Leading a Global Effort to Empower Nurses: Dr. José Luis Cobos Serrano, President of International Council of Nurses

Lindsey Smith

Hi, I’m Lindsey Smith, welcoming you to Raise the Line with Osmosis for Elsevier, an ongoing exploration about how to improve health and healthcare.

It’s commonplace for leaders in healthcare and government to praise nurses as the backbone of the health system and applaud their dedication, but today’s guest says it’s time to walk the talk.

Dr. Jose Luis Cabos Serrano is in his first year as president of the International Council of Nurses, and upon assuming that post, he made it clear he is going to push policymakers to take action to provide nurses with the support they need and will pursue an agenda of empowering nurses themselves.

Dr. Cobos has spent many years as a clinical nurse and as a senior leader in Spain’s nursing community, including as director of the Spanish Institute of Nursing Research and third vice president of Spanish General Council of Nurses. He’s also making history as the first Spanish global leader of the world’s largest health profession, and he’s been a powerful voice for elevating and empowering nurses worldwide.

I’m excited to hear his insights on the evolving needs of the nursing workforce and what it will take to strengthen healthcare across the globe. Thanks so much for joining us today.

Dr. Jose Luis Cobos Serrano

Thank you, thank you so much, it’s a pleasure for me.

Lindsey

So let’s start things off by learning more about you and what first got you interested in medicine.

Dr. Cobos

So thank you so much to invite me to have this opportunity to explain what is my vision in my current position in the International Council of Nurses as president. But of course before, the most important thing is I am a nurse. So during my time, I work in a hospital in traumatology service. So as all nurses, around all services in the hospitals, sometimes in primary care. So I have a long-time experience in the clinical practice. 

After I had the opportunity to be in the same position as director of the ongoing training in the hospital and continuing education with the direction of the hospital, in a big hospital in Spain -- so 2000 nurses -- I had the opportunity with that vision as clinical practice and with management, the ongoing training and continuing education. And after I have the opportunity to contact with the Spanish General Council of Nursing -- it’s the regulatory body, the national association here in Spain -- to develop a big project as a research with 5,000 nurses to analyze what is the nursing practice, how we can implement care plans in the hospitals and other areas. 

It was a new opportunity to learn, of course and after to practice in the research area with a lot of people. I study a little bit more with a master level and doctoral level here in Spain. And after I introduced myself as a director of the Spanish Research Institute for Nurses and after at the political level during the last six years, I participate in the structure of the political level in the Spanish General Council of Nurses, at the last moment as vice president. 

Because I worked on international affairs, I had the opportunity to work together with ICN during a long time and be in the board as a member. Then I had the opportunity to present my candidacy for the presidency. A lot of people invite me to do so and support me from Latin America, Europe, Africa, Asia. So it’s not in my first idea to present the candidacy, but I understand this is a very good opportunity. I have a very global vision, expertise, experiences. So I think it’s a good opportunity. 

For four years, I have now this privilege to be the president of ICN. So for me, it’s a pleasure, it’s an honor. And I understand, like in other areas in the clinical practice, in the research, as a teacher, because I had the opportunity to be in the university too. Now is another time to offer all my experience, all my capacity, for all nurses of course and for all health systems that we can provide and of course if I can change something I’m here to work a lot. This is my background.

Lindsey Smith

That’s awesome. Yeah, I love hearing what got you started because I think it gives us all a feel for kind of what pulled you into this really important work in the first place. I liked what you said about being a nurse first, then you get into research, then you start getting involved with the International Council of Nurses, also known as the ICN. And that’s what brings us to where we are today. So for those who may be unfamiliar, can you provide us with an understanding of the International Council of Nurses and what its mission is?

Dr. Cobos

It’s very important to understand our organizations. First of all, in each country we have some association, council, there are a lot of names to define what is the institution that represents the nurses in the country and what the institution that defend not only the position of the nurses and the job or working condition or something like that. I think it’s very important to understand. We defend what is the competencies, what is the job in the hospitals, in the primary care centers. And this institution is very important for us in each country. 

The International Council of Nurses is the institution that wants to be the global voice of nurses around the world. I can explain in front of the governments or the ministers that we can analyze what is the situation of the health system and what is the contribution from the nurses. And this is very important for us. So our first mission is to be the voice of the Nurses and to provide what is the most important things that we can provide for the health systems. 

