Nurses Urgently Needed: Another Critical Global Shortage

The Ebola crisis has focused global attention on the nursing profession. Rightly so.

Many of the first victims of Ebola have been health care professionals on the frontlines of this deadly disease that has now claimed close to 5,000 lives and affected 9,000 people, according to the World Health Organization.

The global media spotlight has turned on nurse Tina Pham – now treated for Ebola at Maryland’s National Institutes of Health – and on another nurse, Amber Joy Vinson, who is being treated for Ebola at Emory University Hospital.

A nurse in Spain, Teresa Romero, also developed Ebola after treating a patient there. Countless African nurses have succumbed to the Ebola outbreak.

An outcry  from nurses at the Texas Health Presbyterian Hospital where Thomas Eric Duncan, the Liberian man, died of Ebola has also heightened awareness of the difficulty nurses face. In their profession, they can risk getting exposed to infectious diseases and, as the Texas case showed, often are unprotected and ill-prepared by their employers even for the most dangerous infections.

If there is one bright side of the Ebola crisis, it is that it has finally focused global attention on nurses. The world desperately needs more of them.

Years before the Ebola crisis hit, evidence was mounting of a major nursing shortage worldwide – from North America to Africa and Europe. Ebola only exacerbates an already worrisome crisis that has gotten scant attention.

United States

The United States has a very large population of registered nurses—almost 3 million in 2012, and about half a million more than estimated a decade ago.

The problem is not supply—it’s demand. Growing healthcare needs outstrip capacity—especially for skilled and specialized nurses who know how to work in highly complex and technologically driven healthcare systems.

By 2020, the United States may have one million openings for nurses according to the U.S. Bureau of Labor Statistics.

The Affordable Health Care Act—also known as Obamacare—will increase the numbers of citizens with access to healthcare facilities and thus looking for care.

By next year, 30-40 million Americans who previously had no health insurance might show up in clinics and hospitals on an ongoing basis. That is quite a demand push. As a result, nurses may become the equivalent of doctors in many healthcare settings.

No wonder that nursing schools across the United States are struggling to expand capacity to meet the rising demand for care.

It doesn’t help either that a significant segment of the U.S. nursing workforce is nearing retirement age (although the 2008 recession has led many babyboomers to stay in the workforce longer).

Funding for nursing education, like many other forms of U.S. education, has suffered in times of cutbacks. Nursing remains a top professional choice with very strong employment prospects. However, the aging workforce, dwindling enrollment and increased demand will strain the system.

Europe

Europe’s aging populations mean aging nurses, aging nursing educators – and more elderly people who need nursing care. By 2030, 25% of the European population will be over the age of 65.

According to the European Union, Europe may be facing a shortage of one million health care workers by 2020. Next to the United States, the United Kingdom has the largest chronic shortage of nurses.

As in the case of the U.S., an aging population puts a growing burden on healthcare services. A diminishing pipeline of new students in nursing compounds the problem.

Just as is the practice in the United States, Germany is also looking around the world for more nurses—in its case, to China, with an abundance of health care workers.

Joint German-Chinese programs train specialized nurses to address the acute shortage – a shortage that will, of course, also hit China itself, whose population is aging rapidly. What will help Germany and other wealthier (West) European societies is that, in the former Eastern bloc nations of Europe, wages for nurses are up to ten times lower in a country like Romania than in Germany.

While this might help Germany and other countries in the west of the continent to fill its shortages, this is really a strategy of robbing Peter to pay Paul.

As with the U.S., which sources many of its nurses from the Philippines,  or the UK, which “imports” them from countries like Spain and Portugal, these shifts are no real solution.
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Asia

China, despite its own growing healthcare needs, is providing a supply of nurses to fill the global void. The Shandong International Nurse Training Center has a partnership with Germany and other countries to place nurses in assisted care facilities and hospitals.

‎The most recent statistics show that China has approximately two million registered nurses — up 52% from 2005, according to the Chinese Ministry of Health. Yet, with a growing elderly population, nurses will have plenty of work in China itself.

It is not just the U.S., but also Britain and Australia that have been recruiting nurses for years from low-to-middle income countries in Asia like Vietnam and the Philippines—known for intensive education and training of nurses.

Yet, even in these countries, mobility and migration is coming under great scrutiny as governments increasingly recognize two crucial factors: First, while they provide for the initial training of nurses, other nations benefit from the supply thus created. And second, when a disaster strikes, the domestic healthcare system – which is the first line of defense everywhere – is coming up short. That is not a sustainable strategy on either front.

Latin America

English-speaking Caribbean nations have advanced nursing programs and a large nurse-to-practitioner ratio. Again, high wages and better working conditions lure nurses to the United States and Europe. What is initially “merely” a brain drain of nurses quickly turns into an exodus, leaving those countries without a supply.

Africa

Globally, the picture is gloomiest for parts of Africa – as well as India. In 2010, a World Health Organization report revealed that India needed 2.4 million more nurses. In sub-Saharan Africa, the shortages are enormous and data are difficult to come by. ‎

‎South Africa is in the market for 45,000 nurses—in part because many of the domestically trained nurses have moved to Europe in search of higher pay and better working conditions.

The hardest hit countries are those in West Africa—precisely where the Ebola epidemic hit three of Africa’s poorest countries. Weak health systems, lack of infrastructure, poor education and limited access to clean water has further fueled this outbreak.

What to do?

The answer to future nursing needs is as complex as the story of the shortages. One solution is to create more public-private partnerships to create talent pools of highly skilled health professionals.

Another strategy involves global awareness of the nursing shortage and joint solutions to spread the talent. Aligning wages and creating better measurement and standards across countries could help.

In the end, Ebola will force us to focus much more on the nurse shortage issue, which is really a global phenomenon. For all the attention many nations still accord to their militaries, they might be far better off as nations and societies if they spent at least as much attention on nurses (and the rest of their medical and care sectors).

Nurses have the power to change lives.  It is our duty to ensure they are protected and  appreciated, particularly given their occupational risks during this Ebola crisis. This is a time when we have to care about people who care for others.