The Nursing Shortage: A Global Healthcare Crisis

After researching the underlying reasons why so many Filipino nurses migrated to the U.S. for my Global Business Projects class, I became interested and more concerned about healthcare’s global nursing shortage. Did you know that according to the World Health Organization (WHO), 23 health workers (doctors, midwives, and nurses) is the minimum number required per 10,000 population to provide 80% coverage of basic health needs? The United States continuously reports a nursing shortage at 100 nurses per 10,000, while countries in the developing world, like Somalia, Madagascar, and Bangladesh, report as few as two nurses per 10,000 population.

My mom was a nurse for over 40 years, migrating from the Philippines to the U.S. in the 1960s due to a huge nursing shortage post-WWII. Research by the National Institutes of Health (NIH) shows the post-WWII nursing shortage can be attributed to women leaving the workforce to be housewives when the men returned home from war, as well as a growing worldwide population. So, what are the reasons for the current nursing shortage?

Nursing Stock Images NIH

Reasons for the Current Nursing Shortage

NIH studies show the reasons for the lack of nurses worldwide include:
1. Aging populations,
2. Shrinking nursing faculties, and
3. Retiring nurses.

Aging populations. Currently, the United States’ 65 years and older population is the largest it has been at any point in our country’s history. As people age, they frequently have chronic illnesses needing constant treatment. This constant treatment creates an increased demand for healthcare services.

Shrinking nursing faculties. Higher education has been hit hard, experiencing a shortage in nursing faculty. Accepting smaller numbers of students, nursing schools enroll and graduate fewer students than if they were at full staff.

Retiring nurses. In the next 10 to 15 years, analysts estimate one-third of nurses will reach retirement age creating a worse nursing shortage. For many years, the number of nurses leaving the profession has steadily increased. Research attributes this to the fact that most nurses are women, and many of these women transition from full-time to part-time employment when they have children or even choose to quit the profession.

Adding to the reasons above, Chief Nursing Officers (CNOs) surveyed by AMN Healthcare also attribute the nursing shortage to access-to-talent and location. For countries like Britain and the U.S., a national nursing shortage can be more easily addressed by recruiting the best nurses from low to lower middle-income countries like the Philippines, India, Nigeria, and Russia. These countries’ top talent migrates to countries like the U.S., Britain, and Saudi Arabia for better pay or a better life.

But what about the nursing shortages in the Philippines? India? Nigeria? Russia? It is crazy to learn that the Philippines is the leading exporter of registered nurses in the world, yet in 2018 the country had only three nurses to every 10,000 patients. The Philippines’ continues to lose its best talent overseas, and its local hospitals are staffed by underpaid nurses. India has the second largest population in the world, and it is another leading exporter of nurses to the states and Europe. However, the country’s nurse-to-patient ratio is 17: 10,000. As these countries grow, they are feeling the negative impacts of exporting their top talent. Do these countries have enough resources to tackle this healthcare crisis? It will be interesting to see what methods and plans these countries will use to address their nursing shortages.

Effects of the Current Nursing Shortage

Moody’s Investors Service states that a hospital’s biggest expense is labor. A scarcity of talent causes this labor expense to grow. Countries like Saudi Arabia, Britain, and the U.S. boost pay, offer sign-on bonuses, and increase benefits to entice more nurses. Considering research shows the nursing shortage will persist through 2025-2026, hospitals’ and clinics’ profit margins will be negatively impacted for years to come and years to follow.

As previously mentioned, the Philippines is the leading exporter of nurses in the world. Nurses like my mom immigrated from the Philippines to the US for a better life and better pay. Working in the U.S, nurses like my mom and from other lower-income countries have the opportunity to make almost 15 times more in salary than if they worked at a local hospital in their home country. With the Philippines being so successful in exporting nurse labor, almost $28 billion in remittance payments circulate in the Philippines’ economy. Maybe the Philippines should allocate some of that money to address its nursing shortage if they have not done so already.

Nursing is a high-stress and high-demand occupation. Nurses find themselves working extra shifts or having an excess of patients. The stress, long shifts, and an excess of patients can eventually lead to low employee morale and high turnover amongst nurses. NIH research supports the relationship between patient care issues and nursing shortages. Nurses care for more patients when short-staffed. Compared to patients being cared for in hospitals with lower nurse-to-patient ratios, nurses caring for patients in-excess leads to higher mortality and failure-to-rescue rates for patients.

My mom retired from nursing after working for over 40 years in the field. She was tired, angry, and frustrated when she left. The last five years she worked, my mom complained about how healthcare administrators do not know the business of healthcare (emphasis on care) and how she never had enough resources and help. Moving forward, I hope healthcare administrators around the globe can be allies in assisting their providers to deliver their best service. Otherwise, healthcare providers, worldwide, will continue to feel the negative effects of the nursing shortage through their bottom-line and the negative impact of low employee morale.

Written by:  Jennifer Dhir