Almost two-thirds of countries are struggling to provide a safe environment for patient care because of nursing shortages, a new report from the International Council of Nurses (ICN) has suggested.
The ICN has today warned the global nursing workforce is ‘in the midst of an unprecedented crisis’ that risks patient and staff safety, and has made fresh calls to ensure the profession is supported and looked after.
In a report published ahead of International Nurses Day next month, the ICN has described how chronic understaffing, unsafe working conditions and insufficient pay is undermining nurses’ wellbeing and ability to provide quality care across the world.
The ICN said nurses globally are ‘strained and under-resourced’ but are still making a ‘huge impact’ in delivering care to their populations every day.
The report highlighted how nurses are ‘spearheading responses’ to the world’s biggest health challenges, including climate-related emergencies and preventative care for non-communicable diseases.
But the council, which is a global federation of national nurses’ associations (NNAs) including the Royal College of Nursing (RCN), also said worsening working conditions and a rising demand for nursing services had created a ‘perfect storm’ that is pushing health systems to the brink.
The findings are based on a survey commissioned by the ICN on the lived experience of 68-member NNAs over the past three to four years, as well as from drawing on wider research.
This year’s IND theme ‘caring for nurses strengthens economies’, builds on last years’ theme of ‘the economic power of care’.
Is there a global nurse workforce crisis?
The report focuses on the shortage of nurses as a pressing global issue, with the World Health Organization estimating an international deficit of almost six million nurses.
The survey points to the impact of unsustainable conditions on nurse retention and recruitment, with more than six in 10 (62%) NNAs reporting growing demands on nurses since 2021.
This has been coupled with an inability to meet demand, with more than a third (38%) of NNAs describing their country’s capacity to meet the current health care needs of their nation as ‘poor’ or ‘very poor’.
Despite most counties recognising the crisis, the ICN said many rely on ‘short-term solutions’, including international recruitment or ‘task-shifting’ to less skilled workers, at times even worsening the problem.
Howard Catton, ICN chief executive, said: ‘We are used to nurses safeguarding society from catastrophic health outcomes when disaster strikes, just as airbags deploy to protect us in a collision.’
He warned that ‘without immediate action’ to invest in and care for the nursing workforce, ‘we risk a dangerous future where no airbag will inflate’.
‘Caring for nurses is not only about treating the symptoms of our current workforce crisis – it is about addressing the root causes by fundamentally reimagining how health systems value, nurture and sustain their nurses,’ he said.
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At the same time, the number of internationally educated professionals who joined the NMC register in the six months to September 2024 was also down 16.6% compared to the same period in 2023.
Last October, the RCN revealed that the number of people studying to become a nurse had also fallen in every region in England.
How are poor conditions influencing nurse retention and recruitment?
The report revealed nearly half (48%) of NNAs are reporting a major rise in nurses leaving the profession – exacerbating workforce shortages.
It links this exodus with a growing job satisfaction crisis, with the Organisation for Economic Co-operation and Development last year reporting that 61% of nurses experience moderate to extreme job strain, which is double the average across all occupations.
How is a rising threat of violence impacting nurses?
A significant majority (86%) of nurses responding to the survey reported experiencing violence from patients or the general public, while over two-thirds said they had experienced violence from their co-workers.
Some 68% of respondents said that their countries had policies in place to prevent violence against health care staff.
However, a quarter of these respondents dismissed the effectiveness of these policies as ‘poor’ or ‘very poor’, suggesting the need to introduce better measures to protect the global nursing workforce.
During an exclusive interview that month, MP and former district nurse Paulette Hamilton told Nursing in Practice that primary and community nurses are ‘treated as second class citizens’ and need to see more of frontline politicians.
Is there a global trend in nurse pay?
Most of the NNAs responding to the survey said their national nursing workforce had seen little or no increase in their salaries since 2021 (72%).
In fact, over a third (36%) reported that nurses had effectively seen a decrease in real terms pay since 2021.
‘This stagnation in compensation, especially given the increasing demands on nurses, exacerbates challenges in retaining skilled professionals and attracting new talent to the profession,’ the report warned.
This month, Nursing in Practice published its General practice nurse pay: A salary survey of the profession 2025 report – produced with our sister title Management in Practice – to provide exclusive data and analysis on the state of general practice nursing pay and conditions.
How are countries responding to the nursing workforce crisis?
The ICN warned that many countries are over-reliant on short-term solutions in an attempt to resolve their workforce crisis and stressed that a global trend of increasing the supply of new nurses through immigration was only a ‘temporary relief’.
