“As a profession, globally, we are asking for help” Nurses discuss ways to address critical global nursing shortage

Over 630 participants from 115 countries, including leaders of National Nursing Associations across the world, joined a webinar on 28 January to discuss the recent report on the global nursing workforce and the COVID-19 pandemic by the International Council of Nurses (ICN), CGFNS International and the International Centre for Nurse Migration (ICNM).

The report, Sustain and Retain in 2022 and beyond, which was launched on 24 January, revealed how the COVID-19 pandemic has exacerbated the already fragile state of the global nursing workforce. With a shortage of 5.9 million nurses and another 4 million nurses expected to retire in the next 10 years, the nursing workforce was already in a precarious position prior to the pandemic. The report described how the COVID Effect was leading to increased absences, early retirement and burnout which may likely push many other nurses to leave the profession, increasing the shortage to up to 13 million.

In her opening remarks during the webinar, Dr Pamela Cipriano, ICN President, talked about the fear that nurses are facing and the importance of protecting them.

“As a profession, globally, we are asking for help. Because our nurses do not feel valued, they do not feel supported, and we know that over the course of time we need to grow our workforce supply and retain that supply, which is becoming a much more critical aspect when we look at the conditions affecting us right now.”

Professor James Buchan, co-author of the report, explained about the report’s projections of future shortages if there is an exodus from the profession.

“If we just have a 4% increase in the number of nurses who leave, we have another million shortfall. The scale of the impact at the global level is going to be huge unless the issues around burnout and stress are addressed quickly. We are looking at a situation where 4% is a very conservative estimate of the level of impact. Toward 8-12% or more, we get a sense of just how problematic the issue is globally, particularly in countries that came into the pandemic with big shortages because that shortage gap is going to become even more exacerbated.”

Franklin Shaffer, President and CEO of CGFNS International and co-author of the report, warned of a “tsunami” of international recruitment from low-income countries to high-income countries who seek a quick fix solution to nursing shortages. Dr Shaffer reminded participants that every nurse has the right to be mobile, but that policies and bilateral agreements must be put in place to ensure ethical recruitment of nurses.

Howard Catton, ICN CEO, who is also a co-author of the report, said that there was no magic bullet to solving this problem, but rather a “bundle” of policy initiatives and support needed to retain nurses. He stressed that pay was an important factor along with access to vaccines, personal protective equipment (PPE), and mental health support. He suggested that the issue of international recruitment be seen in the same way as offsetting our carbon footprints.

“We all want to reduce our carbon footprint, to reduce our emissions and we have offsetting strategies to making alternative choices, planting trees, growing forests...I think there is something to think about how the offsetting mechanism could be used to educate more nurses, build nursing schools, and support the growth and development of healthcare facilities.”

The leaders of several National Nursing Associations around the world provided snapshots of the situations in their own countries, praising the resilience of their nurses.

Ma. Teresa Maldonado Guiza, President of the Mexican Federation of Nursing Colleges, said that nurses in her country were not being listened to, despite many campaigns. She spoke about the issues of temporary contracts, the need for more appropriate education, and for recognition of nurses with Master’s degrees.

Walter de Caro, President of the Italian Nursing Association said that about half of the nursing workforce in Italy had been infected by COVID-19. The country has one of the lowest staffing ratios in Europe which means high workloads, stress and burnout. He said, “The politicians have called nurses heroes, promising several improvements for nursing, but nothing changed in terms of salary, in terms of career, in terms of autonomy.”

Dr Agung Waluyo, Chief of Home and Foreign Affairs of the Indonesia National Nursing Association said they had been working closely with the government to deliver mass vaccination campaigns which has greatly increased vaccination levels in the country, but they were still lobbying the government for better pay, career pathways and safety.

Dr Ching-Min Chen, President of the Taiwan Nurses Association said that the government had implemented several policies such as prioritizing vaccination and PCR testing for healthcare workers, but that nurses were still facing high workloads and infections rates. The association is predicting a shortage of 15-24,000 nurses by 2024.

Dr José Luis Cobos, Third Vice-president of the Spanish General Council of Nursing, said that his country had a huge deficit of nurses before the pandemic, that working conditions were very precarious, and the remuneration level was unfair considering nurses have to undertake four years of university training before specialising. Nurses in Spain were hit hard by the pandemic. “We are tired, we are burnt-out, we feel neglected and forgotten,” he said. He also warned about addressing shortages by bringing in less qualified, inadequately trained staff which would pose a threat to patient safety.

Ellen Ku, President of the College of Nursing, Hong Kong, described the role of nurses in testing and vaccination during the pandemic, and said that many nurses who had left the profession volunteered to help carry out these programmes due to the shortage of nurses.

Ruben Lastra, Secretary General of the Argentinian Nursing Federation, called for better education, working conditions and salary for nurses, and raised the issue of violence in the workplace.

Perpetual Ofori-Ampofo, President of the Ghana Registered Nurses and Midwives Association, said that nurses leaving the country was one of the key issues facing Ghana at this time. The association was working with the Ministry of Health to ensure that international recruitment is done ethically, and are looking at ways to retain nurses in the country by enhancing training and improving conditions.

Dr Cipriano concluded the meeting by summarising the main points raised, specifically retention of the nursing workforce through safe staffing, appropriate and equitable pay, addressing stress, improving working conditions, and ensuring safety through vaccination. She reiterated the need for ethical international recruitment and a positive educational pipeline for the future to encourage new nurses to join the profession.

Download the communique here

Access the webinar recording here