Editorial – Global shortage of nurses – Rebecca Jester for May 2023 issue

This editorial discusses global and regional nursing shortages, how this has been exacerbated by the COVID-19 pandemic, the impact of the shortages and what is needed to address these issues in the short, medium and long term. Also, to explore the ethical issues concerning recruitment of nurses from low and lower middle-income countries to address the shortfall of nurses in higher income countries.

Prior to the pandemic, the global shortage of nurses was estimated at 5.9 million nurses. The International Council of Nurses (ICN) (2021) projects that over 13 million nurses worldwide are required to bridge the gap in the nursing shortage by 2030. The pandemic has exacerbated the existing nurse supply shortfall and has forced rapid and “emergency” policy responses to try to increase nurse supply, at the system level, in all countries (Buchan et al., 2022). All countries of the WHO European Region (63 countries) are facing significant challenges with their health and care workforce. Personnel shortages, insufficient recruitment and retention, migration of qualified workers, unattractive working conditions and poor access to continuing professional development opportunities are blighting health systems (WHO, 2022).

Global regions face their own specific challenges for examples Gulf Cooperation Council (GCC) countries have traditionally and continue to rely heavily on ex-patriate nurses from countries such as India and the Philippines with circa 20–35% of the nursing workforces across the GCC countries being local citizens. The United Kingdom also has severe shortages of registered nurses and seeks to recruit 5–6000 overseas annually with the figure rising in 2022 to 20,000 to address the shortfall. Overseas nurses bring a wealth of valuable experience and expertise to health care systems in developed countries, but overreliance is a risky strategy and needs to be balanced with a long term approach of attracting nationals into the profession. Also ethically over recruitment of nurses from developing countries can create a shortfall in the countries the nurses are recruited from.

Although there are regional differences contributing to the shortages such as nursing not being viewed as a positive or suitable career choice in some countries many of the factors are shared and include insufficient recruitment and retention strategies, unattractive working conditions and lack of access and support for professional development leading to high staff turnover/attrition, nurses leaving the profession or choosing to retire early,

Shortage of nurses unless addressed promptly and effectively has a negative impact on patient safety and quality of patient care, staff stress, burnout, sickness and attrition.

Nurses working in orthopaedics and trauma during the COVID-19 pandemic have frequently been re-deployed to areas outside of the speciality. This has been particularly prevalent in elective in-patient areas, operating rooms and outpatient clinics. Re-deployment has often been stressful and led to anxiety about having the right up to date skills and knowledge to safely care for patients in other specialist areas including COVID in-patient and critical care units. The pandemic has also exacerbated nurses choosing to retire earlier than planned, leave the profession or return to their home country if working overseas.

All countries of the WHO European Region currently face severe challenges related to the health and care workforce (HCWF). This is particularly prevalent in orthopaedics where waiting lists for elective procedures have exponentially risen and screening services for osteoporosis have come to halt in most countries as resources were re-directed to support COVID patients. Patients waiting prolonged periods for procedures such as total joint replacement and spinal fusions will experience severe pain, disability and reduced quality of life and nurses have a key role to play in both primary care and orthopaedic services to ensure patients are supported with symptom management and support to reduce disability such as walking aids, home adaptations etc until they can undergo the surgery they require.

Some nurses in the UK have in recent months made the difficult decision to take industrial action in an attempt to make the government realise there is an urgent need to address nurses’ pay and working conditions.

There is no quick fix solution to address the issues of nursing shortages and poor pay and working conditions for many nurses globally, but its essential there is a sustained commitment by governments and policy makers to address these issues urgently. Governments and nursing policy makers must consider carefully the impact of over reliance on overseas nurse recruitment as this can lead to shortages in the countries they are recruited from and there needs to be a sustained effort to encourage nationals to consider nursing as a positive career choice and for more training places to be made available. Student nurses also need to receive appropriate financial support to cover their tuition fees and be able to access bursaries and student loans for living expenses.

Recruiting more nurses to the profession is one aspect the other is to retain them. One of the specific challenges facing our speciality is a lack of access to, support and funding for specialist orthopaedic and trauma courses. Employers need to work collaboratively with Universities to look at solutions to permit staff time, funding and support to undertake specialist courses and for opportunities for on-going professional development. Staff having fair access to professional development and specialist training opportunities is one way to retain nurses in the workforce.

In summary nurses need to have working conditions that allow them to deliver safe high quality evidence based patient care and have opportunities for personal and professional development. They need to feel valued for the wonderful work they do supporting patients and their families and this in many parts of the world means an improvement in pay and working conditions and opportunities for professional development.