The global health workforce crisis toward 2030: A scoping review and systems-based policy framework

Abstract

Objectives

To integrate global workforce indicators and narrative evidence in order to develop a systems-based policy framework informing coordinated workforce sustainability strategies toward 2030.

Study design

Scoping review with mixed-methods synthesis.

Methods

A structured scoping review was conducted of peer-reviewed literature, global datasets, and institutional policy documents published between 2014 and 2024. A mixed-methods synthesis combined quantitative analysis of workforce indicators with qualitative thematic analysis of structural drivers, governance gaps, and health system impacts.

Results

Global projections indicate a shortfall of approximately 11.1 million health workers by 2030. The global nursing shortage was estimated at 5.9 million in 2018, while up to 13 million additional nurses may be required over the following decade when existing shortages, projected retirements, and future demand are considered together. An aging workforce, intensified migration flows, insufficient domestic training capacity, and deteriorating working conditions contribute to persistent shortages. Five systemic drivers were identified: deteriorating working conditions, weak retention mechanisms, demographic pressures, governance failures, and unmanaged migration flows. Impacts include increased mortality, reduced continuity of chronic care, weakened emergency response capacity, and widening geographic inequalities in workforce distribution between high-income and low- and middle-income countries. The Systems-Based Workforce Sustainability Framework integrates macro-, meso-, and micro-level determinants and identifies reinforcing feedback loops sustaining workforce instability.

Conclusions

The global workforce crisis is structural and self-reinforcing. Sustainable solutions require coordinated long-term planning, strengthened retention and wellbeing strategies, ethical migration governance, and expansion of domestic training capacity. The proposed framework supports multi-level policy coordination toward workforce sustainability by 2030.

Highlights

• •Global health workforce crisis escalating toward 2030.
• •Five systemic drivers identified across global evidence.
• •New framework links macro-, meso-, and micro-level determinants.
• •Shortages harm patient safety, continuity, and system resilience.
• •Coordinated multi-level policies required for sustainability.

Research in context.

• (1)What is already known about the topic?

Global analyses describe worsening health workforce shortages, accelerated migration, and workforce aging. However, existing evidence is fragmented across professions and regions, limiting a systems-level understanding of the crisis.

• (2)What does this study add to the literature?

This scoping review synthesizes quantitative indicators and qualitative determinants from 126 studies and policy reports. It introduces the Systems-Based Workforce Sustainability Framework, integrating macro-, meso-, and micro-level drivers and identifying reinforcing feedback loops sustaining global workforce instability.

• (3)What are the policy implications?

Findings show that workforce shortages are systemic and self-reinforcing. Sustainable responses require long-term planning, ethical migration governance, improved retention and wellbeing, and expansion of domestic training pipelines. The framework provides a foundation for coordinated multi-level policy action toward 2030.

1. Introduction

Current WHO projections indicate a global shortfall of approximately 11.1 million health workers by 2030. [1] Within nursing, the global shortage was estimated at 5.9 million in 2018, with the greatest deficits concentrated in low- and lower-middle-income countries. [2] Workforce scarcity therefore represents a major long-term threat to health-system resilience and progress toward universal health coverage. These pressures extend across nursing, midwifery, and the wider health workforce and require coordinated investment in education, employment, workforce data, and cross-sector workforce planning. [[3], [4], [5], [6], [7]]

This crisis is driven by the convergence of three major forces. First, workforce ageing is rapidly reducing the supply of experienced professionals at a pace that training systems cannot match; in several high-income regions, up to one-third of nurses may retire within the decade. [8] Second, international migration has intensified, creating global asymmetries in which high-income countries compensate domestic shortages through reliance on internationally educated personnel, exacerbating workforce depletion in low- and middle-income countries. [[9], [10], [11]] Third, deteriorating working conditions, chronic understaffing, burnout and weak retention structures accelerate attrition, particularly among early-career nurses, primary care clinicians and mental health professionals. [[12], [13], [14]]

The consequences extend beyond staffing metrics. Insufficient staffing has been associated with increased mortality, treatment delays, adverse events and weakened continuity of chronic care. [[15], [16], [17]] At system level, persistent instability undermines progress toward universal health coverage (UHC) and weakens preparedness for emergencies and demographic pressures. [18]

Despite abundant reports and datasets, evidence remains fragmented—profession-specific, region-specific or limited to single drivers. A comprehensive synthesis is therefore needed to integrate global workforce indicators with qualitative evidence and structural determinants. The objective of this study is to develop an integrated systems perspective of the global workforce crisis and identify policy-relevant mechanisms shaping workforce sustainability toward 2030.

