About

As WHO Consultant for the Office of the Chief Nursing Officer, Susan served as managing lead in the 25x25 Basic Emergency Care (BEC) campaign. She is an Associate Professor at Dublin City University, served as Deputy Chief Nursing Officer from 2014-2018, and influenced maternity and community policy, including the Sláintecare Action Plan. With over 35 years in the health sector, she has experience in clinical practice, policy development, and academic leadership. She holds a PhD in Children's Research from Trinity College Dublin and founded ArrowHealth, a nurse-led home healthcare service. 

We asked Dr. Kent to share her insights and experiences implementing the WHO’s BEC 25 x 25 campaign.

(Note: Dr. Kent is not currently in the office due to WHO funding issues. The opinions expressed below are her own.)

Today, healthcare providers in 60 countries have received BEC training, yet uptake among nurses and midwives – who represent almost 60% of the global health workforce – is low. How was the Basic Emergency Care 25 x 25 program developed to change this?

With a career grounded in community nursing and national policy development, I have witnessed a long-standing gap: nurses and midwives are frequently the first to respond in emergencies, yet rarely the first to be trained, equipped, or recognized in formal emergency care systems. The Basic Emergency Care (BEC) course is a WHO initiative managed between several departments and available in several low- and middle-income countries (LMICs). The BEC 25x25 campaign is an initiative to train nurses and midwives in 25 countries by 2025. 

The initiative is grounded not just in equity, but in evidence. Nurses and midwives make up the majority of the global health workforce. The 25x25 campaign represents a shift. It’s about ensuring lifesaving knowledge is shared, widely, contextually, and with dignity.

How can governments be encouraged to invest more in their nursing workforce to ensure the sustainability of emergency care services?

Through my policy leadership at the Department of Health, I’ve learned that government investment is driven by vision but secured by proof. In my case, the absence of community evidence of data/metrics was sustained by strategic storytelling. To secure meaningful investment, we must position nurses and midwives not as supporting staff, but as system architects, core to the redesign of emergency and primary care delivery.

We know from global and local data that nurse- and midwife-led models reduce unnecessary hospitalizations, shorten response times, and improve chronic disease and maternal and neonatal outcomes. But in settings where outcome data was absent, as during my policy development work on national strategies, I turned to qualitative, patient-focused narratives. These stories of impact resonated where spreadsheets could not. Policymakers listened because we showed how real lives improved, not just how systems performed.

Governments invest when they see return, and few returns are greater than the ones offered by a well-supported, strategically deployed nursing and midwifery workforce. We must reframe nursing and midwifery not as a cost center, but as the lever for sustainable, resilient, and equitable care. That is the investment case worth making.

What are some of the most important elements that have made the BEC program successful? 

Successful programs amplify the expertise, autonomy, and leadership of nurses and midwives. They empower professionals to act as competent, confident first responders, trusted by the communities they serve. That trust is earned, not granted, and it reflects the deep relationship between nursing, midwifery, and the public. 

From my experience working with the BEC campaign and leading community nursing and midwifery innovation, influencing national policy, and designing transformative curricula, I have found that four elements consistently underpin the success for nurses and midwives: access, relevance, respect, and readiness.

• Access means ensuring that training reaches nurses and midwives where they practice. It must be logistically and professionally feasible, particularly for those juggling heavy clinical workloads and fundamental travel issues.
• Relevance ensures that what is taught mirrors what is faced. Whether in high-income or LIMCs, managing a respiratory emergency or responding to a postpartum hemorrhage, if training does not reflect the reality of care, it will not translate into confident action.
• Respect acknowledges the rich clinical wisdom and contextual insight nurses and midwives bring. These professionals are not passive recipients of knowledge, they are expert creators, implementers and innovators. They know what works.
• Readiness is achieved through simulation, scenario-based learning, peer-to-peer support, and tools that build muscle memory and decision-making confidence. Readiness means being able to act decisively and safely. This requires a certain amount of autonomy and authority. 

What are the essential skills that nurses and midwives need to effectively manage emergency situations in resource-limited settings?

I have always thought that technical skills are only half the equation. Yes, airway management, hemorrhage control, and triage are non-negotiable competencies. But in the real-world settings where most nurses and midwives operate, what distinguishes effective practice is the ability to lead, adapt, and advocate under pressure.

