The worldwide shortage of nurses should be considered a “global health emergency” – yet governments are failing to invest in measures to retain these essential workers, according to Howard Catton, CEO of the International Council of Nurses (ICN).

“The US has lost 100,000 nurses since 2020 and is predicted to lose up to 600,000 by 2027. The number of nurses leaving the UK register is also up since 2020. And in Switzerland, the dropout rates of new nursing students in their first year and second year is between 18 and 36%,”  Catton told a briefing hosted by ACANU, the Geneva UN press association.

Despite increasing evidence of nurses leaving or planning to leave the workforce, “governments are not in sufficiently prioritising investment in the nursing workforce”, he added.

“Improved working conditions and support and investment for the current nursing workforce need to be a priority to hold those nurses that we have.”

Governments are more focused on recruitment than retention of nurses, added Catton – and international recruitment by certain wealthy countries is decimating the healthcare in less affluent countries.

Recruitment from ‘red list’ countries

“A small number of high-income countries are driving 70% to 80% of recruitment activity,  overwhelmingly from countries in a weaker position than themselves. 

“Just in recent days, the UK announced that it had reached a target to recruit 50,000 more nurses earlier than planned. But it turns out 93% of those 50,000 were internationally recruited nurses, and we know that 6,000 of them came from the most vulnerable countries – the red list countries, that the World Health Organization (WHO) advises not to recruit from.”

Fiji has lost 25% of its nurses in the last year to Australia and New Zealand, he added.

In 2023, the WHO identified 55 countries – 37 from Africa – with “low workforce density” that might require “safeguards against active international recruitment” of their health workforce.

“The focus of government action, where we do see it, appears more on recruitment than retention,” said Catton.

“Recruitment, of course, is important in the medium to long term. But there’s a time lag. And the most simple, incontrovertible truth is that improved working conditions and support and investment for the current nursing workforce need to be priorities to hold in those nurses that we have.”

The rise in nurses’ strikes and disputes is an indication of the impact of the post-pandemic cost of living crisis, with a fall in real pay being reported even in Italy, Portugal, Finland and the UK. 

However, said Catton, “The approaches governments are adopting are unsustainable, and we’re concerned that there is a risk of more disputes and unrest over the year to come without the prioritisation of investment”. 

ICN president Pamela Cipriano pointed out that slogans such as “health for all”, ‘leave no one behind’ and universal health coverage all depend on nurses – yet there is insufficient investment in nurses and nursing. 

“We need to move nurses from being invincible to being considered invaluable,” she added, cautioning those wanting to bring in workers who are less experienced and less expensive, “We urge great caution because someone with lesser education and training cannot replace the expertise of a nurse.”

Support for nurses in Palestine 

While the ICN did not involve itself in geopolitics, “there should be complete protection of health care facilities, health care workers and civilians in any area of conflict and war”, said Cipriano.

“We know that that’s been violated [in the occupied territories of Palestine], so we have spoken out against that. We, along with many other groups are calling for peace but also very specifically, protection of health care facilities and adherence to international law.”

The ICN had provided some financial support to Palestinian nurses, who are currently not being paid, “but not anywhere near the magnitude that they would need and hoping that we can help them to connect with other groups that can provide some financial support”, she added. 

Aside from financial support, Cipriano noted that nurses in the occupied territories needed education to deal with “new patient groups” as “the wounds of war are different from normal care”.

“Right now, we know they’re working in conditions where electricity, water supplies, medications, are at risk, so they are working in serious disaster conditions,” said Cipriano.

“Many times our other associations step up to help one another, either financially or it may be that regionally, there can be physical support.”

Tribute to Israeli nurse held hostage

Cipriano also paid tribute to Nili Margalit, an Israeli nurse kidnapped by Hamas on 7 October and held hostage for 55 days.

“She’s a 41-year-old nurse and… [she was able to] get medications to the people who were in the tunnel where she was being kept, to give them hope, to be the communicator, to be the organiser.,” said Cipriano 

“That is what nurses do. They rise in the face of crisis, as well as [during] the daily and life events that that people are facing. 

“In conflict and crisis, we can rely on nurses even though we know it also takes a tremendous mental toll on their well-being.”

Image Credits: © Dominic Chavez/The Global Financing Facility.