Nurses face an overlooked structural barrier in modern health systems, according to a paper published in the open-access journal CABI One Health. The study argues that while nursing professionals perform crucial frontline work across human, animal, and environmental health, their lack of explicit recognition in “One Health” governance leaves clinical systems vulnerable during infectious disease outbreaks.
In Plain English: The Clinical Takeaway
- One Health Framework: A collaborative, multi-sectoral approach connecting human medicine, veterinary science, and environmental management to optimize global health outcomes.
- Zoonotic Pathogens: Infectious diseases that naturally jump from vertebrate animals to humans, representing a primary driver of modern epidemic risks.
- Systemic Governance: Institutional decision-making bodies that allocate funding, shape clinical policy, and direct public health resources during health crises.
The Scope of Invisible Frontline Labor in Zoonotic Surveillance
Lead author Professor Paulo Ferrinho of the Universidade Nova de Lisboa points out that the nursing profession already practices core principles of the One Health movement. Clinicians operate across complex environments, managing patient care, community health outreach, infection prevention protocols, and emergency triage. Yet, because these varied responsibilities are rarely formally categorized under the One Health umbrella, nurses are routinely excluded from strategic policy discussions, academic curricula, and governing boards.
This institutional oversight carries severe operational consequences when novel pathogens emerge. During fast-moving infectious disease events, nursing personnel act as the primary biological defense layer. Without formal representation in preparatory governance, health authorities miss critical operational feedback from the bedside.
| Outbreak Event | Affected Region | Total Infections | Health Worker Fatality Rate |
|---|---|---|---|
| 2014-2016 Ebola Epidemic | West Africa (Guinea, Liberia, Sierra Leone) | More than 28,600 total (815 confirmed/probable health workers) | Two-thirds of health workers with known outcomes |
Linking Sanitary Management to Environmental Conditions
The operational link between nursing administration and environmental safety is not entirely novel. Professor Ferrinho connects modern One Health objectives to Florence Nightingale, whose sanitary management during cholera outbreaks in the Crimean War recognized that individual patient survival depends directly on wider environmental conditions, housing quality, and waste management.
Modern clinical reality demonstrates that this environmental and infectious exposure exacts a heavy toll. During the 2014–2016 Ebola virus epidemic in West Africa, a World Health Organization analysis cataloged 815 confirmed and probable infections among medical personnel in Guinea, Liberia, and Sierra Leone by March 2015. Among those specific cases with a known clinical outcome, two-thirds resulted in patient mortality. These grim metrics illustrate the immense personal hazards frontline nurses face, reinforcing why their specialized knowledge must be integrated into regional surveillance protocols before the next pathogen crosses the species barrier.
Redesigning Nursing Education for International Health Security
To bridge this structural gap, the research paper calls for a fundamental redesign of nursing education programs. Academic institutions must incorporate explicit modules covering zoonotic spillover mechanics, environmental determinants of health, antimicrobial resistance profiles, and climate-induced epidemiological shifts. Elevating nurses from bedside executors to policy-shaping leaders will fortify international health security against future systemic shocks.
References
- Ferrinho, R., et al. (2026). Critical reflections on the positioning of nurses in relation to One Health: Scope, barriers, and opportunities. CABI One Health. DOI: 10.1079/cabionehealth.2026.0031.
