Barbara Stilwell was awarded an Honorary Doctorate for her work as a teacher, researcher, influencer and humanitarian. An expert in strengthening health systems in developing countries, she was also instrumental in establishing the role of nurse practitioner in the UK. The first nurse practitioner course transferred from the Royal College of Nursing to London South Bank University (LSBU) in 2000.
Here, Barbara discusses her career and key inspirations.
"Looking back, it was pretty much a foregone conclusion that I would become a nurse. My mother was a nurse, my aunts were nurses and my uncles were all doctors. I thought about studying medicine too, but in the 1960s that wasn’t such an obvious path for a girl from a working class family to take. I have no regrets about choosing nursing instead. I loved it from the start. My daughter is a nurse, and now my granddaughter is studying paediatric nursing.
Paving the way for nurse practitioners
"The idea of nurse practitioners was inspired by my experiences as an inner-city health visitor. I was working in Birmingham, dealing with a lot of families from the Indian sub-continent. Women would come to the clinic wanting to talk about sensitive things like family planning, screening or childbirth, and there were no female doctors to help them. It was also very clear to me that nurses’ skills and knowledge were being under-used. I happened to read something about nurse practitioners in the US and I thought, why don’t we have something like that here? We set up a trial clinic and I wrote an article for the Journal of Advanced Nursing. Peggy Nuttall, one of the grandes dames of nursing, read it and offered me a scholarship to go and study on the nurse practitioner programme in North Carolina. It all started from there.
"To begin with, we met a lot of resistance. Those early days, when I was trying to set up the first course at the University of Birmingham, were pretty tough. Doctors thought that nurse practitioners were going to take their jobs; and nurses themselves were worried that it would mean giving up nursing. We needed to make clear to people that neither of those things was going to happen. We also had to create the right legal framework, so that nurse practitioners could be properly accountable for what they did. But I was absolutely convinced that nurses had a lot to offer and that this was a sensible move for the British health service. It never occurred to me to stop.
I’m very proud of what we achieved. It’s self-evident that nurse practitioners are cost-effective and that they fulfill a need. They offer greater continuity of care, and they’re better placed to offer advice on health promotion, all of which is incredibly important to patients. I also think it’s helped to make nursing a more attractive and rewarding career.
World Health Organization
"I like change, and I am driven by a desire to try to make things better. When the opportunity arose for me to join the immunisation team at the World Health Organization, I was at a crossroads. I could have rested on my laurels, and been wheeled out to speak at conferences about advanced nursing practice. Instead I stepped into this completely unknown world where I would at best be a drop in the ocean. But, as my son always says to me, you might only be a drop – but at least you’re a good drop.
Learning from experiences abroad
"Working in developing countries it’s impossible to ignore the inequalities. Recently I was in Uganda, visiting a rural area where the midwife didn’t even have a blood pressure machine or a foetal stethoscope; while here in the US my local hospital has 75 MRI scanners. I want to do what I can to try to redress that imbalance, even if I can only make a small contribution.
"My current role has definitely taught me to be a bit more humble. In my 10 years at IntraHealth, I’ve had the opportunity to work all over Africa, in the Palestinian territories and in Afghanistan, trying to build capacity and strengthen healthcare systems.
I’ve learned that technical training and innovations are important, but you have to be aware of the context in which you’re working.
"It’s all very well teaching waste disposal in remote corners of Tanzania, but if the only means they have of getting rid of medical waste is a firepit… well, that’s when you realise that maybe your ideas weren’t quite as clever as you thought they were!
The future of healthcare
"I still think nurses are undervalued. Looking to the future, even the wealthiest are going to struggle with the costs of healthcare. If we really are going to move forward to an era of universal healthcare, where we take a long-term, patient-centred view, looking at prevention and health promotion as well as cure, we’re going to have to consider new delivery models and shift the focus away from traditional roles to focus instead on competences. I think there are some very exciting opportunities for nurses to take on even more extended roles.
"My motto is ‘Be the leader you can be today’. Don’t get too hung up on the future and what might happen. Focus on what you can control and what you can achieve right now."