The global nursing workforce was estimated in 2019-20 as being 27.9 million nurses.
Prior to the pandemic, the global shortage of nurses was estimated at 5.9 million
nurses; nearly all of these shortages were concentrated in low- and lower middleincome countries. The pandemic has exacerbated the existing nurse supply shortfall
and has forced rapid and “emergency” policy responses to try to increase nurse
supply, at the system level, in all countries.
There is a growing evidence base on pandemic impact, both on the personal level
(stress, workload, infection risks, demands made of nurses to “cope” and be “resilient”,
and concern about “moral injury”) and on the implications of the system responses
(re-deployment, new responsibilities, access to PPE, etc.).
The pre-pandemic shortage of nurses has been exacerbated by the impact of the
pandemic. Burnt out nurses are leaving employment or taking absence.
If only an additional 4% of the global nursing workforce were to leave as a result of
pandemic impact, then the increased outflow of nurses would be more than one
million; this would push the global nurse shortage estimate up to seven million.
Each health system and country should conduct periodic nursing workforce impact
assessments, to provide alerts to pandemic related damage being done at the level of
individual nurses, the overall nursing workforce, and health care systems.
Self-sufficiency and nurse supply
The pandemic has increased the immediate need for nurses in all countries and will
further ramp up demand over the next few years.
Many countries must focus on increased supply of “new nurses”, both to meet growing
and changing demand created by the pandemic, and because of reduced current
There is huge variation in the relative size of new supply of nurses from domestic
training, across the high- income countries of the Organization for Economic Cooperation and Development (OECD).
Many low- and middle-income countries entered the pandemic with inadequate supply
There is emerging evidence of increased active and “fast track” international
recruitment by some high-income OECD countries, which could undermine the ability
of some “source” countries to respond effectively to pandemic challenges.
The pandemic has heightened the risks associated with international recruitment:
cutting across international supply to some high income “destination” countries, in the
short term, whilst driving up “push” factors and likely outflow from low-income
There is a growing policy emphasis on the potential of government- to- government
bilateral agreements to “manage” international recruitment of nurses – these
agreements must be independently monitored to assure full compliance by all parties.
There is an urgent need to monitor trends in international recruitment flows using a
self-sufficiency index which can flag how reliant countries are on international inflows,
and how the patterns of flows and impact are changing.