Describe your early clinical practice.

After graduating from a three-year hospital-based diploma program, I worked as a med/surg staff nurse, working all shifts in a facility with about 400 beds. This gave me ample opportunity to serve on committees, be "in charge" and to study.

After getting a diploma in nursing unit administration, I became assistant head nurse on a surgical unit, which I also enjoyed very much. I have to say I had excellent role models in the early years. We worked hard but in a team environment, where opinions counted.

What is the International Council of Nurses?

[It] is a federation of national nurses associations and has member associations in 124 countries. We were established in 1899 and are the oldest and largest international health profession group.

Our mission is to represent nursing worldwide, advancing the profession and influencing health policy. We work in the areas of professional practice, regulation, socioeconomic welfare and advocacy, and [we serve] as a liaison with the United Nations system and other international nongovernmental organizations, developing standards, offering training programs, etc., to meet our mandate.

You have identified several prominent topics confronting nurses. The first of these, globalization, has serious health implications. Can you explain why?

Globalization is bringing the world to all of us wherever we live. With advances in communication and technology, we treat people from around the world-either in our own community or remotely through telehealth. We are also more likely to move about for work and education and to receive goods and services from abroad as well as supplying them to others.

This means we need to be culturally sensitive in our work and travel, be aware of the liability of working across borders and in new settings, and ask questions about new practices, in addition to monitoring new laws that may affect our practice and health care systems-particularly as the World Trade Organization begins to look more intently on facilitating free trade in health services.

The Internet is the most evident example of globalization's impact on our practice. Information, products and services reach us quickly from around the globe, and patients come to us with information and misinformation. They are also self-medicating more and using a variety of products that may not be well-known or regulated.

Globalization is bringing progress and problems, and we need to be knowledgeable if we are to take advantage of the opportunities and curb the problems.

You have said the migration of skilled nurses from poor countries to wealthier, industrialized countries is a "brain drain" in the Third World. How is the ICN addressing the effect that a depleted professional workforce will have on health care delivery in impoverished regions?

ICN raised the issue early on with the World Health Organization and with the International Labour Organization, as well as with the other professions and other nursing groups. Early in 1999, we undertook a study with the World Medical Association and WHO, and more recently have a study under way with WHO and ILO looking at factors that affect migration in both countries that lose nurses and those that gain.

ICN also has participated in regional meetings to address strategies and has developed a framework and position on ethical migration.

We clearly denounce unethical recruitment practices that exploit nurses or mislead them into accepting job responsibilities and working conditions that are incompatible with their qualifications, skills and experience.

We continue to call for an end to aggressive recruitment from countries already suffering depleted nursing resources, particularly developing countries.

Nurses and other health care professionals are increasingly threatened with violence in the workplace. How is the ICN confronting the concerns of nurses who fear practicing in a climate of aggression?

Violence is a key issue for us and we have a major campaign under way. The theme of International Nurses Day this year was "Nurses Always There For You: United Against Violence." It was a huge success.

We have guidelines for nurses on coping with workplace violence, as well as a position statement (these are free and may be downloaded from ICN's Web site at www.icn.ch/guidelines.htm).

We make the topic a part of our regular conferences and congresses, and we have a project under way with ILO and WHO looking at incidence, impact and prevention using a case study methodology.

What is the outlook for nursing in the 21st century? How is the ICN assisting the profession in moving forward?

The 21st century will see nursing coming into its own, with more recognition of the roles nurses can play. Education and research are advancing throughout the world and we must guard against any erosion of education with the shortages.

In many countries, nurses are viewed as the most trusted professionals and we need to make this a universal phenomenon. The way forward is through evidence and a united voice for health and nursing. ICN has a new vision for nursing and is promoting nursing's visibility and policy voice-offering leadership development and working with nurses in governments and associations to strengthen nursing nationally.

The ICN conference in Marrakech, Morocco, in 2003 is called "Building Excellence through Evidence" and will look at evidence, regulation and advanced practice as key aspects of moving forward.