Report: COVID-19 and the International Supply of Nurses
A recent report authored by Professor James Buchan, Adjunct Professor at UTS, and commissioned by the International Council of Nurses (ICN), provides an assessment of the impact of COVID-19 on the global nursing workforce, focusing on how patterns of nursing supply and mobility may change after the pandemic.
The report begins by addressing the situation of the nursing workforce pre-COVID by presenting an overview of the State of the World’s Nursing Report (SOWN), published by the World Health Organization (WHO) and ICN. According to the SOWN report, there is an estimated shortage of 5.9 million nurses, mostly concentrated in low and lower-middle-income countries.
The report examines the level of reliance of countries on foreign-trained nurses in comparison to domestic, trained nurses. A country’s self-sufficiency can be determined by the percentage of the total nursing workforce that was trained overseas.
The report also addresses the supply trends in source countries. The Organisation of Economic Co-operation and Development (OECD) reported that emigration rates for native-born nurses exceed 50% in 20 countries, which are mainly small islands in the Caribbean and the Pacific. Some of these countries have a very small number of nurses in their workforce; therefore, the outflow of nurses can have a negative impact on their healthcare systems.
The report also analyses the impact of workforce outflow in two major source countries: India and the Philippines. There are concerns about an increase in unemployment rates among nurses due to changes in immigration policies and the reduction in the quality of nursing courses due to the high demand for nursing qualification.
According to Buchan:
There has been a long term trend of high emigration rates from some low and middle-income countries, which challenges their ability to meet United Nations Sustainable Development Goal targets and achieve Universal Health Coverage.
The report also assesses the impact of phases of COVID-19 on the nursing workforce. In phase 1, systems developed “surge capacity”, which has involved rapid scaling up of critical care/ intensive care (CCU/ICU) capacity, in some countries accompanied by reduction or suspension of other elements of acute care provision. Phase two has been marked by ensuring system preparedness for additional waves and managing “two-track services”(i.e. COVID-19 and non-COVID-19). The third phase, also referred to by Buchan as “the new normal”, focuses on system preparedness for additional waves. That would include improvement of longer-term CCU/ICU capacity and growth in COVID-related chronic care.
The report states that since many countries were experiencing shortages of nurses before COVID-19, the pandemic has further exposed these existing staffing gaps. Buchan also addresses the reduction in the availability of nursing workforce during the second phase of the COVID-19 pandemic:
As a country moves from “transition” to ”new normal” it is also likely that the impact of COVID-19 will reduce the supply of nurses over a period of months, at least, because some staff will have burned out, and will be absent for a short or long-term period. Others will reduce their working hours.
He argues that countries should consider providing fair pay and employment conditions, as well as career prospects, in order to increase the attractiveness of nursing as a career.
The brief also supports the need for the implementation of workforce policies in order to improve working conditions for women and to close gender gaps in leadership and pay.
The report suggests vital policies that should be adopted, both at country and international levels, to ensure nurse supply post-COVID-19.
At country level, this will require implementing policy bundles with two inter-related objectives: to improve retention of domestically trained nurses, and to ensure adequate domestic training capacity.
This can be achieved by assessing and improving nurse workforce data, reviewing and expanding the capacity of the domestic nurse education system, assessing and improving retention of nurses and the attractiveness of nursing as a career, implementing policies to optimise the nursing workforce contribution, and monitoring and tracking nurse self-sufficiency.
At the international level, countries and international organisations must effectively monitor international flows of nurses; support, implement, document, and evaluate effective and ethical approaches to manage the international supply of nurses; analyse nurse labour markets and workforce projections and invest in nurse workforce sustainability in countries most vulnerable to nurse outflow.
According to Professor Buchan, countries' responses will have a significant impact on the supply of nursing professionals after the pandemic.
If these country-level and international nurse workforce policy responses are implemented effectively in the next few months, and beyond, there can be hope for the future sustainability of supply of the profession.
Read the full report here.
