Rosa María Alberdi [7] argues, it is essential that nurses assume their disciplinary and social responsibility and participate in politics, although not necessarily as professional politicians (although perhaps also as professional politicians, since each political decision that is made affects the health of the population for better or worse).

However, at a minimum, nurses must exercise political competence as the health agents that they are, with the ability to transform society as the ICN demands, so that the rights of citizens are respected and that planetary health is preserved and improved. Additionally, to do so, it is necessary to act and work close to where health decisions are made, e.g., in urban planning, transport, waste, housing, work, economy, and commerce. Moreover, nurses are health professionals with an excellent qualifications to participate and intervene in public life, given their versatility and experience in working with the community. Alberdi maintains that this should not be a job, but a commitment, a priority in the social framework, which, according to our vision, expands the multiple commitments that nurses, due to their disciplinary idiosyncrasy, already have with society.

Many more nurses are needed. The nursing workforce is deficient, and the hiring of more nurses needs to be prioritized politically, as practically all relevant institutions claim, and as the ICN and the WHO Nursing Now campaign have maintained [6].

However, more nurses are needed to whom the health system allows a greater development of skills without corporate resistance or private interests. In particular, leading nurses are needed who practice transformative and friendly leadership capable of breaking classic, outdated, and obsolete models of care based on hierarchical and ineffective work teams, i.e., those that claim that “We have always done it that way here and it works well for us”. This is needed to transform reality by encouraging creativity and innovation and incorporating new and good practices, research, community care and public health, which inspire leaders in areas beyond direct health care.

This transformational leadership is what the nursing of the future needs. We are convinced that the health sector and society share the need for more nurses and for a stronger, more active, more participatory and more transformative nursing leadership, which is in all the forums where it should be: at the hospital level, in primary care, in socio-health centers, in public health, at the local level, in schools, at work, in politics, and in research [8]. These nurses must be able to participate in the decision-making that affects not only nurses but also the community. We assume that the environment presents resistance to change in order to try to preserve unnecessary and selfish power hierarchies; this is another type of inequality that, like all inequalities, is unfair, unnecessary, and avoidable.

However, in the end, it is only about putting the patient and their family at the center of the system and making the most of what each professional can contribute, including nurses, specialist nurses, and advanced practice nurses.

Nurses have plenty of knowledge, talent, competence, and responsibility. They have everything needed to help make health systems better, from leadership to nursing competence. Let us empower ourselves as nurses to transform social reality and improve the health level of the population.

全文翻译（仅供参考）

为庆祝 2022 年国际护士节，国际护士理事会 (ICN) 提出了“护理，引领之声：投资护士，尊重全球健康权利”的口号 [ 1 ]。对于现代和变革性的卫生系统，尤其是变革护士而言，没有比维护公民改善全球健康（即地球健康）的权利更崇高的目标了。例如，疾病在人群中并不是随机分布的，这一点是显而易见的。因此，生病并不完全是运气不好的问题，而是你出生在哪里，你住在哪里，你在生活环境中养成了什么习惯，你拥有什么资源，而护士是对抗健康不平等的宝贵资源[ 2]。此外，出于这个原因，在一个全球化、稀缺和好战的世界中，推广一种新的、更灵活、更果断、多样化和可持续的医疗保健模式应该是当务之急。此外，在这种改变的模式中，护士必须成为解决方案的一部分，而不是旁观者。而且，正是因为这个原因，护理必须是引导的声音，而不是陪伴的声音，因为医疗模式的改变将由护士来完成，或者根本无法完成。因此，护士面临着一个令人着迷的挑战，以便继续成长为专业人士并应对需求和挑战。方便分享我们对护理的现在和未来的特殊愿景，以及需要更多的护理领导、对卫生系统和护理模式转变的更大积极性，护士更多地参与所有重要论坛，尤其是参与不仅影响护士，而且影响整个人口的决策。世界卫生组织长期以来一直坚持需要更多护士参与卫生政策，尽管自 2020 年以来，这一点通过 Nursing Now 运动得到了重申和更加明显[3 ]。在世界范围内，需要更多的护士参与决策，这将转化为对健康倡导的真正和更有力的使用。授权和领导是关键：特别是在护士积极决策的情况下，已经发现某些护理环境客观上在影响健康结果方面非常出色，发病率和死亡率降低，护理质量和改进以及成本控制，以及为社会、公民、用户和专业人士带来多种其他好处。，在健康宣传的影响下，所有这一切都是可能的 [ 4 ]。