2. Methods

2.1. Study design

We conducted a scoping review following the methodological principles of Arksey and O'Malley [18] and the PRISMA-ScR extension. [19] This design was chosen because the global health workforce crisis spans multiple disciplines (public health, health policy, economics, nursing, demography), involves heterogeneous data sources, and includes both peer-reviewed studies and international policy documents. The review was complemented by a mixed-methods synthesis, integrating quantitative workforce indicators with qualitative thematic analysis of causal factors and policy responses.

The aim of this analysis was not to replicate or update existing WHO or OECD reports, but to integrate heterogeneous data sources within a unified systems framework to identify reinforcing policy-relevant dynamics.

2.2. Search strategy

A comprehensive search was performed across major scientific databases and institutional repositories to identify relevant literature published between January 2014 and December 2024. The 10-year timeframe was selected to capture post-2014 evidence, coinciding with major WHO global workforce initiatives and the adoption of the Sustainable Development Goals. All search strategies were executed on the same date to ensure consistency.

Databases searched:

• •PubMed/MEDLINE
• •Scopus
• •Web of Science Core Collection
• •CINAHL (for nursing-specific evidence)
• •EconLit (for health labor market studies)

Institutional repositories searched:

• •World Health Organization (WHO)
• •Organisation for Economic Co-operation and Development (OECD)
• •International Council of Nurses (ICN)
• •World Bank Open Knowledge Repository
• •Global Health Observatory (GHO)

Search terms combined controlled vocabulary (MeSH) and free-text keywords related to:“health workforce”, “nursing shortage”, “health worker migration”, “workforce aging”, “human resources for health”, “global health systems”, “retention”, “health labor markets”.

Full search strategies for all databases are provided in Supplementary File 1.

2.3. Eligibility criteria

Inclusion criteria.

• 1.Focused on the health workforce at national, regional, or global levels;
• 2.reported quantitative indicators (e.g., workforce supply, retirement rates, migration flows, projected shortages);
• 3.Examined qualitative determinants (e.g., working conditions, burnout, career decisions, policy environments);
• 4.Included any health professions group (nurses, doctors, midwives, allied health professionals, community health workers, mixed groups);
• 5.Were published in English between 2014 and 2024;
• 6.Were peer-reviewed articles, systematic reviews, modelling studies, or authoritative institutional reports.

Exclusion criteria.

• 1.Studies limited to single hospitals or micro-contexts without broader workforce implications;
• 2.commentaries or opinion pieces lacking empirical or policy data;
• 3.Documents not available in full text;
• 4.Publications focused exclusively on educational curricula with no connection to workforce supply or retention.

2.4. Study selection

Two reviewers independently screened all titles and abstracts. Full texts were retrieved for articles meeting inclusion criteria or where eligibility was uncertain. Disagreements were resolved by consensus or consultation with a third reviewer. No automation tools were used during the screening or selection process.

A total of 5482 records were identified. After removing 2268 duplicates, 3214 unique records were screened. Of these, 412 full-text articles were assessed for eligibility, and 126 studies and policy reports were included in the final synthesis.

A PRISMA-ScR flow diagram summarising identification, screening, eligibility, and inclusion processes is provided in Supplementary Fig. 1.

2.5. Data extraction

A standardized extraction matrix was developed to capture:

• •Bibliographic information
• •Country/region of focus
• •Workforce metrics (e.g., shortages, density, retirement projections, migration flows)
• •Workforce categories included
• •Study design or policy document type
• •Key causal factors identified
• •Reported impacts on health systems or patient outcomes
• •Proposed policy or organizational interventions

Extraction was performed independently by two reviewers and cross-checked for accuracy.

