High-income countries must shift from bolstering their nursing workforces by recruiting international nurses to training enough of their own to meet healthcare demands post COVID-19 if poorer countries can have any chance of coping with the pandemic, a new report by the International Council of Nurses (ICN) has revealed.
In order to become “self-sufficient” they must also improve workforce retention and the attractiveness of nursing as a career, through measures such as fairer pay and conditions and addressing the risk of burnout triggered by the pandemic.
Led by Professor James Buchan, Adjunct Professor at the University of Technology Sydney (UTS), and ICN Chief Executive Officer Howard Catton, the COVID-19 and the International Supply of Nurses report examined how the COVID-19 pandemic is impacting the global nursing workforce and in what way patterns of nurse supply and mobility may change in the aftermath of the crisis.
The report states COVID-19 has significantly impacted the nursing workforce worldwide.
“Nurses are at the frontline of the response to the virus, are central to successful progress in suppressing it, and will be the mainstay of post COVID-19 health systems,” it says.
“This has been widely acknowledged but has not come without cost. Nurses have fallen ill or died, often because of poor provision of personal protective equipment (PPE), and many others are experiencing work-related stress and burnout.”
The report outlines that many countries were experiencing shortages of nurses before COVID-19 and that the pandemic has exposed the staffing gaps, which could now lead to further short-term reductions for nations hardest hit due to issues such as burnout and early retirements.
Citing data from the recently published State of the World’s Nursing report, the report highlights that one in every eight nurses practises in a country other than the one where they were born or trained.
About 550,000 foreign trained nurses work across the 36 high income countries examined in the report, up from 460,000 in 2011, including 197,000 nurses in the US, 100,000 in the UK, 71,000 in Germany and 53,000 in Australia.
In the face of a global shortage of almost six million nurses, the report says that if high-income countries continue to recruit large numbers of overseas nurses, they will further threaten the ability of low and middle-income countries to meet healthcare demands and cope with COVID-19.
“Up to one in eight nurses, approximately 3.5 million, are living and working in countries other than the ones they were born or completed their training in,” ICN CEO Howard Catton said.
“This has come about because many wealthier nations are supplementing their inadequate numbers of nurses with international inflow, which is the antithesis of self-sufficiency.
“Such gross inequalities in the distribution of nurses is causing harm to countless millions of people, and if it continues, it will make achieving Universal Health Coverage (UHC) nothing more than a pipedream.”
The report argues high-income countries must make policy changes and take action on international nurse supply post COVID-19 to become “self-sufficient” and safeguard future responses to pandemics and broader health system effectiveness.
Actions include training enough nurses to meet healthcare demands, improving retention by making nursing a more attractive career through measures such as fairer pay and conditions, and enhancing the contribution of the nursing workforce by supporting advanced practice and specialist roles.
It also recommends every county start using a self-sufficiency indicator, based on the proportion of practicing nurses born or trained overseas, to track and monitor their progress.
At an international level, the report says the policy response must include effective monitoring of the international flow of nurses, commitment to fair and transparent recruitment and employment practices, and investment in nurse workforce sustainability in smaller and lower income countries.
“There is a real danger that some high-income countries will revert to their pre-COVID-19 practices of bolstering their nursing workforces by recruiting international nurses, rather than prioritising adequate domestic training capacity, and improving retention of nurses and the attractiveness of nursing as a career,” Professor Buchan said.
“They must ensure that the risk of COVID-19 burnout of nurses is addressed, and provide fair pay and conditions of employment, structured career opportunities, and access to continuing education.”
Professor Buchan said if the country level and international nurse workforce policy responses were implemented effectively in the next few months and beyond, there was hope for the future sustainability of supply of the profession.
“Without country level, policy change focused on investing in their own nursing workforces, pre-COVID-19 trends of increasing flows of nurses from low to high income countries are likely to continue, and the iniquitous mal-distribution of nurses may become more pronounced,” he said.
“This “do nothing” option risks undermining both country level progress towards the attainment of UHC, and the overall global response to any future pandemic waves.”