Empowering Nurses: A Conversation With José Luis Cobos Serrano, President of the International Council of Nurses (ICN)

In this exclusive editorial interview, the editor-in-chief of Nursing & Health Sciences, Janet Delgado, speaks with José Luis Cobos Serrano, recently appointed President of the International Council of Nurses (ICN). With decades of experience in advancing professional nursing standards and advocating for person-centered care, José Luis Cobos Serrano assumes leadership of the ICN under the banner of empowering nursing and nurses. This conversation explores the transformative role of nurses amid the convergence of multiple global challenges, including political unrest, migration, population aging, and the accelerated integration of digital technologies into healthcare. José Luis Cobos Serrano reflects on the importance of unity and solidarity among national nursing associations, ethical leadership, and sustainability, addressing issues ranging from the protection of nurses in conflict zones to the integration of planetary health and green leadership into the global nursing agenda. His reflections serve both as a call to action and as a vision of how nursing can help guide humanity toward a more equitable and sustainable future. Q1. Janet Delgado. Congratulations on your appointment as President of the ICN. Each president of the ICN chooses a keyword that governs their term of office, or at least serves as a guiding light for what they intend to do during their term. You have chosen the term empowerment as the guiding principle for your term. Could you explain a little about what empowerment means to you and what your immediate priorities are for the nursing profession? José Luis Cobos Serrano: Nursing, as a profession, and nurses, as professionals, can empower themselves based on a capacity that we often already have within us. It is a capacity that we accumulate over time thanks to professional experience and training. There is enormous potential within the nursing profession that, in many cases, neither society nor healthcare systems are fully exploiting. Empowerment means identifying and mobilizing all that potential to enrich society and healthcare systems. To me, that is the concept of empowerment, although I understand that each person may interpret this term in their own way. At the ICN, we seek to harness this potential on three essential levels: the political level, the social level to reach the general public, and the local and concrete level for nurses. The ICN represents the voice of nursing worldwide, with more than 30 million nurses, and is responsible for collaborating with international institutions such as the World Health Organization, the International Labor Organization, and the United Nations, among others. In these spaces, our mission is to make nursing visible and our voices heard. When I talk about empowering national or local associations, I am aware that each one has its own level of development. Many carry out very important work, but there is still much to be done. The key question is: how can we advance this empowerment? What I propose, first and foremost, is to foster solidarity among all the associations that are part of our organization. Some associations are highly developed, while others are just getting started. In Spain, for example, we have a research institute, a training institute, and a Public Relations and Media Office. On many occasions, we have collaborated with associations, especially in Latin America, partly due to language affinity, by working with them to develop training programs, share educational resources, or support their efforts to negotiate with governments on issues such as working conditions. We also share strategies we have used to implement competencies, such as nurse prescribing. Exchanging experiences, knowledge, and strategies is precisely what I mean by empowering nurses. My immediate priorities focus on three key areas: strengthening the ICN as a global leader in health, helping national nursing associations gain political influence and representation in their countries, and encouraging nurses to play an active role in decision-making, advanced practice, and leadership in care delivery. Q2. Janet Delgado. Many nurses are working in conflict zones. What can the ICN and the international community do to better protect nurses in these high-risk environments? José Luis Cobos Serrano: The safety of nurses and other healthcare professionals in conflict zones is a priority. In conflict situations, the ICN understands that its role is to defend people's lives, which means enabling care for those who are injured and addressing the health needs of populations in these areas. To this end, it is essential to support and protect the professionals working in these areas. The way war is waged is changing, and this must be recognized. Today, drones, high technology, and economic pressure are used. What concerns us most is that healthcare professionals and health centers are being directly attacked, and they should never be the target of attacks. Nurses and healthcare professionals are protected by international rules that are not being respected. Attacks on hospitals or healthcare centers are absolutely intolerable. That is why, first and foremost, what we are doing is to fight for the principle that those who dedicate themselves to caring for others should not be attacked. And this is not about politics or political affiliations. Regardless of the side involved, it must not be permitted to attack healthcare professionals or centers. Some military authorities have stated that vehicles transporting wounded people have had to conceal red crosses or other protective symbols, as these markings would otherwise make them targets for attack. If healthcare professionals are attacked, there will be no personnel available to treat or care for the wounded. At the ICN, we are taking very specific measures on three main levels: at the political level, at the level of social awareness, and at the level of direct support in conflict zones. On the political front, we are meeting with international authorities and representatives to draw attention to violations of human rights and international agreements. We have approached, for example, the Secretary-General of the United Nations to insist that everything possible must be done, including sanctions or other international political actions, to ensure that these agreements are respected, for the sake of humanity and the fundamental right to preserve human life. This is where, as a representative of nursing, I can and must act. At the same time, we are developing social awareness initiatives. We have relaunched the Nurses for Peace campaign, which previously existed with a different vision, to give it greater visibility and increase its impact. I