2.6. Quality assessment

Given the scoping nature of the review, no formal risk-of-bias tool was applied to exclude studies. However, we conducted a descriptive appraisal of methodological robustness, data transparency, and policy relevance. Institutional reports from WHO, OECD, ICN and the World Bank were automatically classified as high-credibility sources based on established global standards.

2.7. Synthesis of evidence

We used a mixed-methods analytical strategy:

Quantitative synthesis.

Workforce indicators (supply, density, shortages, migration rates, retirement projections) were aggregated and compared across regions and professional categories. Where feasible, values were harmonised using WHO/ILO standard definitions.

Qualitative thematic analysis.

Textual data were coded inductively using a three-stage approach:

• 1.Open coding of textual data describing causal factors and system drivers.
• 2.Axial coding to generate thematic clusters (e.g., working conditions, retention, migration incentives, demographic transitions).
• 3.Selective coding to identify cross-cutting determinants shaping workforce sustainability.

The resulting themes informed the development of the Systems-Based Workforce Sustainability Framework presented in the Discussion.

2.8. Ethical considerations

This study involved secondary analysis of publicly available data and published literature. Ethical approval was therefore not required, in accordance with international standards for scoping reviews and the use of publicly accessible data.

3. Results

3.1. Study selection

The search strategy identified 5482 records across databases and institutional sources. After removing 2268 duplicates, 3214 records were screened. Of these, 2802 were excluded based on title and abstract screening.

A total of 412 full-text documents were assessed for eligibility, and 286 were excluded due to insufficient empirical data or lack of relevance to workforce shortages, migration, or aging.

The final sample comprised 126 sources: 64 empirical studies (50.8%), 18 systematic or scoping reviews (14.3%), 22 global policy documents from organizations including WHO, OECD, ICN, and the World Bank (17.5%), and 22 workforce modelling or forecasting reports (17.5%). Table 1 presents this distribution and maps the evidence contributing to the quantitative indicators, qualitative themes, and health-system impacts. Individual sources could contribute to more than one analytical domain; therefore, the supporting references presented in the evidence map are representative rather than exhaustive.

Table 1.

Distribution and contribution of the included evidence to the mixed-methods synthesis.

Panel A. Distribution by source type
Source type	n	%
Empirical studies	64	50.8
Systematic or scoping reviews	18	14.3
Global policy documents	22	17.5
Workforce modelling or forecasting reports	22	17.5
Total	126	100.0

Panel B. Mapping of the evidence across the synthesis domains
Synthesis component	Indicator or thematic domain	Main evidence identified	Geographic scope	Supporting references
Quantitative	Projected health workforce shortage	WHO-projected global shortfall of approximately 11.1 million health workers by 2030	Global	[1]
Quantitative	Nursing shortage	Global nursing shortage estimated at 5.9 million in 2018	Global	[2]
Quantitative	Future nursing requirements	Up to 13 million additional nurses potentially required over the following decade when existing shortages, projected retirements, attrition, and future demand are considered together	Global	[20]
Quantitative	Workforce aging	A substantial proportion of the workforce is approaching retirement in high-income settings	Predominantly HICs	[21,22]
Quantitative	Internationally educated workforce	HICs show considerable reliance on internationally educated nurses	Predominantly HICs and source LMICs	[23,24]
Quantitative	Workforce density	Lowest workforce densities concentrated in sub-Saharan Africa and South Asia	Regional/global comparison	[25]
Qualitative	Working conditions and burnout	High workload, inadequate staffing and psychological strain contribute to burnout and attrition	Multiple settings	[26,27]
Qualitative	Retention and career development	Limited progression, inadequate remuneration and weak retention mechanisms contribute to early-career attrition	Multiple settings	[26]
Qualitative	Migration push–pull dynamics	Wage and career differentials encourage migration and increase HIC dependence on internationally educated personnel	HIC–LMIC flows	[23,24]
Qualitative	Demographic pressures	Population aging increases demand while workforce aging reduces available supply	Predominantly HICs, with global implications	[21,22]
Qualitative	Governance gaps	Fragmented planning and insufficient long-term workforce policies reinforce instability	National and global	[28]
Health-system impacts	Patient safety	Understaffing is associated with mortality, complications and delays in care	Predominantly hospital settings	[12,15,16]
Health-system impacts	Continuity of care	Turnover and shortages disrupt chronic care and primary care delivery	HICs and LMICs	[28,29]
Health-system impacts	System resilience	Workforce constraints weaken emergency response and post-crisis recovery	Global/COVID-19 evidence	[30]
Health-system impacts	Geographic maldistribution	Rural–urban gaps and international workforce losses disproportionately affect underserved settings	HICs and LMICs	[[29], [30], [31]]

