EDITORIAL BOARD Irene Anderson, Principal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Freelance Lecturer and Writer Dimitri Beeckman, Professor of Skin Integrity and Clinical Nursing, Ghent University, Belgium Jacqueline Boulton, Lecturer in Adult Nursing, Faculty Lead for student mobility, electives and global health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London Beverley Brathwaite, visiting senior lecturer, Middlesex University Nicholas Castle, Head of Professions/ Assistant Executive Director, Hamad Medical Corporation Ambulance Service, Qatar Jothi Clara J Micheal, Group Director – Nursing, Global Hospitals Group, India Emma Collins, Nurse Consultant, Sexual Health In Plymouth, University Hospitals Plymouth NHS Trust Alison Coull, Lecturer at Queen Margaret University, Edinburgh Alan Glasper, Emeritus Professor of Nursing Studies, University of Southampton Angela Grainger, Senior Lecturer, BPP University Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Barry Hill, Programme Leader and Senior Lecturer, Northumbria University Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Jacqueline Leigh, Reader In Teaching & Learning School Health & Society, University of Salford Joanne McPeake, Acute Specialist Nurse/ Senior Staff Nurse in Critical Care; Honorary Lecturer/Practitioner in Critical Care, University of Glasgow John McKinnon, Senior Lecturer, School of Health and Social Care, University of Lincoln Michelle Mello, Deputy Director: Workforce Development / National Clinical Lead, Personalised Care Group, NHS England/ NHS Improvement Aby Mitchell, Senior Lecturer Adult Nursing, University of West London Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Hilary Paniagua, Principal Lecturer/Head of Doctoral Studies Faculty of Health & Well Being at the University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Kendra Schneller, Nurse Practitioner, Health Inclusion Team – Vulnerable Adults and Prevention Services, Guy’s & St Thomas’ NHS Foundation Trust John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Jamie Waterall, Deputy Chief Nurse, Public Health England; Honorary Professor, University of Nottingham Brian Webster, 3rd year Adult Nursing Student, University of Dundee Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Research Fellow, Oxford Brookes University.
What lessons can we take from reverse innovation?
Joy Notter, Professor of Community Health Care Studies, Birmingham City University (Joy.Notter@bcu.ac.uk) and Chris Carter, Senior Lecturer, Birmingham City University
For nurses, COVID-19 has radically challenged how they deliver care, with existing resources continually being stretched well beyond normal usage.The result is that innovative approaches are essential to redress shortages, support the continuance of services and maintain patient safety. As nurses who have had the opportunity of working with various Low and Middle Income Countries (LMICs), we believe nursing has been adversely affected by a missed opportunity to recognise the knowledge and expertise seen and learned by nurses who have worked internationally.There is little evidence of how the lessons learnt have been transferred and adapted for application in a high income country (HIC) at any time, never mind during the pandemic.
LMICs work permanently with a limited workforce under financial and resource constraints and have learned approaches to care delivery and equipment use that may be appropriate for our current overstretched and reduced workforce with its increasingly limited resources.We acknowledge that this nursing is extremely difficult and exhausting, in these times of great need, but the role of the nurse remains to deliver care and safeguard patients in the best possible manner, given available resources.This is about working to meet the challenges brought about by the pandemic, by recognising and taking our colleagues’ best experiences and adapting them to fit the healthcare system.
We argue that we need to look more closely at this ‘reverse innovation’, giving formal recognition to evidence that (prior to the pandemic) revealed that working internationally has a long-lasting positive impact on the practice of those who travel (Carter et al, 2019). Health Education England (HEE) (2017) pointed out NHS staff with international experiences bring fresh perspectives, new skills, ideas and approaches that can be used by all clinicians to respond rapidly to identified need. Staff have shown improved clinical and leadership skills, resourcefulness, cultural competence and resilience (Bould et al, 2015; Haines, 2016; HEE, 2017). However, while such positive feedback on individual benefits is useful, the wider impact on established services is missing. For many of these nurses, effective and efficient use of resources has become an integral element of their practice, often have taken for granted. Had this been formalised and their expertise acknowledged, we might have had readily accessible practicebased solutions for use in these unprecedented and challenging situations.
We must not forget that this is only possible because of the generosity of peers in other countries, who welcome us in and have the courage to allow us to see the realities of their lives and the delivery of health care.This challenges the usual perception of knowledge transfer and exchange, which is traditionally seen as sharing of expertise from HICs to health systems in LMICs with benefits for the receiving country stressed and little comment on the outcomes for those partnering with the LMIC. Nevertheless, nurses need to recognise that the gains for the HICs from working with LMICs are immense and could help us deliver safe care in a time when usual and accepted practice is challenged by the global situation we all face.
However, the key lessons learnt from our LMIC peers included the necessity of continually checking that innovative activities do not adversely impact on the ever increasing demands for health care, or further burden our colleagues. Particularly as at the time of writing, the number of COVID-19 infections in the UK, which was reducing through the vaccination programme, is starting to rise again. As we reflect on the changed ‘new’ norm in which we live , we are left with the question: how do we gather together the wealth of experience and expertise nurses hold, and channel it to the greater good? If we do not find a way to do so, then we have lost a unique opportunity to maintain and enhance care, and it is the patient who is the loser. BJN
Bould MD, Clarkin CL, Boet S et al. Faculty experiences regarding a global partnership for anesthesia postgraduate training: a qualitative study. Can J Anaesth. 2015; 62(1):11-21. https://doi.org/10.1007/ s12630-014-0252-4 Carter C, Howard-Hunt B, Mukonka PS,Viveash S, Notter J,Toner L.
‘I’ll never be the same’: the impact of an international elective. Br J Nurs. 2019; 28(3): 186-193 Haines A.Why health partnerships are good for global health. BMJ
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British Journal of Nursing, 2021, Vol 30, No 13