State of nursing workforce a ‘global health emergency’, ICN report finds

ICN report

Facing looming nurse shortages around the world, and rising levels of trauma and burnout triggered by the COVID-19 pandemic, the current state of the nursing workforce should be considered a ‘global health emergency’, according to a new report from the International Council of Nurses (ICN).


Examining the nursing workforce against the backdrop of the global pandemic, the report highlights increased evidence of stress, burnout, absence and strikes. Underlying concerns about poor working conditions and unsafe staffing have become “even more obvious” and must be addressed, it states.

Setting out urgent actions for 2023 and beyond, the report argues that “without sufficient investment in well-supported nurses there can be no effective healthcare system recovery and rebuild” of health systems left severely damaged by the pandemic.

Co-authored by Professor James Buchan and ICN chief executive officer Howard Catton, the report, Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, cites more than 100 studies, revealing that 40-80% of nurses have reported experiencing symptoms of psychological distress, while nurses’ intention to leave the profession has risen by 20%.

“Our report substantiates what we have been saying since the start of the pandemic: nurses were on the front lines, and often on the firing line, and it has taken its toll,” ICN President Pamela Cipriano said.

“Nurses are the professionals who can lead us out of this post-pandemic slump in healthcare, but they can only do that if there are enough of them, if they are properly supported and paid, and if the fragile health systems they work in are rejuvenated with large investments from governments everywhere.”

Central to the pandemic response, the report suggests the scale of actual and potential trauma among the nursing workforce is “huge”. Many nurses who held on for the first few years of the pandemic are now exhausted and are stepping down to less demanding roles, shifting into other sectors, or walking away and retiring. Despite high levels of nurse burnout, there is often an absence of a systematic organisation and employer response, with further burden placed on individual nurses to be ‘resilient’.

Many countries have not invested sufficiently in educating adequate numbers of nurses to meet their populations’ needs, the report adds, leading to overwork and additional burdens for their existing staff, and reliance on the quick fix of harmful and unsustainable international recruitment by wealthier nations.

“Many nurses are leaving the profession, and those who remain are so concerned about the after-effects of the pandemic on patient safety and the wellbeing of colleagues, that they are left with no choice but to take industrial action and even outright strikes,” chief executive officer Howard Catton said.

“All of this is happening at a time when there is a huge backlog of untreated health needs, growth in health demands and a great ambition globally to deliver health for all. The recovery of the nursing workforce is an essential prerequisite to rebuilding our health systems, and to think otherwise is a fantasy.”

Fellow co-author James Buchan, Adjunct Professor at the University of Technology, Sydney, Australia, believes the current state of nursing is a direct result of a lack of action and the absence of a long-term vision and plan for the global nursing workforce.

“The nursing workforce has been severely damaged by the traumas of the pandemic, and the need to rebuild our health services is an additional burden they are now carrying,” he said.

“Without sufficient numbers of nurses who are well-motivated, educated and supported, the global health system will not be rebuilt. We need to see co-ordinated policy responses, both within countries and internationally, that will protect and support the global nursing workforce so that they can be effective in their vital role of rebuilding our health systems.”

Read the full report here

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