Note: Panel A shows the distribution of all 126 included publications by source type. Panel B maps the principal quantitative indicators, qualitative themes, and health-system impacts to the evidence used in the synthesis. The supporting references shown are representative rather than exhaustive because individual sources could contribute to more than one analytical domain.

3.2. Global quantitative findings

Synthesis of international datasets indicates a substantial but geographically uneven global workforce shortfall, projected to reach approximately 11.1 million health workers by 2030. [1] This shortfall reflects different regional combinations of population need, workforce supply, education and production capacity, fiscal capacity to create funded positions, retirement, migration, and retention. [1,2,20,22,23,25] Low- and lower-middle-income regions experience the largest absolute shortages and lowest workforce densities, whereas many high-income countries face replacement needs, geographic maldistribution, retention difficulties, and growing reliance on internationally educated professionals. [1,2,22,23,25] Table 2 unpacks these differences across the principal quantitative indicators.

Table 2.

Global Health Workforce Indicators and their implications (2014–2024).

Indicator	Global estimate	Regional disparities and interpretation	Demand–supply and production implications	Sources
Projected global health worker shortfall by 2030	Approximately 11.1 million	The projected deficit is concentrated predominantly in low- and lower-middle-income countries. Sub-Saharan Africa and the Eastern Mediterranean bear a disproportionate share, whereas many HICs experience shortages despite substantially higher workforce densities.	In lower-resource regions, population growth, unmet health needs, limited education capacity, and restricted fiscal space constrain workforce expansion. In HICs, shortages are more strongly associated with rising demand, retirement, geographic maldistribution, and retention difficulties.	WHO [1]
Estimated global nursing shortage (2018 baseline)	Approximately 5.9 million	Approximately 89% of the estimated global nursing shortage was concentrated in low- and lower-middle-income countries, particularly in the African, South-East Asian, and Eastern Mediterranean regions.	Regions with the greatest population needs frequently have the lowest capacity to finance education, create funded positions, and retain qualified professionals.	WHO [2]
Additional nursing requirements over the following decade	Up to 13 million when existing shortages, projected retirements, and future demand are considered together	The projected requirement does not represent a uniform regional deficit. LMICs face insufficient baseline supply and limited production capacity, whereas many HICs need to replace retiring staff and respond to population ageing.	Expansion of training alone is insufficient unless accompanied by funded employment, effective retention measures, and alignment between graduate production and population needs.	ICN [20]; WHO [2]
An aging workforce and projected retirement	Approximately 4.7 million nurses expected to retire by 2030	Retirement pressure is particularly pronounced in many HICs with older workforce profiles. In contrast, several LMICs have younger populations but insufficient training places and limited capacity to absorb graduates into funded employment.	HICs face substantial replacement demand and may increase international recruitment. LMICs require sustained investment in education, employment, and retention to expand their workforces.	WHO [2]
Reliance on internationally educated nurses in HICs	Highly variable: below 5% in many OECD countries but considerably higher in selected destination countries	Reliance is particularly high in Ireland, New Zealand, Switzerland, Australia, and the United Kingdom, while source countries may experience losses from already constrained workforces.	International recruitment can relieve destination-country shortages in the short term but may reduce incentives to expand domestic production and exacerbate shortages in source countries.	OECD [23]; WHO [24]
Regions with the lowest workforce densities	Sub-Saharan Africa and parts of South Asia and the Eastern Mediterranean	Low workforce density coexists with high population growth, substantial disease burden, rural maldistribution, and limited access to essential health services. Within-country rural–urban disparities may be as important as differences between regions.	Increasing graduate numbers will not correct shortages unless countries can finance positions, distribute personnel equitably, and improve retention in rural and underserved areas.	WHO [22,25]
Mismatch between workforce need, supply, and production capacity	No single comparable global estimate	Some countries experience an absolute shortage of trained professionals; others produce health workers who cannot be absorbed because of fiscal constraints. Meanwhile, HICs may have high production capacity but persistent vacancies caused by attrition, geographic maldistribution, or skill mismatch.	Workforce planning must distinguish population need from labour-market demand, available workforce supply, and education output. Similar numerical shortages may therefore reflect different underlying mechanisms across regions.	WHO [1,22,25]

