In an era marked by global health challenges, the shortage of nurses has emerged as one of the most critical threats to health system resilience worldwide. Despite gradual gains in staffing levels, millions of healthcare systems continue to struggle to fill vital roles, undermining progress toward universal health coverage. This article examines the scale of the nursing shortage, its causes, regional disparities, implications for health systems, and potential solutions.
Global Snapshot: Workforce Growth and Continuing Deficits
According to the State of the World’s Nursing 2025 report published by WHO in May 2025, the global nursing workforce rose from 27.9 million in 2018 to 29.8 million in 2023. Despite this growth, a shortfall of 5.8 million nurses persisted in 2023—slightly improved from a 6.2 million gap in 2020.
Projections estimate the shortfall will decline to 4.1 million by 2030 under moderate improvement scenarios—but demand still rises, with some estimates warning of up to 10 to 13 million unfilled nursing and midwifery positions globally unless rapid action is taken.
Who Is Affected Most? Regional and Economic Disparities
High-income countries
Despite accounting for only 17% of the global population, high‑income countries employ nearly 46% of all nurses worldwide. Nations like Germany, the UK, Australia, Canada, and the USA remain heavily reliant on international recruitment to address domestic shortages.
Low- and middle-income countries (LMICs)
Countries in sub-Saharan Africa, South-East Asia, and parts of Latin America face deep staffing gaps in health systems. The shortages there have not only remained persistent but are exacerbated by migration of trained nurses to wealthier nations—a phenomenon described by nursing leaders as a new form of “colonialism”.
Key Drivers Behind the Shortfall
⚠️ Aging and attrition
About 17% of the nursing workforce globally is expected to retire in the next decade, necessitating 4.7 million replacements just to maintain current. The COVID‑19 pandemic triggered high rates of burnout and early retirement, further reducing active personnel.
Burnout and poor working conditions
Nurses worldwide report high levels of occupational stress—up to 40% show burnout, and 43% report emotional exhaustion. Stress, long hours, and understaffing contribute to retention problems and reduce care quality.
Limited training capacity
Insufficient investment in nursing education, staffing, wages, and infrastructure has undermined workforce growth in many countries. Weak domestic systems fail to train or retain enough talent.
International migration (‘brain drain’)
High-income countries actively recruit nurses from LMICs. African, Caribbean, and Southeast Asian countries face critical staff shortages as experienced professionals leave. Critics say such practices worsen inequity and strain fragile health systems.
Regional Trends and Country Examples
United Kingdom & Germany
The UK, facing thousands of vacancies in the NHS, recruited over 32,000 foreign-trained nurses between 2020 and 2024, even as its foreign aid to vulnerable countries fell sharply—raising ethical concerns over destabilising poorer health systems. Similarly, Germany forecasts a shortage of 150,000 nurses by 2025 and is actively recruiting abroad to fill gaps.
Africa & LMIC hotspots
In the Gambia, Cameroon, and Ghana, nursing vacancies remain high as trained staff emigrate—sometimes driven by poor pay (< $100/month), conflict, or lack of professional opportunities. In Ghana, nearly 42% of healthcare workers plan to leave the country, significantly worsening local shortages.
North America & Canada
Canada’s nursing vacancies surged by over 200% since 2017, making them the largest workforce shortage in the country by 2023 with over 28,000 open positions. U.S. and Canadian systems similarly depend on both domestic training-ups and selective foreign recruitment.
The Human and Systemic Impact
On patient care quality
Staffing shortfalls compromise safe care. Understaffed wards, unsustainable ratios, and burnout increase the risk of medical errors and poor patient outcomes. Countries with low nurse-to-patient ratios suffer disproportionately.
Economic burden
Training a nurse represents a national investment. Losing trained professionals to migration means countries can lose up to USD 1.85 million per nurse in educational and economic value.
Threat to Universal Health Coverage (UHC)
Unequal distribution of nurses hampers progress toward SDG 3 and universal health coverage. Low-income regions are especially affected by weak workforce capacity.
Responses & Policy Recommendations
Invest in education & retention
Countries must expand nursing schools, improve pay, working conditions, and career pathways to retain existing staff and attract newcomers.
Ethical recruitment practices
Adherence to WHO’s global code of practice is essential. Developed countries must ensure recruitment does not harm source countries and include capacity-building support.
Task shifting
Delegating routine tasks to assistant staff or community health workers can help ease nursing workloads in constrained systems.
International support & funding
Increased development aid and workforce funding for vulnerable countries can help them build domestic capacity instead of losing talent.
Why It Matters: The Future of Health Care
For nurses, the field remains among the most in-demand professions globally. Projected job growth far outpaces other sectors, especially in ageing societies and post-pandemic environments.
However, fulfilling this potential requires countries to face staffing challenges head-on—through training, equity-focused recruitment, and systems that support sustainable nurse careers.
The global nursing shortage is more than a staffing problem—it is a global health crisis. With an estimated 5.8 million fewer nurses in 2023, and possible deficits exceeding 10 million by 2030, the world must urgently invest in nursing education, fair recruitment, retention strategies, and international cooperation. Only then can health systems worldwide strengthen resilience, improve patient safety, and achieve universal health coverage.
References
- WHO. State of the World’s Nursing 2025 Report. Geneva: WHO; May 12 2025
- Health Policy Watch. “Critical Global Shortage of Nurses Undermines Universal Healthcare.” May 2025
- Nurses International. “Global Nursing Shortage by 2030.” May 2023
- International Council of Nurses. ICN report: Nursing shortage is a global health emergency. March 2023
- Health Worker Shortage Effects: Financial Times, 2024
- The Guardian. “Recruitment of nurses from global south branded ‘new form of colonialism’.” Mar 2024
- The Guardian. “UK cuts health aid while hiring nurses” Jan 2025
- McKinsey Nursing Survey, Sept 2022–Mar 2023
- Wikipedia: Nursing shortage overview
- Case studies: Ghana, Cameroon, Gambia health migration
