The Global Nursing Shortage and Healthcare

There is growing concern worldwide that the current nursing shortage has far-reaching effects, not only for the people worldwide who need expert nursing care but also for nurses and nursing. A project spearheaded by the International Council of Nurses and the Florence Nightingale International Foundation1 provides a preliminary summary of many of the professional issues arising from the global crisis. The issues are wide-ranging, including political and economic effects of the crisis, ethical challenges, quality-of-care concerns, and professional standards of licensure and registration worldwide.

As the current information from the International Council of Nurses initiative shows, specific evidence concerning the extent of recruitment and migration of nurses across national boundaries is lacking and remains inconclusive. However, since it is clear that there are serious professional and ethical issues involved, the best nursing scholarship is needed if responsible actions are formed for the foreseeable future. The historical colonization and exploitation by the most privileged nations has left a blatant trail of evidence concerning the harm to human well-being that results from irresponsible, uninformed, and ill-advised dominance. Nurses, particularly nurse leaders and nurse scholars, remain culpable as participants if they ignore the looming harm created by the worldwide nursing crisis, and fail to bring their perspectives to bear in debates and the decision-making arenas.

If more powerful nations sustain the historical trend to exploit the less powerful nations in relation to the nursing and healthcare crisis, then the most capable nurses from all areas of the world will gradually migrate to the more privileged and powerful countries, leaving those less privileged with a serious deficit in healthcare. The standards of care will begin to reflect even wider disparities, with higher standards of care for those most privileged, and lower, even unacceptable, standards of care for those with the greatest needs.

The challenges seem so large that it is tempting to retreat. However, I believe that it is possible to take important steps that could create a shift that will benefit nurses and those they serve. Discussion and debate of the issues in each nursing community to raise awareness of the issues is an important first step toward creating this shift. In today's world, every nurse has some contact with nurses and patients from other countries, and serious discussion about the issues as seen from each individual's perspective contributes to mutual awareness and understanding.

If nurse leaders and scholars make a serious commitment to explore the issues involved, and to create well-informed and well-designed proposals for implementation, then they can make important contributions in the direction of worldwide equity and justice. They can renew a commitment to bring the best of nursing education to nurses worldwide. They can engage in exchanges with nurses across international boundaries to better understand the real challenges of nursing and healthcare in cultures that differ from their own. They can use evidence of best practices from nursing scholarship to inform policy-makers and health-related decision makers worldwide. Nurses worldwide have a wealth of knowledge, insight, talent, and ingenuity. What is needed now is a growing sense of the global significance of what they have to offer, and the will to bring their talents to the table.

Peggy L. Chinn PhD, RN, FAAN, Editor

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