倡导健康将使我们的建议得以实施。卫生专业人员有责任成为宣传人口健康的保证人，负责维护患者及其家属的利益并尊重他们的意愿 [ 5]。还需要对护士本身进行宣传，因为卫生专业人员必须成为保证人并监督他们的利益，因为护士的利益就是人口本身的利益。例如，根据《三重影响》报告，如果在护理方面加大推广和投入，无疑会获得三个直接的结果：第一，临床护理和患者与人群护理的改善；第二，减少和改善性别不平等，带来更大的公平；第三，通过改善国家经济来促进卫生系统的可持续性[ 6]。领导力似乎是 ICN 提议和 WHO 认可的关键要素。多年来，在高等护理课程中，人们对概念理解和领导能力进行了深入研究。找到专注于领导和管理的研究生课程也很常见。我们正在培训未来的护士以鼓励积极主动的态度。然而，最近，在与护理专业学生一起工作时，政治能力的概念已经从非常不同的角度被纳入其中。作为罗莎玛丽亚阿尔伯迪 [ 7] 认为，护士必须承担他们的纪律和社会责任并参与政治，尽管不一定作为职业政治家（尽管可能也作为职业政治家，因为做出的每一个政治决定都会影响人口的健康，无论好坏）。

然而，作为健康代理人，护士至少必须具备政治能力，能够按照 ICN 的要求改变社会，从而尊重公民的权利，保护和改善地球健康。此外，要做到这一点，有必要在做出健康决定的地方采取行动和工作，例如在城市规划、交通、废物、住房、工作、经济和商业方面。此外，鉴于护士的多面性和与社区合作的经验，护士是具有参与和干预公共生活的优秀资格的卫生专业人员。Alberdi 坚持认为，这不应该是一份工作，而应该是一项承诺，是社会框架中的一个优先事项，根据我们的愿景，由于护士的学科特质，这扩大了护士的多重承诺，

需要更多的护士。正如几乎所有相关机构所声称的那样，正如 ICN 和 WHO Nursing Now 运动所坚持的那样，护理人员不足，需要在政治上优先考虑雇用更多护士 [ 6 ]。

然而，需要更多的护士，卫生系统允许他们在没有企业阻力或私人利益的情况下获得更大的技能发展。尤其需要领导护士，他们实践变革性和友好的领导能力，能够打破基于等级森严和低效工作团队的经典、过时和过时的护理模式，即那些声称“我们在这里一直这样做的人”对我们很有效”。这需要通过鼓励创造力和创新并结合新的和良好的实践、研究、社区护理和公共卫生来改变现实，这会激励直接医疗保健以外领域的领导者。

这种变革性的领导是未来护理所需要的。我们相信，卫生部门和社会都需要更多的护士，以及更强大、更积极、更具参与性和更具变革性的护理领导，这在所有应该存在的论坛上都存在：在医院层面，在初级保健，在社会健康中心、公共卫生、地方一级、学校、工作、政治和研究中 [ 8 ]。这些护士必须能够参与不仅影响护士而且影响社区的决策。我们假设环境对改变有抵抗力，以试图保持不必要和自私的权力等级；这是另一种不平等，与所有不平等一样，它是不公平的、不必要的和可以避免的。

然而，归根结底，这只是将患者及其家人置于系统的中心，并充分利用每个专业人员可以做出的贡献，包括护士、专科护士和高级执业护士。

护士拥有丰富的知识、才能、能力和责任感。他们拥有帮助改善卫生系统所需的一切，从领导到护理能力。让我们以护士的身份赋予自己权力，以改变社会现实并提高人口的健康水平。

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