A NEW report from the International Council of Nurses calls for a global action plan to address the ‘nursing workforce crisis and prevent an avoidable healthcare disaster’.
The report, published on Monday, reveals how the Covid-19 pandemic has made the fragile state of the global nursing workforce much worse, putting the World Health Organisation’s (WHO) aim of Universal Health Coverage at serious risk.
It suggests up to 13 million more nurses will be required over the next decade, the equivalent of almost half of the world’s current 28 million-strong workforce.
International Council of Nurses (ICN) Chief Executive Officer Howard Catton, who co-authored the report, said the findings underline the severity of the shortages:
‘We knew the situation was fragile because of the persistent historical underfunding of nursing around the world,’ he said adding: ‘But with the latest information about nurse vacancies, their rates of intention to leave, and staff sickness rates, it must now be recognised as a global crisis.
‘We already had a shortage of six million nurses at the start of the pandemic, but with the immense and relentless pressure of responding to Covid and the Omicron variant, and an avalanche of resignations and retirements anticipated, the world will need to recruit and retain up to 13 million nurses over the next decade.
‘The WHO’s International Year of the Nurse and Midwife in 2020 and last year’s International Year of the Health Care Worker were an important starting point in recognising the true value of nurses and other health workers, but it simply was not enough.
‘This is a global health crisis, and it requires a fully funded and actionable ten-year plan to support and strengthen nurses and the health and care workforce to deliver health for all.’
The report, published by the International Centre for Nurse Migration in partnership with CGFNS and ICN, provides a blueprint for what needs to be done at the national and international level to guide nursing workforce planning globally.
It says countries should commit to prioritising nurses for vaccinations, provide safe staffing levels, expand their domestic nurse education systems, increase the attractiveness of nursing careers for women and men, adhere to ethical international recruitment standards, and monitor countries’ ability to be self-sufficient to meet their nursing workforce requirements.
The report’s Key Point Summary states:
- The global nursing workforce was estimated in 2019-20 as being 27.9 million nurses.
- Prior to the pandemic, the global shortage of nurses was estimated at 5.9 million nurses, nearly all these shortages were concentrated in low- and lower middle-income countries.
- The pandemic has exacerbated the existing nurse supply shortfall and has forced rapid and “emergency” policy responses to try to increase nurse supply, at the system level, in all countries.
- There is a growing evidence base on pandemic impact, both on the personal level (stress, workload, infection risks, demands made of nurses to “cope” and be “resilient”, and concern about “moral injury”) and on the implications of the system responses (re-deployment, new responsibilities, access to PPE, etc.).
- The pre-pandemic shortage of nurses has been exacerbated by the impact of the pandemic. Burnt out nurses are leaving employment or taking absence.
- If only an additional 4% of the global nursing workforce were to leave as a result of pandemic impact, then the outflow would be more than one million; this would push the global nurse shortage estimate up to seven million.
- Each health system and country should conduct periodic nursing workforce impact assessments to provide alerts to pandemic-related damage being done at the level of individual nurses, the overall nursing workforce, and health care systems.’
In a section dealing with ‘the profile of the global nursing workforce’ the report explains:
‘The brief builds on recent assessments of the pressures on the global nursing workforce, and is framed by global initiatives, including the report on the “State of the World’s Nursing” (SOWN), the global “Nursing Now” initiative, and the recently agreed global Strategic Directions for Nursing and Midwifery (SDNM).
A key message that has emerged from these initiatives is that, without effective co-ordinated action, the current global shortages of nurses will constrain many countries from achieving Universal Health Coverage (UHC), and is already undermining the effectiveness of responses to the Covid-19 pandemic.
In 2020, the SOWN report was published.20 It was the first global picture of the nursing workforce and presented the global pre-pandemic profile of the nursing workforce. It highlighted significant but varying nurse shortages across the world, which meant that most countries already had nurse supply gaps and faced Covid-19 with an inadequate nursing workforce.
The SOWN report essentially describes the pre-Covid-19 world, using data up to 2019, and is therefore a useful starting point and benchmark for assessment of how the pandemic has impacted the nurse workforce:
- The global nursing workforce was estimated at 27.9 million nurses; nine out of every ten nurses worldwide is female.
- The global shortage of nurses was estimated at 5.9 million nurses.