Note. HICs, high-income countries; LMICs, low- and middle-income countries. Regional comparisons should be interpreted cautiously because workforce indicators vary in their definitions, occupational coverage, reporting periods, and completeness across countries.

3.3. Qualitative thematic findings

Five recurrent thematic drivers were identified across the complete evidence base. These themes were derived from patterns identified throughout the qualitative synthesis rather than from the limited number of sources displayed in the original table. Table 3 has therefore been expanded to show the principal manifestations and system-level mechanisms associated with each theme. The references presented are illustrative of the broader body of evidence contributing to each domain and were selected to represent empirical, policy, and workforce-planning perspectives.

Table 3.

Thematic drivers of the global workforce crisis.

Thematic driver	Principal manifestations	System-level mechanism	Representative evidence
Working conditions and burnout	Excessive workloads, inadequate staffing ratios, psychological strain, administrative burden, and insufficient organizational support	Poor working conditions increase burnout, sickness absence, intention to leave, and actual attrition, thereby intensifying existing workforce shortages.	[20,22,26,27,32]
Weak retention and career development	Limited progression pathways, inadequate remuneration, insufficient professional recognition, and restricted access to continuing development	Weak retention structures reduce workforce stability, particularly among early-career professionals, and diminish the return on investment in education and training.	[20,26,[32], [33], [34], [35]]
Migration push–pull dynamics	Wage differentials, safer working environments, career opportunities abroad, active international recruitment, and limited opportunities in source countries	Migration can alleviate shortages in destination countries while increasing workforce losses and dependence in countries with already constrained health systems.	[9,23,24,34,[36], [37], [38]]
Demographic pressures	Population ageing, an ageing workforce, increasing retirement, and growing demand for chronic and long-term care	Population ageing increases demand for services while workforce ageing and retirement reduce the available supply of experienced professionals.	[8,21,22,34,39]
Governance gaps	Fragmented workforce planning, inadequate forecasting, weak labour-market intelligence, underinvestment, and poor coordination between education and health sectors	Failure to align population needs, education capacity, funded employment, geographic distribution, and retention perpetuates structural workforce imbalances.	[22,28,[33], [34], [35],37,40]

Note: The references shown are representative rather than exhaustive. Individual publications could contribute to more than one thematic domain.

3.4. Combined impacts on health systems

Shortages, burnout, poor retention, and migration imbalances interact to produce measurable consequences for healthcare delivery and system performance. Across the included evidence, four recurrent impact domains were identified: patient safety, continuity of care, health-system resilience, and geographic workforce distribution. Table 4 synthesizes these domains and presents representative examples and supporting evidence.

Table 4.

Combined impacts on health systems.

Impact Domain	Examples	Evidence
Patient safety	Higher mortality, complications, delays	Strong associations reported [12,15,16]
Continuity of care	Turnover disrupts chronic care, primary care gaps	Documented in HICs and LMICs [28,29]
System resilience	Reduced emergency response capacity, slow recovery after crises	COVID-19 revealed weaknesses [30]
Geographic workforce maldistribution	Rural–urban disparities and disproportionate workforce losses in LMICs	Geographic inequalities in workforce distribution reported across and within countries [[29], [30], [31]]

3.5. Synthesis of findings

Overall, findings indicate a structurally interconnected crisis characterized by escalating quantitative shortages, systemic qualitative drivers—including burnout, migration, and governance gaps—and profound health-system impacts affecting patient safety, continuity of care, geographic workforce distribution, and system resilience. This evidence underscores the need for coordinated, multi-level, systems-based responses, as represented in the Systems-Based Workforce Sustainability Framework presented in the Discussion.

