Guest editorial: Building a foundation for Global Nursing Leadership.

As of 2014, more than 19 million nurses were actively providing care to families and communities around the globe (World Health Organization, 2015). Among them were countless nurse managers who directly supervised and supported nurses who cared for patients. The nurse manager is not only responsible for nursing practice and quality of care provided in the unit or facility but also oversees personnel and creates an environment that supports professional growth and employee satisfaction. For nurses in managerial positions, conflict resolution, staff retention and motivation, development of professional opportunities, mentoring, and administrative and regulatory duties are all part of the job. Nurse managers in lowand middle-income countries often face the added burden of addressing infrastructure challenges, such as lack of consistent electricity, running water, functioning equipment, and severe, unbalanced human resource shortages. Frustratingly, they often have little or no direct control in making policies that can meet these challenges. There is a strong feeling like they don’t have a seat at the table, that if they want a say in the process, they need to bring their own chair. The World Health Organization and Global Health Workforce Alliance estimate there is a current global shortage of 7.2 million health workers; 83 countries do not meet the minimum requirement of 23 doctors, nurses, and midwives for every 10 000 people – resources that are needed to provide essential health services (Global Health Workforce Alliance, World Health Organization, 2014). Due to this dramatic shortage, task-shifting – the expansion of the scope of practice of a health professional cadre to include additional tasks and functions – is heavily relied upon. The auxiliary tasks are frequently assigned to nurses, who are already overburdened (Global Health Workforce Alliance/ World Health Organization, 2010). These challenges create an environment for nurse managers in lowand middle-income countries that few in highincome countries can imagine. As the President and CEO of Jhpiego, an international nongovernmental organization that employs hundreds of nurses in lowand middle-income countries, I travel to approximately 20 countries each year to meet with our teams and partners on the ground and to hear directly from nurses and other frontline health workers. While each country’s circumstances are unique, the nurses I meet voice similar concerns about the barriers to doing their jobs well and having access to professional development – often echoing the widely acknowledged reality of inadequate health infrastructure in many lowand middle-income countries. The challenges they cite should not be a surprise to those in the global health or nursing fields – many are barriers for nurses regardless of geography – but they are problems that require immediate action in order to achieve the global goal of universal health coverage. However, there are nurses in low-resource settings who are leading the charge to overcome these obstacles. Indeed, many nurses are doing their best to provide quality patient care, but lack resources, training, and support to perform at the level needed to make a profound difference. Nurses should have a career pathway leading toward acquisition of leadership and management skills as well as opportunities to apply their skills within the health system, from communityand facility-level positions to national policy-level positions. While nursing education has improved globally over the past decade, greater focus should be placed on interprofessional education and practice, including promoting the values and building the communication and analytical skills that enable nurses to take advantage of leadership opportunities throughout their career. Nurses should have opportunities to build a robust set of skills required for effective leadership and management positions within their health system. In addition, emerging nurse leaders need professional coaches and mentors from across disciplines to support their ongoing growth and readiness for progressively senior roles, including mentors who are helping to form national, regional, and global policies that are essential for achieving universal health care.