The COVID-19 pandemic has put an enormous strain on healthcare systems around the world. Nurses have been on the frontlines caring for patients throughout the crisis. This increased demand has exacerbated pre-existing nursing shortages in many countries. Understanding where nurses are needed most can help direct resources and recruitment efforts to the areas of greatest need.
Nursing Shortages Pre-Pandemic
Many countries were already facing nursing shortages prior to the pandemic:
United States
– The United States was projected to have a shortage of over 500,000 nurses by 2030 (AACN, 2022). Key factors included an aging nursing workforce and inadequate enrollment in nursing schools to meet projected demand.
Europe
– Many European countries have struggled with nursing shortages for years. In 2021, Germany was short over 17,000 nurses, while France’s shortage was over 30,000 (OECD, 2021).
Africa
– The World Health Organization estimates there is a global shortage of 5.9 million nurses, with the African region facing the greatest proportional shortfall. Sub-Saharan Africa has 11 nurses/midwives per 10,000 population, compared to 68 in Europe (WHO, 2020).
India
– While India produces the most nursing graduates globally, there is still a shortage of 2 million nurses (WHO, 2020). Maldistribution between urban and rural areas contributes to shortages in some regions.
Impact of the Pandemic on Nursing Shortages
The COVID-19 pandemic placed unprecedented demands on healthcare systems globally. Key impacts on the nursing workforce include:
Increased Workloads and Burnout
– Surges in COVID-19 hospitalizations resulted in increased nurse/patient ratios. Many nurses worked longer hours and additional shifts. This contributed to fatigue, burnout, and nurses leaving the profession.
Nurses Becoming Infected
– Frontline nurses had high risks of becoming infected at work. By September 2020, over 1,700 U.S. healthcare workers died from COVID-19, including over 1,100 nurses (Lost on the Frontline, 2020).
Delayed Retirements
– Some retirement-eligible nurses delayed leaving the workforce to help their colleagues during the pandemic. However, many still plan to retire when the crisis stabilizes, which could worsen shortages.
Decreased Enrollments in Nursing Schools
– New enrollments decreased, as restrictions forced some schools to limit class sizes during the pandemic. This could reduce the pipeline of new graduates in the coming years.
Where are Nurses Most Needed Now?
Several key factors determine where nurses are most urgently required:
Areas With Nursing Shortages Pre-Pandemic
Regions that already faced nursing deficits before COVID-19 have been impacted most severely. For example:
– U.S. states like Florida, Texas, and California faced high nursing vacancy rates pre-pandemic. As pandemic hotspots, shortages in these states have worsened.
– Germany and France have struggled to find enough nurses to staff expanded ICU beds during virus surges.
Locations With Severe Pandemic Outbreaks
Regions experiencing severe outbreaks and surges have dangerous nurse-to-patient ratios:
– In India, nurse-to-patient ratios have reached 1:15 in some hospitals during the pandemic peak, well above the WHO recommendation of 1:6 for ICU patients.
– In Brazil, where COVID-19 has killed over 600,000 people, more than 500 nurses have died from lack of protective equipment and strain.
Areas With Lower Vaccination Rates
U.S. states with the lowest COVID-19 vaccination rates have seen the worst nursing shortages during the Delta variant surge:
| State | Vaccination Rate | Registered Nursing Vacancy Rate |
|---|---|---|
| Mississippi | 44.7% | 17.8% |
| Louisiana | 48.5% | 14.4% |
| Georgia | 49.8% | 11.1% |
Sources: Becker’s Hospital Review, 2021; ANA Health Care Workforce Vacancy Tracking, 2021
High-Resource Settings
Wealthier countries like the U.S., Canada, Australia, and Western Europe face shortages as nurses are recruited internationally to fill vacancies:
– Over 15,000 internationally educated nurses entered the U.S. workforce in 2019. Meanwhile, lower-income countries face lost investment in their nursing education systems.
– Within countries, experienced nurses may leave rural, lower-resourced jobs for urban hospitals with higher salaries and less strain.
Strategies to Alleviate Shortages
Targeted strategies could help fill nursing vacancies in pandemic hotspots:
Financial Incentives
– Sign-on bonuses, pay increases, and overtime pay could attract more nurses to facilities in critical need. Housing stipends can aid recruitment to rural areas.
Mental Health Support
– Counseling, peer support groups, and increased time off could help retain nurses suffering from burnout and fatigue.
Increased Educational Capacity
– Expanding enrollment and faculty at nursing schools, plus tuition reimbursement, could boost graduates. Accelerated online programs can efficiently increase nurses.
Policy Changes on Nurse Immigration
– Changes to visa programs and international nurse recruitment could provide short-term relief to strained systems. But ethical implications must be considered.
Investment in Training and Education
– In low-income countries suffering shortages, increased government funding for nursing schools and salaries is critical to building a sustainable workforce.
Conclusion
The COVID-19 pandemic has intensified nursing shortages globally, especially in regions that already faced strained healthcare systems. Areas experiencing severe outbreaks and undervaccinated populations are most acutely impacted. Both short and long-term strategies are needed to ethically recruit and retain more nurses while supporting their wellbeing. Targeted investment and policy changes could help rebuild the nursing workforce to withstand future health crises.