4. Discussion

This scoping review provides a comprehensive synthesis of global evidence on the health workforce crisis, revealing a system-wide pattern of escalating shortages, intensifying migration flows, and an aging workforce. Quantitative indicators show that the global shortfall of health workers is projected to reach approximately 11.1 million by 2030, with the largest deficits concentrated in low- and lower-middle-income countries. [1] At the same time, qualitative findings demonstrate that these shortages are reinforced by structural drivers such as deteriorating working conditions, weak retention strategies, demographic pressures, and governance gaps, which together create a self-reinforcing cycle of workforce instability. [[26], [27], [28], [29], [30], [31],41]

To make the derivation of the Systems-Based Workforce Sustainability Framework transparent, Fig. 1 maps the quantitative indicators and qualitative themes identified in the scoping review onto four interconnected components: macro-level determinants, meso-level determinants, micro-level determinants, and cross-level reinforcing feedback loops.

Fig. 1.

Mapping of scoping review findings onto the systems-based workforce sustainability framework.

Note. The framework integrates quantitative workforce indicators and qualitative thematic findings across macro-, meso-, and micro-level determinants and depicts the reinforcing feedback loops through which workforce instability is sustained.

The mapping illustrates how macro-level demographic, policy, and labour-market pressures shape organizational conditions, which in turn influence individual professional responses. Attrition, migration, and workforce withdrawal subsequently feed back into workforce supply and organizational capacity, sustaining the reinforcing cycles identified across the evidence.

4.1. Comparison with previous literature

Our findings align strongly with previous global analyses from WHO, ICN, and OECD, all of which emphasize the structural and multi-level nature of the workforce crisis. [[32], [33], [34]] Earlier reports have highlighted the uneven geographic distribution of health workers, the increasing dependence of high-income countries on internationally educated professionals, and the chronic underinvestment in domestic training pipelines. [20,23,25] This review extends those conclusions by integrating both quantitative indicators and qualitative determinants, demonstrating how systemic pressures interact across macro-, meso-, and micro-level domains.

An aging workforce represents an important demographic challenge. OECD and WHO analyses indicate that population aging is increasing demand for health and long-term care while retirement pressures are reducing workforce supply across many high-income settings. [21,22,39] Our synthesis confirms that retirement-driven losses may outpace the capacity of education systems to replenish the workforce, especially in nursing, primary care, mental health, and geriatrics.

Migration patterns identified in this review are also highly consistent with earlier evidence documenting strong push–pull dynamics. [23,24,36] High-income countries continue to recruit aggressively from LMICs, deepening structural imbalances and limiting progress toward universal health coverage in resource-constrained settings. These findings reinforce longstanding concerns regarding limited adherence to the WHO Global Code of Practice on the International Recruitment of Health Personnel. [37]

4.2. Interpretation through a systems perspective

The Systems-Based Workforce Sustainability Framework (SWSF) developed in this review conceptualizes the global workforce crisis as the product of interdependent determinants operating across three interlinked levels:

• •Macro-level: national health policy, migration governance, demographic change, and financing
• •Meso-level: organizational conditions, staffing ratios, management practices, leadership, career structures
• •Micro-level: individual motivations, burnout, career trajectories, and intent to migrate or leave the profession

Three reinforcing feedback loops help explain why workforce instability persists despite targeted interventions:

• 1.Shortage → Burnout → Attrition → More Shortage

Chronic understaffing increases burnout and turnover, which in turn worsens shortages. [26,27]

• 2.Migration → Dependency → Underinvestment → More Migration

Reliance on foreign-trained workers discourages investment in domestic education and retention, perpetuating long-term dependency. [23,24,36]

• 3.Aging → Increased Demand → Shrinking Supply

Population aging simultaneously increases healthcare demand while shrinking the active workforce through retirements. [21,22]

Sustainable workforce strengthening requires coordinated action targeting structural, organizational, and individual determinants simultaneously. While individual components of the workforce crisis—such as shortages, migration or aging—have been described extensively in prior reports, their interaction through reinforcing feedback loops has not been systematically articulated in the policy literature. The Systems-Based Workforce Sustainability Framework addresses this gap by making these dynamics explicit and policy-actionable.