So we analyze what is the situation, for example, in mental health, in primary care, with chronic diseases, all things that we can analyze and we can provide some policy statements or some documents. Sometimes it’s very technical documents to provide our nurses and our association, what is the situation and what is the things that we can provide in each country. Of course, there are 30 million nurses -- the biggest number of the health professionals in the health systems -- so it’s very important to understand that we have very strong organizations and we have the opportunity to represent at the international level, for example, in front of the WHO or ILO, the UN, so all international organizations that discuss about health, about care, about all providers, in this case with nurses, in the health systems.

Be sure that ICN as organization will be there in all events, all meetings that is necessary to hear. I like to say to listen us, it’s very important this mission for us to provide to all things that is necessary. It’s not only, as I said, to defend the position of the nurses, the mission of each nurses. So this is our first and very important mission in front of all international organizations. 

After we have to provide some services for these National Nursing Associations or in some groups, societies, scientific societies or academia, we analyze every aspect of every topics that we can provide some information. It’s not easy, but we provide for example some standards to unify what is the global vision for the studies for nurses. So for our students is very important to understand that it’s necessary clinical practice and of course what is the topics in the curricula of the universities at the university level and provide not only the first level some opportunity to go to the master level and doctoral level. 

Now it’s very important to understand that nurses are prepared for all things. Leadership, management, research, everything, as every other professional. Doctors, physicians, pharmaceutics, all professions that are in the university is the same for nurses. 

Lindsey Smith

Yeah, that’s a really great explanation of the mission. And I think it really highlights the scale of ICN’s work and really why it matters globally. It’s my understanding that it represents more than 140 national nursing associations, and then you mentioned the 30 million nurses worldwide really giving the profession a unified global voice. So thank you for that explanation.

As I noted in my introduction, you have established a theme of empowerment of nurses during your presidency. Can you tell us what that means to you and how you are trying to put that into practice?

Dr. Cobos

Yeah, I think this word is very important to understand my point of view, because of course you can read a lot of definitions in a dictionary or books, but for us and for me, when I present my candidacy, I said a lot of nurses have a lot of knowledge, a lot of competencies, or lot of things that are capacities. So how can we make sure all this knowledge, all these capacities are provided in the health system because sometimes the health system doesn’t give this opportunity. For a long time, if people were asked, what is a nurse? What does it mean to be a nurse? The answer would be it’s one person, not professional, one person that help doctors to provide medicines or something like that.

It’s true, during a long time we participated as a profession with collaborative areas and competencies, but now we changed something to provide us autonomous activities as other professional with a vision with a multidisciplinary team. So I think we have to use this capacity. If we use this capacity, I said we empower the professional, in this case, nurses. And I suggest three levels of empowerment. 

First of all, is the opportunity to empower our organization ICN in front of the international institutions. So we provide all capacity that we have as an organization to defend, as I explained before, all things that are necessary in front of this institution. 

Secondly, it’s important to strengthen and use the capacity and the empowerment of the national associations.  Sometimes it’s necessary to go with this national organization to the government and to the Ministry of Health, for example, to analyze something. So this capacity from ICN and the National Association Organization, we have to strengthen to provide more influence to provide because our intention is to help the health systems to provide more capacity and of course to provide and have healthy communities and population. 

And finally, the third level is to strengthen and use the capacity from each nurses. So we have to use the empowerment in each. Sometimes it’s not about waiting to see what is the action from the institution. No, what is your capacity and what is your vision as an individual nurse? What can you provide in your health system, in your institution? It’s very important to be proactive. Of course we help you with ongoing training, other things that is important, but it’s necessary that you understand and you believe in yourself that you have the capacity. For a long time, nurses are in the second line at the political level, for example. So we have a lot of capacity now. We have the opportunity to improve this capacity. 

This is an historical situation in ICN because in the past, the immediate past president provided the watchword for the next president. But now we select our own watchword. So for me it’s very important everybody understands what is the meaning when we talk about the empowerment in all levels -- at the high level as an institution, at the national level and with each professional nurse.

Lindsey Smith

I appreciate the way you framed that and walking us through those three different levels there. I want to come back to that third level. You are also calling on nurses to empower themselves. What are some real life examples on how they can do that?

Dr. Cobos

For example we provide some opportunities with some programs to develop nurses as leaders. For example, in ICN, we have a leadership center, and we provide some programs, for example, sometimes in Africa, we have the Odena program. And this is an opportunity where they have the capacity to learn more about leadership. So this is one example that they can provide more things at the leadership level. 

