Global Nursing Workforce: Problems and Perspectives

By: Hiroko Minami
President, International Council of Nurses
(Partial version)
You have asked me to speak today on the Global Nursing Workforce: Problems and Perspectives. I am pleased to do so, as today we are immersed in a global health workforce crisis. A crisis caused by a severe
worldwide shortage of employed health care workers, most notably nurses. In 2006, the WHO estimated a global shortage of 4.3 million health workers, including 2.4 million nurses, midwives and physicians.
Translated into availability of care, the shortage means that over a billion people have no access to heath care. Many countries are affected by the shortage and 57, mostly in Africa, have been identified as ‘in crisis’. In these countries, the shortage of qualified health workers, including nurses, has become one of the
greatest obstacles to achieving the United Nations Millennium Development Goals. The shortage is undermining the goals of health systems globally and challenging our ability to meet the needs of our
citizens.
Worldwide the shortage has also raised important questions about safe staffing and accountability. Clearly, both become difficult when there is an inadequate supply of nurses to meet the health needs of individuals,
communities and nations. Today all societies rely heavily on the work of nurses. This is true of developed and developing nations alike. In almost every country nurses provide the majority of health services – up to 80% in some cases. In parts of the world, such as African countries devastated by HIV/AIDS, the work of nurses is all that separates communities from total collapse. With a global ageing population, often requiring additional care and chronic care, we are faced with a nursing workforce that is also getting older. In Canada, 50% of the nurses employed today will retire within the next 10 years. By 2016 Canada will have an expected shortfall of 113,000 nurses. The situation is equally serious in the United States, where a shortfall of 800,000 to one million nurses by 2012 is predicted. Today’s shortage is occurring while thousands of nurses are
unemployed, thus creating both a real and a pseudo shortage. In past shortages, an increasing demand or a decreasing supply was the main contributing factor. But today we see both factors in play – a decreased
supply of nurses cannot meet an increased demand for nursing services.
What is driving this increased demand? It includes such factors as:
– the ageing population
– a rising population growth rate
– a growing burden of chronic and non-communicable diseases
– shorter hospital stays, resulting in increased acuity of care
– globalisation and a growing private sector, both of which have expanded the labour market
– high public trust in nurses, which has sparked increased demand for nurses as the primary entry point to health services
– changes in intern/junior doctor working conditions
– increasing mobility
Coupled with increased demand is a decreased supply of nurses. The reasons for this include:
– an ageing nursing workforce
– increased career opportunities for women
– an increasing number of students who are choosing nursing later in life ? reducing their years of professional practice
– decreased funding of nursing schools and a heavier financial burden on students
– a poor image of nursing as a career, and, importantly,
– unfavourable work environments that include excessive workloads, inadequate support staff, violence, stress, burnout, wage disparities and little involvement in decision making

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