Without addressing the underlying issues of workforce retention, career progression, and empowering nurses to work to their full scope of practice, the global nursing workforce crisis cannot be fixed, the report said.
Overall, 64% of the NNAs the ICN surveyed reported that their country was struggling to provide a safe environment for patient care due to nursing shortages.
‘This underscores the urgent need for comprehensive, long-term solutions that go beyond short-term fixes.
‘Until these structural issues are properly addressed, current strategies will remain insufficient,’ the report said.
How do nurses impact economic growth?
Beyond providing essential care delivery, nurses also play a fundamental role in driving economic growth, the ICN said.
The report pointed to research showing that a 1% increase in nurse density in a nation correlates with a 0.02% increase in life expectancy, which is associated with a 2.4% rise in economic growth.
Put simply, countries which prioritise universal health coverage (UHC) and invest in a ‘well-supported nursing workforce regularly see higher life expectancies and healthier populations, which directly enhance the economic productivity of their societies’, the report noted.
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What factors are impacting nurse health and wellbeing?
The report listed workload, workplace safety, and violence against health workers among the factors undermining nurse health and wellbeing globally.
It points to findings from Euronews in 2023, which revealed that one in three frontline nurses had witnessed patients die due to staff shortages.
And it discussed the shocking findings of the Global Consortium of Nursing and Midwifery Studies (GCNMS) survey which last year found that less than a third (32%) of nurses earnt enough per month to keep them out of poverty.
The ‘Caring for Nurses Agenda’
In response to this crisis, the ICN has launched a ‘Caring for Nurses Agenda’ – described as a ‘comprehensive, actionable model’ which aims to protect and promote nurse wellbeing globally.
The agenda focuses on seven key areas where change is needed:
1. Ensure adequate staffing and skill mix for effective care
Implement evidence-based workforce planning and a balanced skill mix to ensure safe staffing levels and sustainable workloads. Continuously monitor workloads and proactively address staffing gaps to minimise risks and prevent nurses from being overstretched.
2. Invest in the right resources and equipment
Provide nurses with the essential resources, equipment, technology and infrastructure required for safe and effective care delivery. Ensure the timely update and optimal functionality of medical equipment, while maintaining a steady supply of care materials that adhere to quality standards. Furthermore, prioritise investment in digital tools to drive productivity improvements and optimize care delivery efficiency.
3. Provide safe and decent working conditions
Uphold nurses’ right to safe, healthy working environments. Implement robust safety protocols and ensure personal protective equipment, ergonomic tools, and protected rest periods to prevent occupational hazards and fatigue. Decent working conditions mean ensuring that every nurse has dignity, respect, rights, and a healthy work-life balance.
4. Support education, professional development, and optimal scope of practice
Prioritise investment in high-quality nursing education and continuous professional development that equips nurses with the skills required to meet evolving health care demands. Empower nurses to work to their full scope of practice by modernising policies and regulations to enable advanced practitioner roles. Provide clearly defined career pathways and ongoing professional development opportunities and ensure nurses’ expertise is valued.
5. Build supportive, high-performing organizational cultures
Cultivate a culture of excellence that prioritises people-centred care and continuous improvement. Foster inclusive, collaborative, and transparent environments with strong mentorship programmes and enable nurses as leaders and decision-makers
6. Improve access to health care and well-being supports
Related Article: New rules for care providers wanting to recruit staff from overseas
Remove barriers to health care access for nurses by streamlining pathways to ensure easy, timely access to preventive care, treatment and support services. Ensure these services are readily available and designed to meet nurses’ unique needs.
7. Value nurses with fair, competitive compensation
Provide salaries and benefits that reflect nurses’ expertise, responsibility, and dedication to patient care. Address pay equity and ensure fair workload distribution. Support flexible working arrangements to accommodate diverse needs and increase workforce retention and job satisfaction.
Source: The International Council of Nurses Caring for Nurses Agenda
Dr Pamela Cipriano, ICN President, said the agenda was about moving nurses from being ‘invisible to invaluable’.
‘Over the past several years, ICN has laid out the evidence and steps to support investing in nurses and nursing for a sustainable workforce and stronger health systems. Integral to sustaining our workforce is investing in their wellbeing,’ Dr Cipriano added.
To mark IND last year, Nursing in Practice spoke with practice nurses who said they were still working to ‘push the agenda’ to show their competence and skills.
