More than 4.5 billion people lack access to essential health services, while globally 60 million lives are lost due to failures of health care systems, translating into a 15% loss of global GDP.

Yet the consequences in terms of poor health and economies are preventable through increased investments in nurses who deliver upwards of 80% of hands-on care, according to a new report from the International Council of Nurses (ICN). 

Investments in the health workforce in low and middle-income countries (LMICs), and particularly nurses, would result in a massive return on investment at a ratio of 10:1, the report finds.

The economic burden of inadequate health systems is at the forefront of the report, whose release coincides with Sunday’s observance of International Nurses Day. This year’s theme on “the economic power of care” echoes the outsized contributions nurses make to global economic growth, and identifies critical areas for strategic investments in the face of increasing healthcare demands and burnout.

“What governments must recognise is that such investment in nursing is not a cost: investing in health care saves money, and our experts say having a healthy population could boost global GDP by $12 trillion or 8%,” remarked ICN President Pamela Cirpriano. 

The report finds that countries need to increase the size of their nursing workforces so that they have 70 nurse for every 10,000 population, in order to reach key Universal Health Coverage (UHC) benchmarks by 2030. And that means at least 30.6 million more nurses need to be educated and employed around the world. 

The report cites WHO data from 2023 to the effect that effective Universal Health Coverage (UHC) could save 60 million lives by 2030, and increase global life expectancy by 3.7 years.

“But achieving it requires a massive increase of investment in the nursing workforce,” Cirpriano stressed, noting that, “nurses are the drivers of Primary Health Care (PHC) which has been recognized by the United Nations as the catalyst for reaching the UHC 2030 goals.”

Cost-cutting measures will backfire

Although nurses make up 50% of the healthcare workforce, national investments in nurses education, salary and conditions have been eroded, rather than bolstered, in the post-COVID era.  

“Faced with the global shortage of nurses instead of investing in the current nursing workforce we are seeing too many governments choosing short-term and cost reduction driven policies, such as international recruitment, creating new non-registered nurse roles and looking to reduce the length of nurse education,” said ICN Chief Executive Officer Howard Catton.

“These are the wrong choices, taking us in the wrong direction, and seriously risk putting people off joining the profession and seeing more of our experienced nurses quit or leave earlier than they would have done. 

Even in high income countries such as the United States see “nurses frequently grapple with insufficient staffing levels, heavy workloads, and resource constraints, all of which can detrimentally affect their job satisfaction and retention,” said Lisa Kitko, RN & PhD, dean of the University of Rochester School of Nursing, speaking to Health Policy Watch. 

“It’s essential to recognize the economic value that nurses bring to health care organizations through their expertise, skills, and contributions to patient outcomes,” she said. “As the largest health care profession, and most trusted, nurses are uniquely positioned to improve lives and strengthen communities. They consider the future of health care more systemically, integrating the physical, social, and mental well-being of patients.”

A 1:10 return on investment ratio for nursing

The report notes that every $1 invested in health systems generally brings a return of $2-$4. “Stronger health systems equal better health, and healthier populations bring significant returns on investment.” 

But the economic returns are even greater for lower-and-middle-income countries (LMICs). Investment in the LMIC health workforce, particularly nurses, would result in a massive return on investment at a ratio of 1:10.

“We know investments in nursing will create improvements in health care delivery, be a catalyst for economic development, and will advance peace and social well-being,” said Cipriano. 

“What we do has an impact far beyond the visible care we deliver in hospitals, homes, communities, and crisis settings.”

The report notes the cascading benefits of investments in the nursing workforce include not only better direct job creation but better health overall, leading to productive gains in other sectors.

An opportunity for increased gender equality

Investing in nursing and the broader care economy also “is crucial for closing gender gaps,” the report streses. Improving pay, working conditions, and career advancement opportunities in nursing empowers women and stimulates the rest of the economy, especially in the context where approximately 90% of nurses worldwide are women.

For the same reasons, investing in the nursing workforce also can help alleviate poverty, especially for women and girls.

Such investments also require more economic focus and renumeration for roles that are now unpaid care work. Some 76% of unpaid care work is performed by women, and  when care work is paid, it is characterized by low wages. The report sees the economic opportunity in improving pathways to better paid care work. “Better care systems and recognizing and redistributing unpaid care work can significantly contribute to closing gender gaps in labor markets,” notes the report.

Furthermore, the report highlights how investments in nursing have cascading economic benefits, including globally. One prominent example is the more than $50 billion that nurses educated in the global south and working in the global north send home in remittances each year.  At the same time, LMICs have also suffered a significant nursing “brain drain” as affluent countries rely increasingly on importing nurses from abroad, rather than investing in a stronger domestic healthcare work force.  

“What is important now is to make sure that we reinforce to the world that nurses no longer want to be hidden,” said Cipriano at a recent webinar. ICN CEO Howard Hatton added that “for too long, people have dismissed the economic value of caring as being irrelevant or of having no value, that is plainly wrong.” 

“Social cohesion, peace, and prosperity”

While much of the report identifies the economic implications of nursing, it also makes an argument for the connections between the work nurses do and peace. The report notes that “through their work, nurses address the root causes of ill health and the risk factors that lead to conflict.

As frontline workers and primary care providers, nurses “see the connections to other issues, such as political conflicts, family breakdowns, loss of jobs, poverty and mental health crises,” the report states.

“With their trusted position within communities, nurses can play a critical role in bringing people together, building bridges and the wider partnerships and relationships that are the foundations of peace and community cohesion.”  

Kitko, who is also a vice president of the University of Rochester Medical Center, said that she’s “observed a growing acknowledgement from health care leadership of the need to invest in nursing education, training, and professional development. Today, nurses have unprecedented opportunities to shape policy, conduct research, deliver high-quality care, and spearhead transformative changes aimed at strengthening the well-being and resilience of our nursing workforce.”

At the same time, many societies and governments continue to undervalue nursing, she notes, warning that “people often overlook the advanced education, specialized skills, and leadership roles that many nurses hold.

“We must continue to promote the image of nursing, highlighting nurses’ expertise, compassion, and impact on patient care.”

Image Credits: Kate Holt/USAID, International Council of Nurses , International Council of Nurses.