Now we extend, for example, this program in Latin America with the Odena program. We have sponsors for that because it’s very expensive. So we need money for that. And this is one example that they can introduce at the leadership level.

In other levels, for example, if we have the capacity for the primary care centers or mental health or all these capacity, we have some examples. We have an initiative with the BBC and we have some videos and we provide some examples around the world in the clinical practice, in the research area. So there are a lot of examples that you can see in two or three minutes of this video where they can look at some example we invite all students for example or new nurses that some people thinking about what is for example the area where I can work or what is the situation is only in the hospital...no we have other areas and we provide this example because it’s very important to show. 

For example, this morning I had a meeting with the military area and we have nurses in the military area and of course there are sometimes areas that nobody knows about. In the schools, for example, nurses can provide the nutrition, exercise. If we provide this information for children, maybe in the future we’ll have a more healthy society. So there are a lot of examples where we can provide these capacities and these opportunities.

Lindsey Smith

Those sound like some amazing resources that we can direct our listeners to. We can put that information in the show notes following the show. I want to kind of switch gears a little bit and talk about some of the challenges that nursing is facing today globally.

Dr. Cobos

Yeah, the challenges is very interesting. I talk about my background at the beginning and I said I have the opportunity to work with the Spanish Council of nurses and I said, maybe I should go because during a long time I work with the clinical practice and with patients. So when I think, maybe I go to a desk, for example, and I have to think a lot of things. So I think it’s very important people to think what is the future of the health system or the work for nurses in 10 years, 20 years. This is very important. 

So when we have to think about the challenges, for example, about competencies. In the last 20 years, I worked very hard and with a strong position in nursing prescribing, for example. This is very important challenge to implement new competencies in our health systems and the capacity of nursing for that is very important. Our vision is now increasing awareness of chronic diseases, for example. Populations are aging. So maybe we have to change the vision of our providers. During a long time we provide care in acute situations with very important hospitals, this is very important. We invest in technology or something like that. But what about the chronic diseases? It’s necessary to increase this professional that care in chronic diseases and the professional that is expert in that are nurses. It’s very clear for us is very important. 

So the challenges for us is to go to the government and say, please, you have to invest in nurses because a lot of people and a lot of politicians said, you are very important. Your contribution is very important for the health system. I hear every day that words. I think it’s important, but I said thank you so much, but don’t talk more about that. We need actions.

We need 6 million more nurses around the world now if we can provide the health to all people. Now is the time to invest in nurses around the world. But it’s necessary to have money for that, of course. It’s necessary to provide more capacity in the universities and working conditions because I think we have problems, for example, to retain the nurses around the world. This is a global vision. Sometimes there is lot of work, the working conditions are not very good. So if nurses have more or better working conditions, maybe we can retain all people in the jobs.

This week I had the opportunity to see a new movie in the cinema. I don’t know if the audience knows about this film from Switzerland and the protagonist is a nurse during one day in a hospital. The title is Heldin in German, is like a hero. I don’t like very much to talk about nurses as a hero because that’s another thing, but the movie reflects very clearly what is the job in a hospital for a nurse, a lot of things, a lot of pacing for one nurse. So I think it’s very important to analyze and I’m very happy with this film. 

I invite all people in the audience to go to the cinema to see it because I think this is an opportunity to create this environment. What is the nurse now? What is our challenges for the future. Here is a very clear example. 

Of course, we have some other examples to influence, for example, in the leadership area or with some countries in Korea, for example. They haven’t a law or regulation of nurses in the country and with us, with ICN and the national association we influenced in the government and now they approve this nursing law, to have the opportunity to recognize nursing as a profession in the health system.

Other countries, in Malaysia for example, the government wants to increase the number of hours per week for nurses to work and we stopped that initiative because it’s very important. 45 hours for example is incredible because in a lot of countries it’s around 35.

40 in a week is too much, but again is an opportunity. This is the challenges for the future for our profession working conditions.

Of course violence is very important because now we know in some areas of conflict — areas for example in Israel with Gaza and Palestine, in Africa, Sudan or Lebanon — there are a lot of areas at the big level, in global level, we have some war. And this is very important, to protect the health professional.

We wrote a letter to the general secretary of the UN and said, it’s very important because where is the humanity today? If they attack the profession that to provide care is only to save and to provide health to people. It depends on what is the political situation for us.

Everybody can have the opinion but I think for us it’s very important to say that you cannot attack our hospitals because if not, I said again, where is our humanity? I think we have to talk about that with big countries and say this should not be possible. They need to understand we help people independent of the countries or the political situation. 

