Recently, I met with African nursing leaders who told me stories of nurses in countries such as Ghana and Nigeria earning the equivalent of only a few hundred US dollars a month – sometimes less than $300 – while being offered opportunities abroad with salaries many times higher.

They described a growing crisis, where nurses are now leaving not yearly or monthly, but almost weekly. In some hospitals, managers only discover a nurse has accepted a post overseas when a resignation letter is pushed under the door. One nurse leader told me: “We are training nurses for export.”

Migration itself is not the problem. Like anyone else, all nurses have the right to migrate and pursue opportunities. But many have been put in an impossible position, where they are also leaving behind families, colleagues and communities they care deeply about.

And the countries they leave behind are losing the experienced nurses they have trained, often with little evidence of any meaningful reinvestment in return.

This story is now being repeated across the world at an alarming scale. This is why, ahead of this month’s World Health Assembly (WHA), the International Council of Nurses (ICN) has written to WHO Member States recommending concrete actions to address the escalating international recruitment that is deepening workforce shortages in lower-income countries and threatening global health system sustainability. 

We are calling for coordinated co-investment by recruiting countries into nurse education, retention, and workforce and leadership development.

But this is not just a story about migration and workforce shortages.

This situation speaks to the profound global failure to understand the true power of nursing and the enormous cost of not investing in it.

No nurses, no care

The world faces a global shortage of 11 million health workers. More than half, 5.8 million, are nurses.

That fact alone should be setting off alarm bells everywhere. No nurses means no healthcare. Nurses are the backbone of health systems. But right now, that backbone is showing signs of spinal instability.

We are asking nurses to carry more and more: ageing populations, rising chronic disease, pandemics, conflict, climate-related crises, mental health pressures, and widening inequalities. Yet too often we continue to treat nursing as a cost to be contained instead of one of the smartest investments societies can make.

That is why this year’s International Nurses Day report from ICN, Our Nurses. Our Future. Empowered Nurses Save Lives is so important.

The report moves beyond outdated, one-dimensional images of nursing to show how nurses both save and improve lives at scale. For too long, nursing has too often been portrayed only through the language of compassion and sacrifice. Compassion matters enormously. But nursing is also power: economic power, clinical power, leadership power, workforce power, and social power.

Our report sets out seven key nursing powers that are transforming health systems around the world.

There is the Power of Trust: year after year nurses remain the most trusted profession globally, a foundation that becomes critical during health emergencies, public health crises, and vaccination campaigns.

There is the Power of Practice: advanced nurse practitioners and specialist nurses are delivering high-quality care, reducing waiting times, improving outcomes, and expanding access, particularly in underserved communities.

There is the Power of Numbers: nearly 30 million nurses worldwide represent the single largest health workforce on earth.

Another of the most important powers is what we call the Power of Proximity.

Nurses are where people are. In hospitals, clinics, schools, refugee camps, conflict zones, remote villages, and people’s homes. Nurses are often the first health professional a person sees and the last one they remember. They understand communities because they are part of those communities.

That proximity saves lives.

And when nurses are empowered to work to their full potential, the evidence is overwhelming. Expanding primary healthcare, where nurses are central, could save 60 million lives by 2030. Closing global health workforce gaps could prevent  189 million years of life lost and add US$1.1 trillion to the global economy.

We can’t see these as “soft skills”. These are hard powers delivering hard outcomes.

Investing for impact

This year’s report builds on ICN’s wider work, including our 2024 report, Our Nurses. Our Future. The economic power of care. This has consistently shown that investing in nursing is not a cost to health systems and economies; it is one of the highest-return investments societies can make. Investing in health brings a $2–4 return per $1, while poor health reduces GDP by 15%.

Yet despite all this evidence, many countries continue to underinvest in nursing. Exacerbating inequalities, high-income countries continue to underinvest in educating enough nurses domestically while increasingly relying on international recruitment to fill workforce gaps.

This means many lower-income countries are effectively financing the health systems of wealthier nations through the loss of their trained nurses. Countries already facing severe shortages are losing experienced clinicians, educators, and leaders faster than they can replace them.

At the same time, destination countries are making substantial savings. Training costs are being avoided. Workforce gaps are being filled quickly. Tax revenues are being generated by internationally educated nurses working in destination countries.

But where is the reinvestment?

Recent evidence submitted by ICN to a UK All-Party Parliamentary Group inquiry highlighted the enormous financial benefit that recruiting countries derive from this model. By recruiting abroad, data shows that the UK has saved £14 billion in health workforce training costs. Canada has saved an estimated C$1 billion.

In effect, lower-income countries are subsidising the workforce costs of richer nations. Some high-income countries are effectively outsourcing responsibility for nurse education internationally while failing to adequately reinvest in the systems they depend upon.

That is neither sustainable nor equitable. It risks creating exactly the perceptions many countries are now voicing openly: neo-colonialism, exploitation, and a growing erosion of global solidarity.

WHA as a turning point

This is why ICN has urged WHO Member States to use this year’s World Health Assembly as a turning point.

In our letter, we call for practical and collective action to strengthen the WHO Global Code of Practice on the International Recruitment of Health Personnel.

That includes coordinated co-investment by major recruiting countries into nurse education, employment, retention, leadership development, and workforce planning in source countries.

We are proposing practical mechanisms: proportionate reinvestment linked to recruitment, directing a share of education savings and tax revenues into source-country health systems, debt relief linked to workforce investment, and even a global fund to strengthen fragile health workforces.

Imagine the impact if high-income countries pooled resources and coordinated action instead of acting individually and reactively.

The sums involved would not be insignificant. But neither are the savings currently being made.

And the return on investment would be enormous: stronger health systems, greater global health security, reduced inequalities, and a more sustainable global workforce for everyone.

Strengthen support for nursing

At the same time, we are increasingly concerned that the global focus on nursing and the health workforce risks being diluted precisely when it should be intensifying.

Last year, WHO Member States agreed to extend the Strategic Directions for Nursing and Midwifery and to accelerate progress. That word matters: accelerate.

Yet we are still hearing concerns about cuts and reduced capacity at exactly the institutions and programmes designed to support the global health workforce.

We understand the financial pressures that the WHO and many governments face. These are difficult decisions. But support for the very people who deliver healthcare, the foundations upon which health systems are built, must be the very last place to cut.

Because ultimately, this conversation is about far more than staffing numbers.

Nursing is also one of the largest majority-women workforces in the world. Investing in nursing means investing in women, in economic participation, in education, in families, and in reducing inequality.

This International Nurses’ Day, we should celebrate nurses. But celebration alone is not enough.

We must also recognise nurses’ power to change lives, strengthen economies, and transform societies and finally invest in that power for the sake of all our health.

Howard Catton is CEO of the International Council of Nurses.

Image Credits: World Bank/Flickr, Flickr – World Bank, International Council for Nurses, Brian Otieno /Global Fund, Studioregard.ch.