Where Have All the Nurses Gone? Part I

by Kate Rowley, MBA

A Three Part Series

by Kate Rowley, MBA

state of world's midwifery

The American Nursing Institute (ANI), a program of Global Health Services Network (GHSN) was developed to address the global nursing shortage which is affecting numerous countries throughout the world.   Many people ask where the nurses have gone and, indeed, some migration patterns of nurses are contributing factors.  It is true nurses are leaving under-resourced countries for developed countries [1] [2] [3], leaving a nursing shortage in already suffering countries.  But developed countries also struggle with high rates of nurse turnover [4] [5] [6] and the inability to achieve desired staffing levels.  In reality, no one country is coming out on top.  The global nursing capacity is not adequate and must be addressed.


While globalization has allowed nurses to expand their employment options to a global scale, it’s not the cause of the nursing shortage, but merely a symptom of an unsustainable system.  Nurses haven’t “gone” anywhere.  Globalization has simply exposed the painful truth: there is a massive gap between the number of existing nurses and the number of nurses needed.


Why Do They Leave? 

The nursing profession is suffers with the same causes for employee turnover as any other occupation.  In short, globally, the nursing profession suffers poor working conditions and inadequate skill levels to meet contemporary medical practices.

income by country

Addressing Working Conditions 

In general, nursing is still viewed in many countries as an undesirable job.  Hours are long and varied, often with no designated holidays.  Tasks involve bodily functions of strangers.  The heavy physical and emotional toll of the day-to-day care goes unappreciated and unnoticed.  Cultural and religious taboos often limit the nursing eligibility pool to young, unmarried women.  In contrast, in the US and many other developed countries, the nursing profession is highly respected and is consistently ranked as one of the most trusted professions [7].  There are several approaches that can be considered to address the perception of nursing and the working conditions.

Higher salaries

The temptation of higher salaries is a common reason for attrition in every industry and company.  In our globalized world, the disparities in income ability between industrialized or developed countries and emerging or developing markets exacerbates this lure.  The capability of a nurses from under-resourced countries to support their family, immediate and extended, is greatly increased when they find employment in developed countries.  In addition, some employers offer enticing benefits, such as health insurance, housing, meal stipends, childcare, etc., all which enhance the attractiveness of a new position.

Better Working  Conditions

The appeal of better working conditions also draws many nurses away from their home country.  In some nations, there are regulations on working hours and conditions.  As a result,  working hours are limited to protect patient safety and protect nurses [8].  Additionally, overtime is limited and nurses are compensated for overtime hours.  In countries where 24-hour shifts for multiple days are common, countries with limited hours and compensated overtime become immensely appealing.  Countries and health care facilities which provide on-the-job safety education and protection from a variety of health hazards are also preferable to a locations that do not.

Professional Environment

Nurses often spend an inordinate amount of time on non-nursing skills, due to outdated clinical protocols and poor facility design.  This contributes to burnout and a highly unmotivated workforce.  Outdated clinical protocols, lack of a support system, and weak management all contribute to low engagement and low job satisfaction ratings, both of which are driving forces of attrition.  Redesigning hospital policies and improving the culture to support nurses could alleviate these stressors.

Professional development is highly successful strategy to boost skills and enhance a nursing career path.  Health care organizations may offer international-level skills training to improve patient care, but this also empowers nurses and elevates their engagement in their work.  The ability to obtain continuing education makes a nurse highly desirable in emerging and developing countries and it creates additional career paths, such as education and administration in their home countries.

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