The International Council of Nurses (ICN) has participated in the World Health Organization’s (WHO) 5th Global Forum on Human Resources for Health this week and made a number of interventions on the challenges facing the global health workforce. ICN President Pamela Cipriano, ICN 2nd Vice President Karen Bjoro and ICN CEO Howard Catton all actively participated in sessions across the four days on a wide range of issues. Dr Cipriano led a session on the health workforce response during COVID-19, assessing the impacts, challenges and opportunities.
At one of the closing sessions Mr Catton was invited to join a roundtable of 40 leaders including ministers, heads of financing institutions and health worker organisations with a focus on advocating for investment in the health workforce. Recognising that now was a critical moment for health system investment in the post-COVID era, Mr Catton was asked to set out the importance of investment and strengthening health systems from a nursing perspective.
Mr Catton said he was optimistic about finding solutions to the global health agenda, which includes the ageing population, noncommunicable diseases, health promotion and prevention, because all those issues are ones that nurses can and do tackle every day.
“There are more than 28 million nurses around the world who are currently working on these issues, but nurses are also creating solutions and new approaches, new models of care, and advanced and specialist practice that are really making a difference to people’s lives. The problem is we are not integrating, embedding and aligning those innovative nurse-led approaches to be part of the mainstream of health care systems.
We know that not enough nurses are being trained right around the world, but we also need to fund post-graduate advanced nursing courses to support nurses in developing their roles, to have attractive career structures that will create the pipeline of specialist nurses who will help to address the health challenges the world faces. We need to align the planning and development of nursing roles, nursing education and how we fund service models to maximise the impact that nursing can have.”
Mr Catton spoke about the need for all countries to aim to be self-sufficient in producing the number of nurses that they need to meet their populations’ needs. He said it was “bitterly ironic” that the countries that recruit the most international migrant nurses to their shores are the same countries that have some of the best health education systems in the world. He asked why those countries could not come together to provide education for enough nurses to meet the world’s needs.
“The mutual benefits that we hear about concerning international migration are hard to determine: a scheme that would see ‘donor’ countries benefiting from having their nurses educated by the education systems of the main recruiter countries would be real and tangible example of the mutual benefits that we hear about.”
Mr Catton said one of the reasons that the training and education of nurses is not aligned with the needs of countries is because there are not enough nurses in senior positions where they can influence national health care policymaking.
“It is not just that many countries do not have a government level Chief Nursing Officer: it’s about having nurse leaders in key positions at all levels in health care organisations. If they are not there, policymakers are not going to hear about nursing evidence or receive nursing advice that could prove crucial to aligning services to patient needs and improvements in health care everywhere.”
Mr Catton spoke about ICN’s monitoring of the effects of the pandemic on nurses, including in the recent Recover to Rebuild report, which highlighted the toll the pandemic has taken on individual nurses and the profession as a whole.
He said he was sceptical that the WHO’s projection that the health care workforce shortage would be ten million by 2030 since ICN’s research suggested the global nursing shortage alone could be as large as 12 or 13 million.
"We had a six-million shortage of nurses before the pandemic, we know that we have nearly five million nurses who are due to retire in the next few years, as well as the COVID effect, we know from our report that we have growing leaver rates and intention to leave rates. That is why I am cautious about saying that the shortage gap is going to reduce to ten million, because I don’t see a trend like that with nursing. The hard facts are that the supply and demand gap for nurses is increasing, and we are not seeing any significant increases in the education of nurses around the world.”
Mr Catton said the danger is that the road to a health care worker shortage of “only” ten million - which would still be hugely significant – is achieved by substituting or diluting the nursing and health care workforce.
“Community health workers are important, but we must be very careful not to look at headline numbers and try to reduce shortages by changing skill mix. We must not fundamentally change skill mix or substitute workers inappropriately, because that could put patients’ health at risk.”
Mr Catton said the current increase in strikes and disputes are about both pay and conditions and patient safety concerns.
“Nurses know that if there are too few staff they risk burning out because it has an impact on their health and well-being but also they see the missed care, the increase in untoward incidents, the increases in mortality. Addressing shortages to ensure safe staffing is critical to patient safety as well and nurse well-being.”
He said the damaging and flawed perception that health is a cost that is a drain on economic growth continues to persist and that needs to be tackled head-on whereas the evidence supports the view that health is both a driver and a multiplier for economic growth.
“We need to challenge that thinking because it is incorrect, investment in health is clearly a driver of economic growth. The pandemic exposed the huge economic costs of weak health systems and that when health fails, economies fail. In addition, there are also immediate short-term costs for our health systems because of failing to invest in the workforce, including higher turnover, higher sickness and higher burn-out as well as the additional costs of agency workers and cover.
Health is at the centre of our social ecosystem. Without it, we do not have economic stability and prosperity, we do not have patient safety and we do not have security in our health systems, as the pandemic so dangerously revealed. Lack of investment in health care affects every part of our societies and every aspect of our lives. If we make the right investments, we will make enormous strides toward the global goals we all want to achieve. And if we get this all right for nursing, it will make significant changes to gender equality and women’s lives as well.”
Download the communique here