Is global nursing prepared for future challenges and opportunities?

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Is global nursing prepared for future challenges and opportunities?

December 3, 2024

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The inaugural State of the World's Nursing Report was released in 2020, just as the world faced the challenges of a pandemic. The data for this report was sourced from the years 2016, 2017, and 2018, prior to the pandemic, which significantly affected the global nursing profession.

Dr Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO), announced plans for a second State of the World’s Nursing Report, set to be published in 2025. All countries are expected to submit data on their nursing workforce to the WHO, with the aim of launching the report in April next year. This report will be presented at the World Health Assembly in May, where discussions will take place regarding the next global nursing strategy. Howard Catton (pix), CEO of the International Council of Nurses (ICN), emphasized the importance of this data as it will inform the upcoming strategy.

Howard provided this update during the 22nd Asia Workforce Forum (AWFF) and the 18th Alliance of Asian Nurses Associations (AANA) meeting, hosted by the Malaysian Nurses Association (MNA) and ICN from November 20-22.

He added that revisions and an extension of the current nursing strategy are anticipated for the next four years, which will be further discussed at the upcoming ICN congress in Helsinki.

Illustration 1: Global distribution of nurses from the State of the World's Nursing Report 2020.

Unequal access: The stark disparities in global nurse distribution
The State of the World's Nursing Report 2020 illustrates the global distribution of nurses (see illustration 1 above), highlighting an estimated shortage of six million nurses worldwide. Despite this known shortage, there is a stark inequality in nurse distribution. Areas marked in red indicate regions with fewer nurses per capita, showcasing a significant disparity—from over 90 to more than 100 nurses per 10,000 population in some areas, compared to those with less than 20.

Furthermore, there are notable differences in nurse production across various regions. While the data may not encompass every aspect, it underscores the vast variation, with some areas having fewer than 20 nurses per 10,000 population, while others exceed 100.

Research conducted by the Career Nurses Association has revealed that factors such as nursing salaries and education costs have led to a substantial decrease in the number of nurses. This highlights the critical impact of these variables on the overall population of registered nurses.

NHS graph: Illustrating the rise of qualified nurses and support staff in healthcare roles.

The surge of nursing support staff outpaces qualified nurses
Governments may have an incentive to unify all nurses in efforts to enhance healthcare outcomes. By educating nurses and nurturing future generations, they aim to strengthen the workforce. A graph from the National Health Service (NHS) in England illustrates the substitution of various healthcare roles, showing a notable increase in both qualified nurses and nursing support staff. While the growth of qualified nurses is commendable, the rise in nursing support staff has been even more significant. When combined, these numbers present an impressive picture of overall growth in the nursing sector.

This highlights the necessity of clearly defining the role of support staff, whose primary function is to assist nurses in delivering care. Evidence suggests that a well-trained and skilled nursing team is crucial for maintaining patient safety and the quality of care.

Professional nurses often transition into roles as associate professional nurses. However, those who have received education and training may not remain in their positions for the next two years, especially in regions where there is a stark contrast in the ratio of professional to associate professional nurses.

A presentation by the British Medical Association emphasized the imbalance between supply and demand in the nursing workforce. Currently, growth is evident, but addressing this disparity in policy and strategy over the coming years is essential.

The issue of supply and demand encompasses various factors, including stock levels, substitution, and migration. Migration has historically influenced workforce dynamics, but recent trends show a decline. High-income countries, which should have been exploring substitution strategies, have repeatedly faced the negative consequences of global migration patterns.

Using nursing workforce development to strengthen economies
Some countries have intentionally educated nurses to bolster their economic stability and support local industries.

“I visited Peru last week and saw an exhibit in a museum detailing how children and nurses were encouraged to migrate to Germany in the 1970s as part of a career-building initiative. Although it may not seem significant now, the museum highlighted that these individuals sent back up to $150,000 to the Korean economy during that time. This illustrates the substantial impact nurses can have on economic growth. While there were many registered nurses in practice, the risk to patient safety was reportedly higher compared to other professions operating in Spain versus France,” Howard shared.

Recognizing the essential contributions of nurses
When prioritizing care delivery, it inevitably results in some missed services, which should not be blamed on individual nurses. Such decisions often come from the wrong department, affecting the time available for patient care, public education, prevention, and advice. Nurses also need time for care conferences and professional development. In critical situations, prioritizing interventions is essential, and this requires meaningful conversations about improving public health and prevention strategies.

"We need to enhance public perception and understanding of the vital work nurses perform. Currently, there is a demand for nurses, and the pace of work is insufficient. This is partly due to inefficiencies, leading to increased risks that must be addressed," he said.

Why nurse staffing matters
Patient safety: Inadequate nurse staffing can lead to higher rates of hospital-acquired infections, more falls, increased medication errors, poorer patient experiences, “failure to rescue,” missed care, and elevated patient mortality rates.

Nurse safety: Proper staffing results in lower stress levels, reduced illness rates, decreased absenteeism, improved morale, better retention rates, and lower burnout rates.

The importance of maintaining an adequate number of nurses is clear, as it directly correlates with the quality of care provided and overall patient outcomes, including life expectancy.

To boost capacity, various short-term solutions are available, including international migration and establishing new targets for community health workers. However, safety warnings are becoming increasingly urgent, and we must acknowledge past practices to develop effective solutions.

What needs to be done
We should outline clear recommendations and publish a practical guide detailing ten steps that many researchers often overlook. Providing the necessary evidence is crucial. Governments need to assess their own recommendations alongside those from other organizations.

The demand for healthcare is outpacing supply, with insufficient funding allocated to primary health care, as well as public and mental health initiatives. There is a concerning trend of aged and long-term care becoming nursing-free zones. While boosting capacity through skill mix dilution and international recruitment is one approach, glaring safety and quality issues are being ignored. We must also recognize advanced nursing practices and nurse-led models as critical solutions that deserve greater support.