The world must stop assuming that nurses will just “show up” no matter what, according to Dr Pamela Cipriano, president of the International Council of Nurses (ICN).
Speaking exclusively with Nursing Times, Dr Cipriano shared her key reflections on the State of the World’s Nursing (SoWN) 2025 report, unveiled last month on International Nurses Day.
“We cannot continue to just assume that nurses will show up”
Pamela Cipriano
Published by the World Health Organization (WHO) in partnership with the ICN, SoWN 2025 is the muchanticipated successor to SoWN 2020.
Dr Cipriano said the latest report came at a critical time.
“We’re dealing with the aftermath [of Covid-19],” she said.
“We knew at the time… that [there] was not going to be a switch to flip when it [was] over. And so that’s where we are… that’s also why this report is so important, [as is] the follow-up work that will occur.”
In some respects, the new report told an all-too-familiar story: persistent global nursing shortages despite an increase in nurses, a workforce with unfulfilled wellbeing needs, and deep disparities between rich and poor nations.
However, some of the findings surprised even Dr Cipriano.
For example, the report found that the global nursing workforce shortage had reduced from 6.2 million in 2020 to 5.8 million in 2023. Dr Cipriano welcomed this, but admitted she thought the drop would have been larger.
The ICN president was also surprised at the scale and impact of nurse migration: one in seven nurses were found to be practising in a country other than the one in which they were born.
The ICN – as well as nursing organisations in the UK, such as the Royal College of Nursing – has, in recent years, called for more sustainable international recruitment and for agreements between recipient and sender countries to be more equitable.
Key findings from the State of the World’s Nursing 2025
Global nurse shortage down from 6.2 million in 2020 to 5.8 million in 2023, and expected to be 4.1 million by 2030
High-income countries host 46% of world’s nurses, despite representing only 17% of world’s population
International recruitment more prevalent in high-income countries (23%) than low-income ones (3%)
Advanced practice nursing present in 62% of countries, compared with 53% in 2020 report
Only 42% of countries have provisions for nurse wellbeing
Median entry-level wage for nurses globally is US$774 (£575) per month
Nursing gender pay gap is 7% in favour of men, despite profession being 85% female
Countries with national chief nursing officer or equivalent up from 71% (2020 report) to 82% now
Dr Cipriano, a registered nurse in the US, said the report showed the need for “mutually beneficial” agreements, and for the strengthening of the WHO’s Global Code of Practice on the International Recruitment of Health Personnel, which prohibits active recruitment in countries struggling with nurse numbers.
“Accountability, commitment and having teeth in these documents, like the code, needs to be stronger,” she said.
“There has to be pressure to say ‘you have to be ethical’. We have had some countries, like some of the Pacific Islands, that lost a quarter to half of their nursing workforce during the pandemic. And they’re not going back. That’s a travesty.”
Dr Cipriano further emphasised the importance of wealthy, developed countries easing their reliance on overseas-trained nurses.
“We’re seeing that in England,” she said, pointing to a move by UK governments away from international recruitment.
She drew attention to the broad issue of working conditions, on which SoWN 2025 commented extensively. This included: lacklustre wellbeing support for nurses across the globe, including in wealthy regions like Europe; violence in the workplace; and attacks on nurses in humanitarian crisis areas.
With SoWN 2025 being published in the aftermath of the pandemic, which thrust wellbeing and working conditions into the spotlight, Dr Cipriano wished to emphasise that violence against nurses “permeates all settings”.
“It used to be that the vast majority [involved] patients acting out, but it was in a small number,” she said.
“With the added stress and strain within our workplaces, there’s a lot of employee-to-employee violence, in addition to public visitors, patients. And then, of course, we have the unconscionable violence that we see in areas of conflict and war.”
She warned that “caring for nurses’ physical environment, physical and mental health and [protecting them] is critical”. The size and sustainability of the nursing workforce were “fundamental” to tackling this, she said.
“Because when you don’t have enough nurses, not only is care compromised, but it really [affects] those who are then left there working. They don’t feel protected, they are working harder, they’re experiencing much greater fatigue,” she added.
“Understaffing is an issue around the globe”
Pamela Cipriano
“So, understaffing is an issue around the globe. The high-income countries have it much better… but, in general, almost every single country will tell you they don’t have enough.”
At stake, should SoWN 2025’s recommendations be ignored, Dr Cipriano said, were the United Nations’ sustainable development goals, which include universal health coverage.
As the pandemic did for SOWN 2020, she said, geopolitical instability threatens these ambitions.
She pointed to reductions in international aid by some countries, including her home nation of the US, as an example.
“If those agreements continue to erode, that really affects the whole global community,” she said.
“When I think about the sustainable development goals, I see health as central to almost every single one.”
Dr Cipriano acknowledged that, for many countries, money was in short supply.
But, she said, investing in health – particularly nursing – was necessary and made financial sense, something her organisation has highlighted in recent years.
“We are part of a chorus that is singing the song [that says] we have to start [by] investing in health and investing in our people,” she said.
While recognising that SoWN 2025 had some positives, she said the “high-level takeaways tell us we have work to do”.
She also noted that the feedback the ICN received from its members day to day supported this.
Dr Cipriano warned: “We cannot continue to just assume that nurses will show up. That’s what they do.
“Nurses are very dedicated. They show up for the emergencies. They showed up in the pandemic. They put their lives on the line.
“They were ostracised and discriminated against and feared for their own lives and their families’ lives. And we cannot let that happen again, because we are threatening one of the most valuable resources for health.”
