Healthcare workers are the bedrock of an effective healthcare system and nurses comprise nearly 60% of the global healthcare workforce. Despite this significant presence, investment in professional development and leadership opportunities remains stagnant. Although the COVID-19 pandemic sparked widespread calls for rapid investment and renewed attention to the nursing profession, meaningful financial support hasn’t materialized. According to the World Health Organization (WHO), the financial void is greatest in low-income countries (LICs) where only 25% report the existence of leadership development programs.
The interpretation of the WHO’s latest projections that the global nursing shortage will shrink by 2030 is misleading. The global distribution of nurses is heavily skewed toward high-income countries where there’s a tenfold difference in density of nurses compared to LICs. According to the WHO’s 2025 State of the World’s Nursing Report, nearly 80% of the world’s nurses are found in countries representing less than half of the world’s population.
We can’t afford to be complacent and assume that the projected reduction in the global workforce shortage will result from an equitable distribution of training, capacity building, or leadership opportunities. In light of recent changes at the U.S. Agency for International Development and the looming budget cuts at the WHO, individual governments and the private sector must step forward now with sustained, strategic investment in the nursing workforce.
For the past 8 years, I’ve lived and worked overseas, witnessing the challenges of delivering safe and effective healthcare in low- and middle-income countries (LMICs). Outside of the United States, the perception of nursing is drastically different. To illustrate this difference, consider a statement a medical director at a private hospital in Jordan said to me just three years ago during a meeting about strengthening nursing care, “We realized we needed to improve the patient care at the hospital, so we hired more female nurses to add a softer touch.” This statement was made at the end of the pandemic, after the world had supposedly come to recognize the critical role of nurses in delivering effective patient care. Hearing such a derogatory statement, which reduces the value of nursing to a perceived gender trait, is disheartening. More recently, at another private hospital, the nursing director explained their hiring criteria to me: “We’re a private hospital, and patients expect a pretty face. I have to hire nurses who look pretty.”
As a U.S. educated nurse, it’s staggering to hear comments like these made about the nursing profession in the 21st century. Yet, I’ve learned first-hand that awareness of nursing’s positive impact on patient outcomes doesn’t transcend national boundaries.
During the Covid-19 pandemic, I worked as quality director at a private hospital in Ghana. In that position, I led the public health team and gained firsthand experience providing patient care at the end of the global supply chain.
In the first weeks of the pandemic, the WHO recommended screening patients based on travel history. I knew that the screening protocol could be delegated to a nurse. However, the medical team objected and told me, “No Ghanian will accept a nurse performing a screening. The public won’t believe the nurse’s assessment and they will expect a physician to ask the questions.” In the end, physicians performed the COVID-19 screening due to the public’s perception of nursing, not medical necessity.
I share my experiences of working overseas to highlight the limited influence of nursing within health systems around the world. As a profession, we must advocate for investment in opportunities that will advance the profession and focus not only on pre-licensure education, but also on clinical competency maintenance, advanced practice training, and leadership development.
Take for example a hospital administrator’s comment to me: “I don’t understand why the nurse wants to leave 15 minutes before the shift is over. Before she has completed her work, she is picking up her bag and wanting to leave. In England and the U.S., I have seen nurses staying after their shift, working hard to make sure everything is completed.”
Comparing work habits across nationalities is meaningful only when the environment is equitable. Before criticizing differences in work habits, we must first examine the environment in which nurses are expected to perform. Hospital executives in LMICs may express a desire for “American-style” nursing performance, but fail to invest in the wages, working conditions, and professional development needed to foster it. To illustrate this point with another candid example, one hospital executive stated bluntly to me when discussing the nursing personnel at her facility, “We should do more for the nurses at our hospital, but we don’t.”
Shifting the perception that nurses are a cost burden to a country’s healthcare system requires advocacy at all levels. We must support our international colleagues around the globe so that their impact on patient outcomes is measured. As an individual, you can advocate in many ways, including the following:
- Join the WHO Nursing and Midwifery Global Community of Practice to gain insight into global nursing issues and initiatives.
- For nurses who have the unique opportunity to work abroad, engage with the local nursing workforce in post-licensure professional development.
- Identify opportunities to make continuing education material and clinical leadership trainings publicly accessible and widely available.
- If the health system where you work is engaged in an international partnership, advocate for leveraging it to bolster nursing post-licensure clinical competency training and leadership development.
- If you teach at a nursing school with a global health program, consider shifting your focus from students to practicing nurses by developing sustainable opportunities for mentorship and professional development in partner countries
Around the world, nurses play a critical role in delivering safe, effective patient care. As a profession, we must galvanize nursing’s ability to demonstrate measurable impact on patient outcomes. Achieving this requires sustained investment in professional development and expanded leadership opportunities.
Amanda Slagle, MPH, MSN, RN, CPHQ is a Certified Global Nurse Consultant in Dulles, VA.
References
Aiken LH, Cerón C, Simonetti M, et al. Hospital nurse staffing and patient outcomes. Revista Médica Clínica Las Condes. 2018;29(3):322-7. doi:10.1016/j.rmclc.2018.04.011
Blegen MA, Goode CJ, Park SH, Vaughn T, Spetz J. Baccalaureate education in nursing and patient outcomes. J Nurs Adm. 2013;43(2):89-94. doi:10.1097/NNA.0b013e31827f2028
Lukewich J, Martin-Misener R, Norful AA, et al. Effectiveness of registered nurses on patient outcomes in primary care: A systematic review. BMC Health Serv Res. 2022;22(1):740. doi:10.1186/s12913-022-07866-x
Rosa WE, Binagwaho A, Catton H, et al. Rapid investment in nursing to strengthen the global COVID-19 response. Int J Nurs Stud. 2020;109:103668. doi:10.1016/j.ijnurstu.2020.103668
White House. Withdrawing the United States from the World Health Organization. January 20, 2025. whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization
World Health Organization. State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership. iris.who.int/handle/10665/331677
World Health Organization. State of the World’s Nursing 2025: Investing in Education, Jobs, Leadership and service delivery. iris.who.int/bitstream/handle/10665/381329/9789240110236-eng.pdf?sequence=1
