What the global survey of the nursing workforce tells us – and what’s missing
Flawed figures for the UK are a distraction in the State of the Worlds Nursing report
The first ever global survey of the nursing workforce, published in April, aimed to provide a compelling case on the value of the nursing workforce globally and to set out a forward-looking agenda for nursing policy.
The State of the World's Nursing 2020 report, developed by the World Health Organization in partnership with the International Council of Nurses and the global Nursing Now campaign , was published in celebration of 2020 being the International Year of the Nurse and Midwife.
Shining a light on...
Flawed figures for the UK are a distraction in the State of the World’s Nursing report
The first ever global survey of the nursing workforce, published in April, aimed to provide a ‘compelling case on the value of the nursing workforce globally’ and to set out a forward-looking agenda for nursing policy.
The State of the World's Nursing 2020 report, developed by the World Health Organization in partnership with the International Council of Nurses and the global Nursing Now campaign, was published in celebration of 2020 being the International Year of the Nurse and Midwife.
Shining a light on the global nursing workforce
By the beginning of the year, the report had been developed and drafted – by the time it was published in April, the world had changed. The COVID-19 pandemic reinforced the need for nurses but arguably distracted from and reduced the profile of the report itself.
The report draws on nursing workforce data from 191 countries. Headline figures are that the global nursing workforce is estimated at 27.9 million, of which 19.3 million (69%) are designated ‘professional nurses’ and six million (22%) are ‘associate professional nurses’. The remaining 9% were not classified.
What is a ‘professional nurse’?
The definitions used in the report are based on the 2008 International Standard Classification of Occupations (ISCO):
- Professional nurses assume responsibility for the planning and management of the nursing care of patients, working autonomously or in teams with medical doctors and others
- Nursing associate professionals provide basic nursing and personal care and generally work under supervision or in support of medical, nursing or other health professionals.
The report is explicit that this categorisation does not include nursing aides or healthcare assistants.
Uneven distribution of nurses across the globe
The report highlights how the nursing workforce is unevenly distributed across the globe, with more than 80% of the world’s nurses found in countries that account for only half of the world’s population.
The global shortage of nurses was estimated at 5.9 million in 2018, with 89% concentrated in low-income and lower middle-income countries.
The report also highlights that one nurse out of every eight practises in a country other than the one in which they were born or trained, and that the international mobility of the nursing workforce is increasing.
It notes that ‘many high-income countries in different regions appear to have an excessive reliance on international nursing mobility due to low numbers of graduate nurses or existing shortages’. The UK is one of these countries, with a systematic dependence on international nurses.
Report recommends three main areas of action
The report concludes with a series of recommendations for governments and other stakeholders, summarised in three main areas of action:
- Invest in the ‘massive acceleration’ of nursing education to address global needs, meet domestic demand and respond to changing technologies and advancing models of integrated health and social care.
- Create at least six million new nursing jobs by 2030, primarily in low and middle-income countries, to offset the projected shortages and redress the inequitable distribution of nurses across the world.
- Strengthen nurse leadership to ensure that nurses have an influential role in health policy formulation and decision-making and contribute to the effectiveness of health and social care systems.
Undeniable issues with data for individual countries, including the UK
While the key recommendations are uncontroversial, there are more challenging issues when country-level data is examined. As is often the case, when reporting moves from the aggregate level down to source country data, any data discrepancies become more obvious.
The overall report makes it clear that there are data limitations and definitional challenges that remain to be fully addressed. The aggregate global analysis can only be as accurate as the data provided by each country. And when you look at the one-page summary country profile for the UK, the country level data challenges become clear.
The UK profile sets out key indicators but it currently has major limitations. It reports 423,200 ‘professional nurses’ and 94,000 ‘associate professional nurses.’ A footnote highlights that the professional nurse data ‘excludes nurses practising within primary care, social care and other care settings across the UK’, meaning it is significantly under-reporting the number of professional nurses delivering care in the UK, by at least tens of thousands.
A second problem is the profile reporting of 94,000 ‘nursing associate professionals’ in the UK, as it is unclear who they are. The Nursing and Midwifery Council records around 1,500 of the new ‘nursing associate’ category on the register, but this is well short of the reported figure.
One possible explanation is that the UK data could have included the UK definition of ‘healthcare assistant’ and other nursing support staff in this category, despite the main text of the report noting that the ISCO definition of ‘healthcare assistant’ was not to be included in the data.
Although these country-level discrepancies do not undermine the key global messages of the report, they are a distraction and limit the utility of the country profile. More dialogue with the UK agencies that provided the data could remedy this, improving coverage and clarity.
James Buchan is professor in the faculty of health and social sciences at Queen Margaret University, Edinburgh
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