Global nurse leaders warn scale of critical challenges facing nursing is a global health emergency

1 March 2024
IWFF 2024

The International Council of Nurses (ICN), in partnership with the Joint Virtual Swedish Nurse Organisation, held the International Workforce Forum (IWF) in Stockholm, Sweden this week. The IWF brought together more than a dozen leading National Nurses Associations (NNAs), representing millions of nurses, with high level members of the World Health Organization (WHO), and Sweden’s Ministry of Health.

Nursing organizations from Europe, North America and Australia, attending the Forum, said there was a core group of critical challenges facing the nursing workforce. These profound challenges led them to reaffirm a call made by ICN more than a year ago that we are experiencing a global health emergency.

They highlighted a wide range of concerns detrimentally affecting nurses’ working environments and consequently creating major risks to public’s health. These issues included international migration, recruitment and retention, workload, safe staffing levels, violence, and burnout.

ICN President Dr Pamela Cipriano who opened the proceedings, addressed the issue of the deteriorating work environment:

“We saw the serious and sometimes deadly challenges that our nurses went through during the pandemic, but as we fast approach the third anniversary of WHO declaring the pandemic on 11 March, we find that nurses are still being profoundly affected in their daily work by shortages that undermine safe staffing, lack of fair pay, poor conditions and violence in the workplace, all of which were exacerbated by the pandemic and its aftershocks.

‘Together we have a responsibility to address these multiple challenges and shift nursing from being invisible to being seen as invaluable and that means ICN will continue to lead and fight for improvements in the nursing working environment.

‘We are also calling for a policy shift from a focus on supporting individual nurse resilience to ensuring that all health care systems - providers and employers - meet their duty of care to ensure that nurses are fully supported and can work in safety to provide effective care to their patients. Nurses are some of the most resilient workers in the world, but they should not be expected to do their vital work in isolation, without support.

Sweden’s Minister for Healthcare, Acko Ankarberg Johansson, attended the Forum and echoed Dr Cipriano’s words, telling participants of her personal commitment to improve the working environment and conditions of nurses, and underlining their key role as leaders in the health care system.

Sineva Ribeiro, President of JSNO and President of Vardforbundet, and Dr Oili Dahl, Vice President of JSNO and President of the Swedish Society of Nursing said:

“JSNO appeals to responsible ministers and employers to work towards Sweden becoming self-sufficient in registered nurses and frame a national plan for safe staffing. We also urge employers to respect the profession's requirements for development, training, and working conditions.”

Nursing organization leaders agreed there was a crucial need for countries to implement a package of policy solutions, with a focus on urgent priorities as well as long term improvements to recruitment policy and domestic production and retention of nurses.

Many of the nursing organizations present at the Forum were from countries at the forefront of international recruitment, heavily reliant on nurse migration, despite being amongst the richest countries in the world. They were deeply concerned about the impact of increasing global recruitment activity and the damage and potential danger to the source countries’ health systems.

In response, ICN Chief Executive Officer Howard Catton said:

“The picture our NNAs have painted at the Forum is that crisis in nursing amounts to full scale global health emergency. Governments must not close their eyes to these warnings but act.

‘We have heard directly from our NNAs about their very deep levels of concern about over reliance on migration. They strongly support the right of individual nurses to move across borders to improve their careers and their lives, but equally they are highlighting the risks of growing large scale nurse migration.

‘ICN has called for strengthening of the WHO’s voluntary code on international migration and the need to see tangible mutual benefits for the nursing workforce from the source countries. The current system is unsustainable and is causing real harm in countries that are losing their nurses through emigration. We want to see strengthening to the code that brings mutual benefit to nurses and health systems in all countries that import and export nurses internationally.

‘In addition, ICN is calling for the WHO Pandemic Accord, currently being finalized, to strengthen its language on workforce, especially in relation to the WHO’s voluntary code on international migration and widening inequalities.”

Mr Catton said the Pandemic Accord should also address the lack of accurate data on nurse infections and deaths during any future pandemics.

“The lack of accurate data on nurse infections and deaths during the COVID-19 pandemic and since is unacceptable: it is vital that all countries collect such data because it will help to ensure that nursing staff are fully protected during pandemics and other health emergencies and honour the sacrifice of nurses who lost their lives.”

Mr Catton also said that health workers, and especially nurses, should be represented in any governance arrangements that will be established to monitor the Pandemic Accord.

Senior representatives from WHO attending the IWF shared early information about the next State of the World’s Nursing (SOWN) report, which is due to be published in 2025. They discussed the plan for data collection. It was agreed that NNAs have an essential and critical role to play in ensuring the integrity of the country data to be used to develop the SOWN report.

The full International Workforce Forum Communique will be on the ICN website shortly. NNAs attending the IWF:

  • Australian College of Nursing
  • Österreichischer Gesundheits- und Krankenpflegeverband (Austria)
  • Canadian Nurses Association
  • Canadian Federation of Nurses Unions
  • Finnish Nurses Association
  • Icelandic Nurses Association
  • Irish Nurses and Midwives Organisation
  • Consociazione Nazionale Associazioni Infermieri (Italy)
  • Japanese Nursing Association
  • Norwegian Nurses Organisation
  • Joint Virtual Swedish Nurse Organisation
  • Royal College of Nursing (UK)
  • American Nurses Association

CGFNS International also attended the meeting as an observer.