reiterate that this is not a matter of political ideology, but of protecting healthcare professionals: nurses, doctors, and other health workers who are suffering these attacks. We seek to make a clear call to society to raise the awareness of protecting both those who receive care and those who provide it. Just a few months ago, we had to report a massacre at a hospital in Sudan, where a terrorist attack killed thousands of patients and their family members, as well as healthcare professionals. This must never happen again. It is also utterly unacceptable for a bomb to be dropped on a pediatric hospital in Gaza. The question we must ask is: how is this possible? Even if healthcare facilities are sometimes used as human shields, this can never justify such attacks. We cannot stand idly by while this continues. Finally, in terms of direct support, the ICN has programs to assist conflict zones and the nurses working under such conditions. One specific example is Ukraine, where many nurses were forced to flee and were received in Poland. We helped establish mechanisms to recognize their professional qualifications, provided additional training so they could continue working, and coordinated the delivery of medical supplies. Support was also provided for transportation: in the absence of vehicles, nurses were supplied with bicycles so they could travel between different areas and reach hospitals for work. More recently, with support from the European Union and several European countries, we have launched a recovery program focused on mental health. Nurses in conflict zones are under enormous psychological pressure, and many consider leaving the profession. To prevent nurses leaving their profession, a multi-phase program was developed: an initial online phase with training and psychological support tools; a second in-person phase, with strict safety measures, in which 25–30 nurses participated in intensive four-day workshops; and a third online phase for follow-up and support. Our goal is to expand this program, run new editions, and extend it to other conflict zones, including, conditions permitting, areas like Gaza. However, we are aware that there are areas of conflict where it is extremely difficult to reach and provide all the necessary assistance. P3. Janet Delgado. The concept of planetary health highlights the profound interconnectedness between human well-being and the health of our planet's ecosystems. Given the current shortage of nurses and the growing demands of an aging population, how can nurses realistically take on leadership roles to address environmental degradation, climate change, and ecological justice? José Luis Cobos Serrano: The planetary health approach aligns very directly with the One Health framework, which the ICN is actively working on in numerous countries. This approach is based on the recognition that human health cannot be understood in isolation but is deeply interconnected with animal health, ecosystems, water, forests, and the wider environment. Recent experiences with epidemics and pandemics have demonstrated how viruses, bacteria, and other microorganisms, many of them of animal origin, can jump to humans and cause major health imbalances. This reality requires close collaboration between professionals from different disciplines: nurses, doctors, veterinarians, public health agents, even outside the health field, such as engineers, forest rangers, and other sectors, to anticipate risks, prevent diseases, and protect collective health. In this context, nurses can realistically assume leadership roles precisely because they are already present at the levels where prevention and education have the greatest impact. From public health, primary care, and community health, nurses contribute to monitoring water quality, promoting healthy habits, and implementing preventive actions that reduce environmental and health risks, among others. A clear example is the incorporation of school nurses in Spain, as well as in other countries. Their role is not limited to dealing with specific incidents or chronic diseases, but focuses on health education, preventing substance abuse, promoting healthy habits, and respecting natural resources. These early interventions make it possible to raise a more aware, healthier, and more committed citizenry from childhood onwards. Seemingly simple educational actions, such as teaching children to recycle, separate plastics, glass, and paper, or reduce unnecessary consumption of resources, have a very powerful multiplier effect. In many cases, it is the children themselves who transfer this learning to their homes and act as agents of change within their families. This shows that nurses, when placed in the right settings, have enormous social influence and can lead sustained transformations that impact both human and environmental health. For this leadership to be viable in a context of staff shortages and high pressure on healthcare services, it is essential to have adequate support systems in place. These include policies that strengthen the presence of nurses in public health, prevention, primary care, and community settings; institutional support for their participation in international projects and campaigns related to the One Health approach; and support from professional associations to facilitate their involvement in national and regional initiatives. The ICN, for example, actively participates in these movements at the global level and encourages national associations to join existing initiatives in each country, as is the case in Europe and especially in the Nordic countries, where there is a strong tradition of environmental awareness. Likewise, nursing leadership in planetary health extends to the healthcare system itself. The management of highly polluting hospital waste, the safe handling of toxic substances such as chemotherapy drugs, and the reduction of plastic use are areas in which nurses play a key role. The ICN has developed manifestos and official positions on climate change, plastic reduction, and sustainability and works internationally to minimize the presence of microplastics in the environment and, by extension, in the human food chain. In short, nurses can lead the response to environmental degradation, climate change, and ecological justice because they are already agents of change in the settings where health is built day by day. To empower them, structures are needed that recognize their educational, preventive, and community roles, facilitate interprofessional collaboration, and integrate sustainability as a central pillar of health systems. In this way, it will be possible to move toward a real transformation that simultaneously protects the health of and the while to the needs of patients in the Janet Delgado. 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