And there are more challenges for us. In the area of violence sometimes nurses suffer attacks from some patients or their family that are very nervous in emergency areas or elsewhere. I think it’s very important to protect our professionals. 

So in these all topics, we are working a lot. I think it’s important that we provide some agreements into, for example, WHO. With WHO, we work with strategic orientations around the world and all countries in the last WHO assembly approve, again, what is our challenges for the next years and we provide solutions. It’s not only to say all that problems are on the table, yeah but what is the solution that we provide? 

We published 10 very specific policy actions, very clear, very clear to provide to the governments what is the solution that we understand is necessary in our health system. So be sure that ICN is not only saying, we have a lot of problems. Yes, but we have a solution for you. 

Lindsey Smith

I like what you said there at the end that although you have a lot of challenges, you are very solution-oriented as you move forward and work through these different challenges. Shortly after your election, you said that you’d be prodding politicians and policymakers to take action, to live up to their praise of nurses. Can you give us some examples of what you’ve been pushing them to do?

Dr. Cobos

Yeah, I talked about some example before, but at the beginning of September not long after I started as president of ICN, I went to WHO offices and I have a meeting there to say, I am the new president and this is very important for us to be in contact. Of course, our staff, our CEO, Howard Catton is in the office and is very close with them and we have to analyze what is the situation at the health level around the world with WHO.

So I have this meeting very, very, early in my mandate. I wrote to the UN General Secretary to provide our vision because for example, in September, in the assembly of the UN they approved one very important policy statement about the chronic diseases -- hypertension, diabetes, cardiovascular diseases. They provided a lot of information and all countries approved this policy statement. But curiously, we analyze and there not any comments or any actions with professionals.

So they talk for example for some problems for cancer or something like that. It’s necessary to forbid smoking or to increase the tax for cigarettes or for forbidding drugs or something like that, but nothing about what is the role of the professionals in this area. So I write that it’s necessary to change a little bit.

I had some meetings, for example, with the Minister of Health in Spain. I talked because she’s a member of the board of the directors in the WHO as representative of Europe. So I talk with her that it’s important to increase the investment in health professionals. So I think we need these actions. It’s not only to say, yeah, we have this paper but what is the solutions in the real clinical practice?

If we said we don’t have enough professionals, we have to invest in the universities to provide new students, new providers. And after we have to provide well-being and working conditions very well for them to retain them.

For example, with ILO, we have a convention, it’s 149 convention, it’s a document that not all countries approve and support where in this document we provide some solutions to provide good working conditions so I had a meeting with ILO to influence and to insist that is important maybe to have an actualization in this convention document. This is very important for me and for ICN in this moment.

Lindsey Smith

Yeah, you’re so right. Action is so important here. And I think we’re all really excited to see what else you will do, in your presidency to come. I want to talk a little bit, about Osmosis from Elsevier. We are a teaching company and we love to fill knowledge gaps. Is there a topic you think osmosis should make a video about to fill a gap that is of particular concern or interest to you?

Dr. Cobos

Of course, the education is very important. In this strategic plan, we have a chapter very specific for education. We understand unifying the curricula around the world is very important. It’s not only in the university at the first level, because after, our students, study all during all life. For all of us, we need ongoing training and continuing education. 

There are a lot of providers like you that can provide very clinical education for some diseases or something like that. But in general, I think there are three levels that are very important: research, management and leadership. For me, I understand there is a gap because research during a long time is not an area that is specific for nurses — maybe physicians, biologists and other professionals — but not for nursing. Now we have the capacity to earn a masters and achieve at the doctoral level. So research is very important. 

The other thing is management. For example, I’m very happy because last week in Peru, the government approved and decided that one nurse should be named as a general director in a hospital. It’s the first time in Peru. There are a lot of examples in USA, in Spain, or other countries but in Peru is the first time that one has to go to this position as general director in a hospital. I think we are very proud of that because this is an example that we have the capacity, so please it’s necessary the providers have this area that is not very usual to provide for nurses at the management level.

And the other thing is leadership. And I said before, we need some nurses in the government, maybe as a prime minister. In some countries we have some examples. In New Zealand we had the opportunity to have one first minister or minister of health as a nurse. In Spain, not at the central government, but in the region, we have some nurses as regional ministers. Of course, first of all, they have to believe that they can do it. But we have to provide the education and the ongoing training in leadership. We have global programs in our center, in our leadership center.

