Nurses need more visible roles in the modern 'One Health' governance

Nurses may be one of the most important parts of the health care workforce – yet their contribution is overlooked, according to a new paper examining the profession's place in the growing 'One Health' movement to connect human, animal and environmental health.

Nurses are already central to One Health

The paper, published in the open access journal CABI One Health, argues that nursing is already practicing many of the principles at the heart of One Health. Nurses work across clinical care, community and environmental health, infection prevention and emergency response.

"Nurses are already contributing to One Health in many settings, but their contributions often remain invisible because they are not explicitly conceptualized or recognized as One Health, limiting their participation in governance, education and strategic decision-making," says lead author Professor Paulo Ferrinho of Universidade Nova de Lisboa, Portugal.

These limitations matter when infectious diseases emerge. During an outbreak, nurses are skilled frontline first-response workers central to screening, patient monitoring, education, communication and community engagement.

Nurses' role in outbreak preparedness and response

The paper describes how these capabilities place nurses at the centre of One Health preparedness with roles across pandemic preparedness, detection and response, from surveillance and reporting through to case management – all while facing significant personal risk.

During the 2014-2016 Ebola outbreak in West Africa more than 28,600 people were infected and 11,325 died. A WHO analysis of the epidemic identified 815 confirmed and probable Ebola infections among health workers in Guinea, Liberia and Sierra Leone by March 2015; among those whose outcome was known, two-thirds died.

Nurses' expertise, knowledge and performance in the face of such risks during deadly outbreaks highlight why the profession should be embedded in preparedness, surveillance and response before the next pandemic arrives.

From Florence Nightingale to modern One Health governance

This connection is not as new as it might seem. Professor Ferrinho points to Florence Nightingale, whose vision and administration of nursing during repeated cholera outbreaks during the Crimean War placed the protection of individual human health alongside attention to the wider hospital and war environment.

"Florence Nightingale understood nursing as extending beyond individual patient care to the protection of health through attention to sanitation, living conditions and the environment," says Professor Ferrinho. "She anticipated important elements of the systems-oriented perspective that underpins One Health today."

However, nursing remains under-represented in modern One Health governance. Nurses need meaningful representation in local and global decision-making alongside medicine, veterinary science, environmental health and public health. But fragmented systems and limited representation are holding back their contribution.

Empowering nurses to strengthen global health systems

The authors call for One Health to become a more explicit part of nursing education, including training in zoonotic disease, environmental health, antimicrobial resistance, climate-related health risks and systems thinking.

Nurses already underpin much of the practical work of One Health. Giving them a more visible role as educators and leaders feeding into policy will strengthen global health systems. Failing to recognize and empower them will leave health systems less prepared and less resilient during the next outbreak.

"Strengthening nursing's role in One Health should not simply add responsibilities to an already constrained workforce, but should be accompanied by appropriate education, authority, resources, remuneration and protected time, as well as meaningful rather than symbolic participation in decision-making," says Professor Ferrinho.