ICN report says shortage of nurses is a global health emergency

A new report from the International Council of Nurses (ICN) says the worldwide shortage of nurses should be treated as a global health emergency. It says health systems around the world will only start to recover from the effects of the pandemic and be rebuilt when there is sufficient investment in a well-supported global nursing workforce.

The report, Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, co-authored by Professor James Buchan and ICN Chief Executive Officer Howard Catton, builds on the analysis in ICN’s Sustain and Retain report, published last year, which highlighted the terrible impact the pandemic has had on individual nurses and the global nursing workforce.

Recover to Rebuild cites more than 100 studies which show 40% to 80% of nurses reporting having experienced symptoms of psychological distress, nurses’ intention to leave rates having risen to 20% or more and annual hospital turnover rates increasing to 10% and even more.

The report recounts the vital and often dangerous role nurses played during the pandemic and provides evidence from studies of nurses in Australia, Belgium, Canada, Czech Republic, Germany, Ghana, India, Iran, Ireland, Jordan, Malaysia, Mexico, The Netherlands, Norway, The Philippines, Poland, Republic of Korea, Romania, South Africa, Spain, Sweden, United Arab Emirates, The United Kingdom, The United States of America and others. This evidence shows how the COVID Effect has compounded our already fragile health systems and the unequivocal need for substantial and sustained investment.

ICN President Pamela Cipriano said: “Our report substantiates what we have been saying since the start of the pandemic: nurses were on the front lines, and often on the firing line, and it has taken its toll. Nurses are the professionals who can lead us out of this post-pandemic slump in healthcare, but they can only do that if there are enough of them, if they are properly supported and paid, and if the fragile health systems they work in are rejuvenated with large investments from governments everywhere.

‘Health systems are struggling everywhere under the strain of securing a sufficient workforce, and leaders know that the workforce is key to solving the healthcare crisis. We have laid out in our report what is needed, but only government leaders can make it happen. The investments politicians make in the nursing workforce and the health systems they work in will help to bring Universal Health Coverage within reach and repay dividends for people for decades to come. But the clock is ticking. It’s time to stop ignoring the solutions and take decisive action now. Nurses are the essential life force for building healthier communities, which leads to healthy workers, health security and economic security.”

The report says the stress, burnout, absences from work and strikes affecting the nursing workforce are symptoms of the current perilous state of healthcare, and that they must be addressed urgently if nurses are to successfully take on their central role in the recovery of health systems globally.

It goes on to say that relying on individual nurses’ resilience is not an option, and that governments must take responsibility and make amends for their inadequate planning and policy responses, which have created a chronic worldwide nursing shortage.

Many countries have not invested sufficiently in educating adequate numbers of nurses to meet their populations’ needs, the report says, leading to overwork and additional burdens for their existing staff, and reliance on the quick fix of harmful and unsustainable international recruitment by wealthier nations.

Countries that have a long tradition of educating nurses ‘for export’ are now also experiencing problems, with India now seeing a big increase in demand for nurses domestically, and the Philippines, where the government has now acknowledged a shortage of up to 350,000 nurses, originally identified by the Philippine Nurses Association.

Howard Catton said: “The worldwide shortage of nurses needs to be considered as a global health emergency and recovery from the current situation must to be a priority for governments everywhere.

‘Last year, we provided evidence of the immense toll the pandemic has taken on the wellbeing of nurses, and our latest evidence shows that it is not only continuing to have a damaging effect, but its impact is getting worse. Many nurses are leaving the profession, and those who remain are so concerned about the after-effects of the pandemic on patient safety and the wellbeing of colleagues, that they are left with no choice but to take industrial action and even outright strikes.

‘All of this is happening at a time when there is a huge backlog of untreated health needs, growth in health demands and a great ambition globally to deliver health for all. The recovery of the nursing workforce is an essential prerequisite to rebuilding our health systems, and to think otherwise is a fantasy. And without a sustainable, properly distributed global nursing workforce, the realisation of the goal of health for all will only ever be a pipe dream.

James Buchan, who is Adjunct Professor at the University of Technology, Sydney, Australia, said:

“The current situation is a direct result of a lack of action and the absence of a long-term vision and a plan for the global nursing workforce. The nursing workforce has been severely damaged by the traumas of the pandemic, and the need to rebuild our health services is an additional burden they are now carrying.

‘Without sufficient numbers of nurses who are well-motivated, educated and supported, the global health system will not be rebuilt. We need to see co-ordinated policy responses, both within countries and internationally, that will protect and support the global nursing workforce so that they can be effective in their vital role of rebuilding our health systems.”

The report says the remedy for the current situation is for governments to take urgent action, and plan more effectively for the future. Among the immediate actions required are updating the World Health Organization/ICN 2020 State of the World’s Nursing Report, undertaking assessments of the impact of governments’ policies on the nursing workforce, commitments to support early access to full vaccination programmes for all nurses, and the proper implementation of safe staffing levels.

There should also be plans put in place to review and, if necessary, expand the capacity of domestic nurse education systems, monitor each country’s self-sufficiency in producing its own nurses, invest in the recruitment and retention of nurses, and improve nurses’ career development opportunities.

In addition, there should be an agreement to implement and evaluate effective and ethical approaches to the managed international supply of nurses, and a commitment to investing in nursing workforce sustainability in small states, lower income states and fragile states, which were most heavily impacted by the pandemic and are most at risk of losing their nurses to international recruitment.

Download the press release here