I have seen nurses stabilize patients while simultaneously coordinating with anxious family members, arranging emergency transport, and navigating the complex hierarchies of care decision-making, all without immediate backup. This is what I call leadership under uncertainty. It demands cultural sensitivity, emotional intelligence, and unshakable professional confidence. It is not a soft skill, it is a survival skill, both for the patient and the system. In today’s world, nurses and midwives must be trained not just to act, but to lead, to influence, and to advocate when care is needed most.

What role does simulation-based training play in enhancing the quality and accessibility of BEC training for healthcare providers?

Simulation doesn’t just teach, it transforms. It takes theory and turns it into reflex, into muscle memory, into confident, life-saving action. Simulation has been a game-changer, not only in skill acquisition but also professional empowerment.

Whether a midwife mastering neonatal resuscitation or a nurse practicing hemorrhage control, simulation makes training real, relevant, and deeply human. It meets learners where they are, geographically, professionally, and emotionally, ensuring that emergency preparedness is accessible, not elite.

But its impact goes even further. When nurses and midwives lead simulations, power dynamics shift. Colleagues watch, listen, and learn. It breaks down hierarchy, builds mutual respect, and changes how teams function under pressure. 

Simulation becomes more than a tool, it becomes a platform for professional visibility, credibility, and leadership. Simulation democratizes knowledge, elevates practice, and reshapes systems to better reflect the realities and capacities of the nursing and midwifery workforce.

How do you measure the effectiveness of the Basic Emergency Care training in improving patient outcomes and reducing preventable deaths?

The WHO has developed robust methodologies for evaluating the impact of BEC programs across countries, and the results are compelling: these programs have demonstrated astounding reductions in preventable deaths and tangible improvements in emergency care delivery, especially in resource-limited settings. However, while metrics matter, they are only part of the story. We must balance data with meaning.

Standard indicators, such as response times, hospital admission rates, referral patterns, and mortality statistics, are essential for assessing system performance. But in my experience, the most powerful measure is the frontline voice. When a nurse says, “This training gave me the confidence to act,” or “Because of this, I saved a life,” that is an impact no graph can fully capture.

Evaluations also include measurement of increases in clinical decision-making autonomy, escalation confidence, interdisciplinary collaboration, and continuity of care. The evidence consistently shows that, post-training, nurses and midwives are better equipped to intervene early, act decisively, and lead with authority in high-pressure situations.

If the WHO continues to map professional confidence and agency to patient outcomes, it will strengthen the case, not only for scaling emergency care training, but for sustained investment in nursing and midwifery leadership as a cornerstone of resilient health systems.

What partnerships or collaborations have been important for the success of the BEC 25 x 25 campaign, and why?

The most enduring and transformative partnerships are those built on co-design, mutual respect, and shared purpose. In my experience, it is not enough to deliver training, we must embed it into the fabric of health systems so that it becomes part of how care is delivered, not an occasional intervention.

Throughout my career, I have fostered strategic collaborations with nursing and midwifery councils, departments of health, operational services, regulators, education providers, simulation labs, digital health innovators, and community-based public health networks. These partnerships have done more than implementing programs, they have enabled structural change.

Within the BEC Campaign, bringing these actors together enables integrated emergency preparedness into routine care, particularly in non-hospital and primary care settings. This facilitates a move from reactive response to proactive resilience, equipping nurses and midwives not just with clinical skills, but with the leadership capacity to shape systems.

How can the nursing profession advocate for better recognition and support in emergency care roles within health systems?

Too often, nurses and midwives are called upon to lead during crises, yet remain excluded from the crucial conversations where preparedness, policy, and reform are shaped. Our voices matter, and we must ensure they are heard. We need to work to embed leadership development into emergency care training, education curricula, and advocating for nurses’ roles in national strategy at the Department of Health. 

We train to save lives, but we must also train to shape the systems in which those lives are saved. Nurses and midwives must not only respond to emergencies, but they must also be equipped to lead legislative change, influence budget decisions, and hold health systems accountable. True impact lies not only in resuscitation, but in representation.

Is there anything you would like to share that we haven't covered?

If we want sustainable emergency care systems, we must not just empower the profession, we must elevate its voice, locally and globally, until it becomes indispensable in both clinical and policy arenas. Emergency care begins in the community, with nurses and midwives as its stewards. My life’s work in community nursing, policy innovation, and education has taught me this: when we empower those already doing the work, we ignite a transformation in health systems from the ground up. 

This is not just a vision, it is a call to action.

Nurses and midwives have always been at the heart of care delivery, but we now face the opportunity to redefine the future of healthcare. We are ready. We are capable. We are leading. But the question is, will the systems we serve rise to meet this moment?