The year nobody expected.

A mere dozen months ago, we were all set to celebrate the International Year of the Nurse and Midwife, poised to shine in the global spotlight with the spring release of the first State of the World’s Nursing report. There were plans to fete us with dinners and awards. “Give them ribbons, buttons and badges to wear,” one website suggested.

How quaint and frivolous that sentiment seems now in light of the continuing shortages of the masks, face shields, gowns, and gloves that we need to protect ourselves, our patients, our families and communities from COVID-19

Nurses in the spotlight.

The pandemic changed everything—except for the fact that nurses did land squarely in the spotlight this past year. Nurses—as always—were asked to multitask when the first confirmed cases led to sustained global transmission. We dug in even as we pivoted, attempting to prevent hard-won health gains from being reversed. For example, women still needed prenatal care. Lockdowns didn’t preclude families from requiring essential preventive and lifesaving treatments for countless infectious and chronic diseases—including malaria, HIV, TB, diabetes, and cancer—that suddenly took a backseat to COVID-19.

An ongoing stress test for the health care system.

Nurses called on every skill we ever learned, and then some. We provided care and kept vigil. We suffered and succumbed, with thousands of our ranks sickened by COVID-19 and too many hundreds of us dying.

At the same time, the pandemic highlighted gaps and deficits that have long plagued our profession. More painfully and irrefutably than any official report, COVID-19 revealed the true value of quality education, astute leadership, fair compensation, and job safety and satisfaction. When and where any of these are lacking, the effects can be measured in lives lost, ours and those of our patients.

Never has it been clearer that nursing is the backbone of health care everywhere. Never more evident that Love-a-Nurse buttons can’t hold together a critical profession, much less the health systems it underpins. Investment and serious support are necessary to secure a nursing workforce capable of delivering on the United Nations Sustainable Development Goals and of ensuring health for all.

Towards a stronger, more resilient profession.

As a nurse-led global health affiliate of the Johns Hopkins University, Jhpiego is working with partners from Baltimore to Botswana not only to build back, but to build better. The foundation of resilient health systems in a post-pandemic world will be a stronger, more forward-thinking nursing profession.

If the pandemic has an upside, it is that it may propel global policy dialogue using data from the recently published State of the World’s Nursing report as well as from the State of the World’s Midwifery report, to be released in 2021. In addition, the pandemic informed the 2020 Triad Statement of the International Council of Nurses, International Confederation of Midwives, and the World Health Organization, a powerful call to action that addresses everything needed from education and eliminating the gender pay gap to suitable working conditions.

At the outset of what was to be nursing’s celebratory year, I coauthored an editorial, “Thirty Million Strong,” in AJN about what our profession needs to look like in the coming decade, stressing that the health of the world hinges on the success of nations to appropriately value and support the nursing profession. This challenging year has made this crystal clear. What a decade this year has been . . .

By Leslie Mancuso PhD, RN, FAAN, president and CEO of Jhpiego.