Nurses and midwives account for 50% of the global health workforce and represent good value for money (World Health Organization (WHO), 2020). Lower nurse staffing levels in hospitals are associated with worse patient outcomes (Ball et al, 2014). Despite this, 1 in every 8 nursing posts remain unfilled, with 43 000 vacancies in England alone (NHS Digital, 2019). WHO (2020) estimates that to meet the Sustainable Development Goals on health and wellbeing, the world will need an additional 9 million nurses and midwives by 2030.
Furthermore, nursing is becoming increasingly complex, with pressures on service provision exacerbated by the pandemic, and patients living longer with multiple and complex comorbidities. Some 10% of the current nursing workforce are considering leaving the profession, with newly qualified and nurses nearing retirement more likely to leave (Health Education England, 2014). An anecdotal increase in the number of applicants applying to study nursing may go some way to address the problem. However, universities are limited in the number of applicants because of placement availability and staff to provide mentorship. Potential solutions can be explored through a range of different perspectives.
Globally, it is essential that a collaborative approach is taken to develop a strategy to protect and support nurses. Nationally, it appears that the current NHS system, rooted in the socialist ideology that underpins the NHS, seems outdated in a contemporary neoliberal infrastructure. Streamlining policy development by placing the NHS outside the political arena could provide a solution to workforce planning. More effective financial investment across all levels of healthcare would include financial support for nursing students as essential to address underlying problems. This is particularly relevant when considering the amount of healthcare expenditure when compared with similar-sized economies (Organisation for Economic Co-operation and Development, 2019). Effective financial investment could include a refocus of health care from individual factors to tackle the wider socioeconomic determinants of health, including housing, employment and education (Dahlgren and Whitehead, 2006) and towards more primary health care and disease prevention.
Organisations can demonstrate supportive leadership to encourage staff engagement and shared decision making, and invest in the enrichment of workplace culture, creative job design and systems working, effective use of technology and communication (NHS Employers, 2020). From a professional perspective, there are calls to protect the title ‘nurse’ by limiting it to those who are registered with professional regulators (Mitchell, 2021). Having nurse representation at global, national and local levels would ensure nurses are contributing to policy making and strategic development. The issue of resilience in nursing is concerning as it puts responsibility on individuals rather than organisations and governments taking responsibility for finding solutions. I suspect there is little individual nurses can do to impact workforce challenges without a change in the organisational infrastructure at a global, national and local level. Nurses must be engaged in the political process to have their collective voices heard; however, some nurses are reluctant to become political animals, particularly as the issue of strike action can be seen as controversial.
Despite a recognition of the challenges ahead in terms of workforce planning, and suggested recommendations about how to address them, I fear that, unless we act immediately, it may be too little too late, with not only the profession being at risk, but also global public health.