Considerations for organisations facing nurse shortages

A shortage of nurses, physicians and other healthcare workers is the reality across the United Kingdom and Europe.^1,2 The U.K. National Health Service (NHS) reports a vacancy rate of 7.5% (31,294 vacancies) for nurses as at the end of March 2024; ¹ and a European Commission 2020 report found that the majority of European Union countries experienced shortages of nursing professionals.² Looking to the future, the World Health Organisation (WHO) is forecasting a shortfall of 10 million healthcare professionals (HCPs) by 2030.³

The reasons for the nurse shortage and other HCP shortfalls are multi-faceted. The Covid pandemic contributed to stress and burnout for HCPs.⁴ According to the WHO, more than three-quarters of nurses suffered from some degree of mental distress relating to the pandemic, and in Europe 9 out of 10 nurses stated that they wished to quit their jobs.⁴ An ageing workforce is also an issue, along with demographic factors and burnout that are contributing to a shrinking labour force.⁵

In the “State of the World’s Nursing 2020” report, the authors highlight that nurse retention, and the equitable distribution of nurses, are challenges shared almost universally by countries around the globe.⁶  One of the causes is the acceleration of international mobility, driven by financial and other reasons, which has had a significant impact on the availability and equitable distribution of nurses.⁶

The migration of nurses from low-income countries to work in high-income countries has been recognised for some time.⁶ This results in inequities in care across different regions. For example, 81% of the world’s nurses are employed in Europe, the Americas and the Western Pacific region, which together account for 51% of the global population.⁶ The countries facing low nurse densities are predominantly in Africa, South-East Asia and the Eastern Mediterranean region.⁶  This uncontrolled pattern of migration can worsen nurse shortages, and also contribute to inequitable access to health services.⁶    

Retention and job satisfaction: universal concerns in countering nurse shortages

While the contributing factors and specific challenges may vary, retention and job satisfaction are universal concerns for the organisations that employ nurses around the world. Job satisfaction can play an important role in the decision to stay in a nursing job or leave. In a study from France that looked at turnover rates in intensive care units (ICUs), for example, researchers found that social support from supervisors and colleagues contributed to lower turnover rates, as did being able to take breaks during the workday.⁷

In recognition of these challenges, governments are launching comprehensive initiatives aimed at improving nurse retention and recruitment.^8,9

WHO/Europe and European Commission announce €1.3 million initiative to boost nursing retention and recruitment

WHO/Europe and the European Commission are taking action with a €1.3 million program, announced in September 2024, aimed at supporting EU member states by boosting nursing retention and attracting new nursing recruits.⁸ The €1.3 million funding commitment will be applied across all 27 EU member states, with priority for the countries facing the most significant shortages of nursing staff.⁸

The 36-month program will focus on:⁸

• driving evidence-informed retention and recruitment strategies
• scaling up efforts in the mentorship of the new generation of nurses
• protecting nurses’ health and well-being
• supporting countries with implementing safe staffing measures
• optimising the integration of digital solutions

WHO/Europe’s Framework for Action on the Health and Care Workforce features five pillars

The Framework for Action on the Health and Care Workforce in the WHO European Region 2023–2030, released by WHO/Europe in September 2023, outlines a comprehensive plan to invest in and protect health and care workers.⁹ Among the goals of the plan: support the supply of staff, improve retention and recruitment, and improve performance.⁹

The plan is focused on five pillars:⁹  

Pillar 1 – Retain and recruit: Address health and care workers’ needs

This pillar is focused on protecting the mental and physical health and well-being of health and care workers, including protection against occupational risks.⁹ It includes the goal to improve retention of existing health and care workers, and to encourage the return of those who have left the professions.⁹

Occupational risks for HCPs might include occupational exposure to hazardous drugs (HDs), for example.¹³ Surface wiping, contamination monitoring, personal protective equipment (PPE) and closed system transfer devices (CTSDs) offer ways to mitigate these risks.^10,11,12,13

More on this topic: Addressing nurse retention with healthcare worker safety

Pillar 2 – Build supply: Strengthen education and training, skills and competencies

This pillar acknowledges the need for additional competencies for healthcare workers, such as the ability to use digital health tools including artificial intelligence.⁹ It also highlights the importance of continuing to acquire new knowledge and skills throughout their careers, including continuous professional development (CPD) programs and the adoption of CPD standards and approaches.⁹

For example, training and ongoing educational programs for nurses involved in vascular access are a key part of vascular access management (VAM) programs.¹⁴ The objectives of these hospital programs include an in-depth assessment of current infusion practices, and finding ways to improve clinical performance, improve safety, and find cost savings.¹⁴

More on this topic: International Nurses Day: empowering nurses in vascular access

Pillar 3 – Optimise performance: Redefine teams and skill mix; use digital solutions

This pillar builds on pillars one and two, expanding the focus to include the way work is organised, the use of digital solutions, and ensuring that facilities and equipment are adequate.⁹ This includes strategies such as redefining teams and skill mix, developing multiprofessional teams, and ensuring the most effective use of health and care professionals’ knowledge and expertise.⁹

Vascular access teams, or VATs, offer an example of teams that efficiently bring together expertise and experts.^15,16 These multidisciplinary teams in hospitals are responsible for selecting, placing, monitoring and removing vascular access devices.^15,16

Pillar 4 – Plan: Implement comprehensive health and care workforce policies; improve data; coordinate multiple stakeholders in line with changing needs

This pillar defines the key factors related to planning, ensuring that all stakeholders are included (i.e. health, government, finance, education ministries in the country, professional and patient organisations, key private sector entities).⁹ It also highlights the necessity of regulating health and care education and training institutions, as well as the need for strategic workforce planning, robust health information systems and access to data.⁹

Pillar 5 – Invest: Increase and sustain smarter public investment in the health and care workforce, which contributes to economic growth and societal cohesion

This pillar emphasises the importance of investing in health and care workforce education, development and protection, and the benefits of new approaches such as boosting digital health skills, offering more flexible working arrangements, and ensuring satisfactory working conditions.⁹

New programs put the focus on nurse shortages and patient needs

In announcing the €1.3 million WHO/Europe and European Commission program, Dr Hans Henri P. Kluge, WHO Regional Director for Europe, commented: “Nurses are key to our health systems, yet many countries are struggling to retain or attract the numbers needed to meet the growing and evolving needs of their populations. This new initiative is a sign of our joint commitment to address that and to ensure that patients get the high-quality, professional care when and where they need it.”⁸ 

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