Need for primary care nurses ‘has never been greater’, says ICN chief

Growing global pressures mean the need for nurses working across primary and community care settings ‘has never been greater’, the head of the International Council of Nurses (ICN) has said.

In a meeting of global journalists, ICN chief executive Howard Catton told Nursing in Practice that ‘much more’ should be done to support nurses working outside of hospitals.

Nursing in primary care and the community has always ‘had its moment’, he said, but the need for the profession was now vital.

‘There has always been a time for primary healthcare nursing, but it feels more important than ever before,’ Mr Catton warned.

‘When we look at the global health challenges that we face, we need to do much more to support primary and community nursing healthcare solutions and the need for these nurses has never been greater.’

Creating careers in primary healthcare nursing

While stressing the importance of primary care nursing, Mr Catton noted that most nurses continue to work in hospital settings.

Given this, he argued that more must be done to encourage nurses into primary healthcare roles, including clearer career pathways, community-based experience during education and access to mentoring.

‘We need to do more to promote and support and enable people to develop nursing careers in primary healthcare roles,’ he said.

Mr Catton pointed to lower income countries as offering some of the most positive examples.

In these settings, nurses often work in remote and rural communities and are ‘recognised as the key health profession to bring health for all’, demonstrating the potential impact of well-supported primary and community nursing, according to the ICN chief.

Responding to ageing populations and chronic disease

According to Mr Catton, many countries recognise they are struggling to strengthen primary healthcare systems while responding to ageing populations and rising levels of chronic disease.

‘There’s a real recognition that many, many countries are facing challenges around strengthening their primary health care systems,’ he noted.

He added that nurses are central to addressing these pressures and are increasingly driving innovation.

‘Around the world, we’ve seen nurses absolutely embracing technology,’ he said, describing how the combination of nursing expertise and digital tools was placing nurses ‘at the forefront of some new models of care’.

But he warned that progress has been slower in areas such as workforce investment and leadership.

‘There are still really big issues around investing in the profession, protecting people at work,’ he said, alongside the need to include nurse leaders ‘in key decision-making’ roles.

Nurses paving the way to universal health coverage

Mr Catton described nurses as fundamental to achieving universal health coverage, particularly through primary healthcare.

‘When we look at the road to universal healthcare coverage, we will find it paved every step of the way by nurses in public health and prevention roles, nurses in mental health, from sexual health through to end-of-life care, supporting ageing populations [and] people with chronic conditions to stay at home as well.

‘We know just how fundamental primary healthcare is. It’s the major solution to how we are going to address the global increasing healthcare needs and demands that we see around the world, and to do that in a way in which is realistic and which is affordable as well,’ Mr Catton explained.

‘We have to keep people out of hospitals,’ he added.

The ICN has long stressed the vital need to invest in primary care nursing to achieve universal health coverage.

In 2023, the World Health Organization (WHO) suggested the world was ‘off track’ to make significant progress towards universal health coverage by the target of 2023, and recommended health systems reorient towards using a primary healthcare approach.

More recently in May, the WHO warned that the ‘pattern of inequity’ within nursing across the globe must be urgently addressed to achieve universal healthcare.

Dealing with the fundamentals

Reflecting on 2025 as a whole, Mr Catton described how unpredictable politics and institutional changes were impacting on the work of the ICN.

‘This year has felt incredibly uncertain at times, in terms of the global situation, increasing wars and conflicts, the impacts of climate change and some very significant disasters that we’ve seen right the way around the world,’ he recalled.

Mr Catton pointed to the Trump administration’s major decision to withdraw from the WHO in January, alongside other financial challenges facing economies globally.

More recently, the US government has caused controversy by its decision last month to exclude nursing from the federal definition of ‘professional degrees’.

Speaking more widely, Mr Catton said nursing ‘has all the golden ingredients’ of a ‘compelling career’, but that some basic issues needed to be addressed to keep nurses in the workforce and encourage new professionals to join.

‘We have to deal with the basics around decent work, respect at work, career progression, leadership opportunities, recent and fair pay, or inequality either,’ he added.

In June, the ICN launched a new definition of a ‘nurse’ and ‘nursing’ in a bid to help better describe the profession’s scope and contribution to global health.