4.3. Implications for health workforce policy

The findings of this review support several strategic priorities for global workforce policy:

• 1.Strengthen long-term workforce planning. Countries require robust forecasting models, integrated labour market intelligence, and better alignment between education capacity and service demand. [33,39]
• 2.Invest in retention and wellbeing. Improving working conditions, reducing administrative load, and protecting staff wellbeing are essential to breaking the shortage–burnout cycle. [26,27,32]
• 3.Reform migration governance. Ethical recruitment should be reinforced through bilateral agreements, compensation mechanisms, and stronger compliance with WHO guidelines. [37,38]
• 4.Expand domestic training pipelines. Many regions—particularly LMICs—need rapid scaling of nursing and allied health education programmes to meet projected demand. [1,40]
• 5.Strengthen system resilience. The COVID-19 pandemic revealed vulnerabilities linked to workforce shortages; rebuilding resilience requires stable staffing, flexible skill-mix models, and investment in community and primary care services. [30,31,35]

4.4. Implications for clinical practice and nursing

Given that nursing represents the largest segment of the global health workforce, the implications are particularly significant. Our findings show that:

• •nurse shortages represent the largest share of the global deficit [20,25];
• •working conditions and burnout are especially acute among nurses [26,27];
• •migration patterns disproportionately affect nursing, particularly from LMICs to HICs [23,24,36];
• •career pathways and retention structures for nurses remain underdeveloped in many countries. [32,33]

Strengthening nursing leadership, expanding advanced practice roles, and prioritizing retention are therefore essential components of any long-term workforce strategy.

4.5. Policy implications

Addressing global workforce shortages requires coordinated long-term planning that strengthens domestic training pipelines, improves retention and reduces structural dependence on internationally educated nurses. Policy action should prioritise investment in primary care and community health systems, alongside the expansion of advanced nursing roles. Furthermore, workforce sustainability must incorporate routine monitoring of burnout, wellbeing and retention as core indicators to guide system performance and inform strategic planning.

4.6. Limitations

This review has several limitations. Heterogeneity in reporting standards and data availability across countries limited comparability of workforce indicators and prevented robust quantitative synthesis. Migration data remain particularly incomplete in many regions, constraining interpretation of trends. In addition, reliance on secondary sources introduces potential bias and restricts causal inference. Nonetheless, the breadth of evidence included allows identification of convergent structural drivers and provides a coherent systems perspective on global workforce sustainability.

4.7. Future research directions

Future research should focus on cross-country evaluation of workforce interventions, improved modelling of retirement patterns and migration flows, and longitudinal analyses of workforce resilience. Advancing standardized global indicators for workforce wellbeing and integrating artificial intelligence and predictive analytics into workforce forecasting will also be essential to support more accurate and policy-relevant projections.

4.8. Conclusion

This scoping review provides the most up-to-date synthesis of global evidence on the structural, organizational, and professional determinants driving the health workforce crisis. Quantitative indicators reveal a substantial and geographically uneven workforce shortfall, projected to reach approximately 11.1 million health workers by 2030 [1]. Qualitative findings demonstrate how shortages are perpetuated by burnout, inadequate retention strategies, migration dependencies, demographic pressures, and longstanding governance gaps.

By integrating these insights within the Systems-Based Workforce Sustainability Framework, this study advances a comprehensive conceptual model that explains how macro-level policies, meso-level organizational dynamics, and micro-level professional decisions interact to shape workforce stability.

The implications are clear: incremental or isolated policies will not reverse current trajectories. Sustainable workforce strengthening demands long-term planning, investment in retention and wellbeing, ethical migration governance, and expansion of domestic training pipelines.

Without decisive, system-wide reforms, health systems will face increasing difficulty meeting population needs, protecting patient safety, and achieving universal health coverage.

Ethical statement

This study involved secondary analysis of publicly available data and published literature. No primary data collection involving human participants was conducted. Therefore, formal ethical approval was not required in accordance with institutional and international guidelines for scoping reviews.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this work, the author used ChatGPT (OpenAI) for assistance in language editing, structural refinement, and clarity improvements. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the final version of the manuscript.

Funding

This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

The author declares no competing interests.

Appendix A. Supplementary data

The following is the Supplementary data to this article: