The World Health Organization (WHO) released its anticipated State of the World's Nursing 2020 report last month as the coronavirus pandemic highlighted the daily heroics of nurses around the globe. As we celebrate the 200th birthday of Florence Nightingale this week and continue to recognize National Nurses Month, let's take a look at this first-of-its-kind report and examine its major takeaways.
The WHO, in partnership with the International Council of Nurses and the global Nursing Now campaign, released the report in recognition of 2020 as the Year of the Nurse and Midwife. In the foreword, the organization points out that, while there is a lot to celebrate, there are vast inequities in the global distribution of the nurse workforce that must be addressed. The foreword also included a plea to governments and stakeholders from around the world to make significant investments in nursing education; to create at least 6 million new nursing jobs by 2030, primarily in low- and middle-income countries; and to help strengthen current and future nurse leadership. The organization argues that most countries can reach these goals with their own resources.
Here are some of the report's key findings.
• The nursing workforce is expanding, but this expansion is inequitable, insufficient to meet the rising demand, and leaves certain populations behind. Although nursing is confirmed as the largest occupational group in the health sector and grew between 2013 and 2018, a global nursing shortage of 5.9 million still remained as of 2018. To that point, over 80% of the world's nurses are located in countries that account for only half of the world's population. Further, 89% of nursing shortages are concentrated in low- and lower middle-income countries.
• To address the nursing shortage by 2030, the total number of nurse graduates must increase by 8% per year on average and the capacity to employ and retain these new nurses must improve. Current trends indicate that the world is on track for a needs-based nursing shortage of 5.7 million, primarily in Africa, southeast Asia, and the eastern Mediterranean.
• The evidence suggests that advanced practice nurses can increase access to primary care in rural communities and address disparities in healthcare access for vulnerable urban populations.
• One out of every eight nurses practices in a different country from the one in which they were born, which shows that the international mobility of the nursing workforce is increasing. Failure to manage nurse migration can exacerbate shortages and health access inequities. Many high-income countries are excessively reliant on international nurses due to low numbers of graduate nurses or existing nursing shortages in their countries.
• Although most countries have a body responsible for nursing regulation, nursing education and practice "is not harmonized beyond a few subregional mutual recognition arrangements." Regulatory bodies are challenged to keep education and practice guidelines updated and nursing workforce registries current.
• Approximately 90% of the nursing workforce is made up of women, but few healthcare leadership positions are held by nurses or women. There is also evidence of a gender-based pay gap as well as other forms of gender-based discrimination. Legal protections for nurses to ensure fair working hours, conditions, pay, and other social protections are in place in most countries, but they are not equal across regions. Further, 37% of countries reported having safety measures in place to prevent attacks on healthcare workers.
The report underscores the need for drastic action in the next decade to solve these issues and inequities. The authors laid out some future directions for countries to pursue moving forward:
• Countries need to increase funding to educate and employ at least 5.9 million additional nurses and address the global shortage. This requires additional investments in nursing education, amounting to an estimated $10 million per capita in low- and middle-income countries.
• Countries must strengthen their capacities for healthcare workforce data collection, analysis, and use.
• Nurse mobility and migration should be monitored effectively and responsibility and ethically managed.
• Additional investment is needed in nursing faculty and to expand clinical placement programs to attract a diverse student body.
• Policymakers, employers, and regulators should coordinate to provide a positive, enabling work environment for nurses. They must also ensure that staffing levels are adequate and that policies are in place and enforced to address and respond to sexual harassment, violence, and discrimination within nursing.
• Gender-sensitive nursing workforce policies must be planned and put into action, including an equitable and gender-neutral system of remuneration among healthcare workers.
• Professional nursing regulation must be modernized, including the development of harmonized nursing education, credentialing standards, and interoperable systems to allow regulators to verify nurses' credentials and disciplinary history easily.
The full report is available for download here, and an easy-to-read summary can be found here.