- Nearly all (89%) of these shortages were concentrated in low- and lower middle-income countries.
- High-income countries had more than three times the nurse graduation rate (38.7 graduate nurses per 100,000 population on average) as did low-income countries
- One out of six of the world’s nurses was expected to retire in the next 10 years, meaning that 4.7 million new nurses would have to be educated and employed just to replace those who retire; higher rates would be evident in some high-income countries.
- One in every eight nurses practised in a country other than the one where they were born or trained.
In essence, the pre-pandemic world was already short of almost six million nurses, reported huge shortages in some regions, had a growing replacement challenge driven by poor retention and by ageing and retirement of the workforce, and was witnessing a growth in international mobility of nurses.
In some countries, there was the added problem of nurse unemployment existing alongside nursing shortages – with countries and health systems reporting nurse shortages but not being able to employ existing nurses because of limited resources or relatively poor pay and career prospects in nurse employment.
Then, in 2020, the Covid-19 pandemic erupted, and spread across the globe. It has had an unprecedented effect on nursing – driving up demand for nurses, who are the critical “front line” health professionals, whilst at the same time cutting across nurse supply: causing death, infection, increased absence and increased leaving rates.
It has had a multiplier effect, exacerbating the shortage factors that had already created a global nurse-supply gap before the pandemic, whilst adding huge new pressures at the level of the individual nurse and the health system.’
CGFNS International Inc. President and Chief Executive Officer Dr Franklin A Shaffer, another co-author of the report, added: ‘We can anticipate that there will be a migration tsunami as more than ever before, countries around the world turn to the international nursing supply to meet their workforce needs.
‘The pre-existing unequal distribution of nurses around the world will be exacerbated by large-scale international recruitment to high-income countries as they look for a “quick fix” solution to solving their nursing shortages, which will only widen inequalities in access to healthcare globally.’
Lead author of the report, Professor James Buchan of the University of Technology Sydney, (UTS) and the University of Edinburgh, said:
‘Covid-19 has had a terrible impact on the nursing workforce in terms of the personal effect it has had on individual nurses, and the problems it has exposed within many healthcare systems.
‘Pre-existing shortages exacerbated the impact of the pandemic and burned-out nurses are leaving because they cannot carry on any longer.
‘Governments have not reacted effectively to the growing worldwide shortage of nurses, and now they must respond to the pandemic, which is an alarming game-changer that requires immediate action.’
The report says a long-term plan is needed to stem the tide of those leaving nursing because of the additional stresses resulting from Covid-19, and to create a new generation of nurses to grow the profession to meet increased future demands of an ageing global population.
ICN President Pamela Cipriano said: ‘Nurses have been on the front lines of the pandemic for two years now.
‘The influence they have had on the survival and health of the people they serve has been enormous. Despite enduring heavy emotional and physical burdens of providing care for their patients and communities, they have shown great resilience. But resiliency has its limits.
‘Without nurses, it is clear our health systems would collapse. All of the evidence in this report shows that it is vital to act on a new ten-year plan that guarantees investments to stabilise and build the nursing workforce.
‘Delivering on commitments to support nurses with safe work environments, staffing levels and workloads, involvement in decision-making, mental health services and equitable compensation will catalyse interest and growth to build the profession.
‘Nurses deserve to be recognised and rewarded for their immeasurable contributions to the health of people everywhere.’
Catton added: ‘We can no longer afford to undervalue and underfund the nursing profession, not only for the sake of the health of nurses, but for the protection and sustainability of our entire global health system.
‘Let’s be clear: we are not talking about stop-gap solutions, getting through the current pandemic, or even preparing for the next. We are talking about being able to address all the healthcare needs that have built up and been delayed since the onset of the pandemic.
‘If we do not address all these present and urgent needs in a sustainable way over the next decade, the WHO’s ambition of Universal Health Coverage will be thwarted.’
According to Dr Shaffer: ‘Ethical and properly monitored international migration will always provide individual nurses with an opportunity to develop their careers and follow their dreams.
‘But as this report shows, governments must act quickly to ensure that people everywhere have access to nursing expertise whenever they need it.
‘CGFNS and the ICNM can help governments to ensure that international recruitment is ethical and that both the recruiting countries and the nurses involved can benefit from the process.’