 

So, I provide you some ideas and some examples that you can explore a little bit more because sometimes we focus on diabetes, diseases or something like that. It’s important, of course, it’s important, but maybe more other topics that are more across the opportunity in the health system is important. So I provide you this three examples.

Lindsey Smith

Those are fantastic ideas and exactly the kind of topics that could make a real difference for our learners. So we will take that back to the content team for consideration. And I think it ties in really nicely to what you were saying earlier about empowerment for those nurses. 

We do have many students and early career health professionals in our audience and I wanted to ask you, what is your advice to them about meeting the challenges of this moment and approaching their career in health care?

Dr. Cobos

I want to say to our students, maybe you choose this studies or maybe you don’t know nothing about what is a nurse, but you are maybe in the university for three or four years, in some areas for five years, and you discover, what’s a nurse, what is our job in a health system. When you take the hand of our patient, I think you charge yourself with what is the capacity that you have to provide health. I think this is beautiful. This is the most important thing for us, how we can provide health to you, to the patient.

So, this is the passion for me because this is my experience too. I had the opportunity to be a doctor in the university, but I said, no, I select nursing studies because I believe that we are very close to the patient and we provide other things that is care for the population and the patient. 

And be assured that you have a lot of institutions to help you and our challenge is to provide one voice in front of the health systems in the government in all areas that is possible. We defend you. We provide you standards and we believe you are prepared for all things that is necessary now in the health systems.

Please believe your job is necessary. So sometimes you may believe I have to leave my profession. Of course it’s not easy. Sometimes we have hard moments. Very, very, very hard. But believe that you have the capacity. You are prepared for that. 

Of course, explore a lot of things. Open your mind. Open your eyes around the world. But be careful. Some students are maybe in some areas in India, in Africa and say our working conditions are very bad and I want to leave. The immigration now is a problem. I haven’t enough time for all topics, but this is very important that maybe sometimes some people or some students need to go other countries. If it’s for an experience, or it’s for increasing your knowledge, of course, go to another country and have this opportunity. 

But remember, what is your country, where is your society, your communities? You have to return. Come back to your country because sometimes they provide you with a lot of money in the universities. You have this capacity to learn. So please believe that we have to be in the future, very important and as a real backbone in the health systems.

Lindsey Smith

Thank you so much for that advice. There were so many nuggets in there to pull out, but nursing really is the backbone in our healthcare systems and I know our audience will really appreciate hearing that from someone with your experience.

Dr. Cobos

I want to mention there are two very important . This year in Tennessee, we have the Advanced Practice Network there. We have a very important conference there in Nashville. So I invite all the audience to go. And of course, our International Congress in Taipei in 2026 in July. So I invite all the audience to go there because it’s a very important opportunity to share with all nurses around the world. It’s around 10,000 nurses in the International Congress. So please take in account these opportunities.

Lindsey Smith

For sure, those are two great events to get on your radar. Before we wrap up today’s episode, is there anything we didn’t cover that maybe we should have?

Dr. Cobos

I think it’s very interesting. Thank you. Thank you so much for your questions because you drive very well this interview to talk about everything. Of course, most important thing is our challenges and the shortages around the world is a very important topic for us. But be sure, ICN is your institution that represents you and represents your voice.

I talk with every institution, I talk with every minister, all that is necessary. We know that it’s necessary to see action and so we’ll be there where it’s necessary. So I think we have very good time to provide more things forx nurses around the world.

Lindsey Smith

You once said nursing must be at the heart of the solution and I couldn’t agree more with that statement. That brings us to the end of today’s conversation. Thank you again, Dr. Cobos for sharing your time and vision with us.

Dr. Cobos

Thank you so much.

Lindsey

That brings us to the end of today’s conversation. It’s one thing to call nurses the backbone of our health system, but as Dr. Cobos reminded us, it’s another thing entirely to act on that belief. His commitment to pushing policymakers, elevating the nursing profession, and strengthening support for the global workforce is both urgent and inspiring.

With decades of experience as a clinician, researcher, and leader in Spain’s nursing community, Dr. Cabos brings a perspective that’s grounded in real practice and informed by global collaboration. Hearing his insights on what nurses need now and what it will take to build a stronger, more equitable healthcare system has been invaluable.

I’m Lindsey Smith. Thanks for checking out today’s show. Remember to do your part to raise the line and strengthen the health care system. We’re all in this together.