scholarly articles on nursing shortage

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Article Contents

Introduction, the current nursing workforce—what do we know, how are shortages calculated and why do shortages of nurses arise, how can nurse shortages be reduced, gap analysis, concluding comment, acknowledgements, conflict of interest statement.

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Global nurse shortages—the facts, the impact and action for change

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Vari M Drennan, Fiona Ross, Global nurse shortages—the facts, the impact and action for change, British Medical Bulletin , Volume 130, Issue 1, June 2019, Pages 25–37, https://doi.org/10.1093/bmb/ldz014

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Nurses comprise half the global health workforce. A nine million shortage estimated in 2014 is predicted to decrease by two million by 2030 but disproportionality effect regions such as Africa. This scoping review investigated: what is known about current nurse workforces and shortages and what can be done to forestall such shortages?

Published documents from international organisations with remits for nursing workforces, published reviews with forward citation and key author searches.

Addressing nurse shortages requires a data informed, country specific model of the routes of supply and demand. It requires evidence informed policy and resource allocation at national, subnational and organisation levels.

The definition in law, type of education, levels and scope of practice of nurses varies between countries raising questions of factors and evidence underpinning such variation. Most policy solutions proposed by international bodies draws on data and research about the medical workforce and applies that to nurses, despite the different demographic profile, the work, the career options, the remuneration and the status.

Demand for nurses is increasing in all countries. Better workforce planning in nursing is crucial to reduce health inequalities and ensure sustainable health systems.

Research is needed on: the nursing workforce in low income countries and in rural and remote areas; on the impact of scope of practice and task-shifting changes; on the impact over time of implementing system wide policies as well as raising the profile of nursing.

Achieving population health, universal health coverage and equitable access to health care is dependent on having a health workforce that is of sufficient capacity, capability and quality to meet epidemiological challenges and changing demand 1 . The World Health Organization (WHO) predicts increased global demand for health and social care staff with the creation of 40 million new jobs by 2030. 2 Professionally educated nurses are numerically the largest professional group in most countries and comprise about half the global healthcare workforce. 2 In 2014, WHO and the World Bank calculated a global shortage of 9 million nurses and midwives. They predicted this will reduce by 2030 to 7.6 million but it will have a disproportionate impact on regions such as Africa. 3 This scoping review 4 addressed the questions: what is known about the current nursing workforce, how are shortages calculated and why do shortages of nurses arise, what can be done to forestall such shortages in a national and global context and where are the evidence gaps?

A scoping review maps out the breadth of issues, identifying areas for policy and research. 4 The review has drawn on the publications of international organizations with remits for health workforce (WHO, Office of Economic Co-operation and Development[OECD]) and nursing (International Council of Nurses [ICN]), reviews concerned with nursing workforce and shortages identified through database searches (SCOPUS, Medline, CINAHL 1-1-2008–1-12-2018) and follow up of cited literature and key authors. The review excluded literature concerned with midwives and nurse-midwifes.

WHO estimated 21 million nurses/midwives 2 globally in 2014, although there are variations in definition and deployment, which we explain later in this section. Despite the 2008 global financial crisis, the number of nurses has grown in many countries 5 . The absolute numbers range from over 3 million nurses in large countries such China, India and the United States to under 5000 in smaller countries such as Guinea, Iceland and Jamaica 3 . Many countries, however, have very little data on the distribution, types or trends of their nursing workforce that contrasts with information held about the medical workforce 2 .

Nurse shortages have to be considered in the context of international variation in health system development, size of the economy, the population size as well as the presence of other key health professionals, the most important of which is medicine. The international variation in ratio of nurses to population and doctors is illustrated in Table 1 .

Examples of variation by country in ratios of nurses to population and to doctors in 2017 or nearest year data available

Data compiled from four OECD sources 5 , – 8 .

The figures in Table 1 , however, mask some fundamental variations as to who counts as a nurse; not all countries have legislation to protect the title and education level of ‘nurse’ 9 . Registered nurse (RN) academic levels also vary; for example, in Europe RN education is at diploma level in seven countries, e.g. Luxembourg, but at degree level in others, e.g. United Kingdom (UK) 10 . Some countries regulate multiple levels of nurse, such as practical nurses and advanced practice nurses. Regulated practical nurses have different names: enrolled nurse (Zambia), licensed practical nurses (US), nurse assistant (Ghana) and nurse associate (UK). Advanced practice roles are those in which RNs, with additional training, undertake diagnostic and treatment roles traditionally the domain of the doctors. Like practical nurses, these are variously named: nurse clinician (Botswana), nurse officer (Lesotho) and nurse practitioner (US). Advanced practice roles and education are not always regulated, for example as in the UK 11 . Some countries also have nurse anaesthetists who are licensed to provide general and regional anaesthesia independently. Countries that have nurse anaesthetists include: Sweden, 12 the US that has over 42 000 13 and Ghana where, regulated by the General Medical Council, there are 14 nurse anaesthetists to every one doctor anaesthesiologist 14 . The scope of practice of nurses also varies. For example, in some countries, RNs have legal authority to prescribe pharmaceutical drugs independently although there are differences as to which nurses (on registration or with additional education) and which classes of drugs 15 . The extent of the scope of practice and advanced practice roles in any country reflects historical and contemporary issues including shortages or mal-distribution of doctors as well as support or otherwise from medical professional bodies.

Four further points are relevant in considering the global nursing workforce and shortages. Firstly, 90% of nurses are women 2 . Even in countries where there have been active programmes to increase the recruitment of men, such as the US, less than 10% are male 16 . Secondly, in most countries the majority of nurses earn less than the average wage of that country 2 . There is some evidence that male nurses on average earn more than female nurses 16 and that nurses from minority ethnic backgrounds earn less and are under-represented in senior grades than those of majority ethnic origin (see for example evidence from the UK 17 ). Thirdly, the majority of nurses are employed within hospitals (see Table 2 ) despite broader international policy aims of strengthening primary care. Lastly, the majority of nurses are salaried employees although in a few countries some practice as independent, self-employed professionals as in the infirmiers liberales in France (see Table 2 ) 18 . Taking into account these similarities and variations in the education, deployment and scope of practice of nurses, we turn now to consider shortages of nurses and the causes.

Nurse employment in different sectors from five exemplar high-income countries in 2018 or nearest year

Data Sources US Bureau of Labor Statistics 19 , Australian Health Workforce 20 , NHS Digital England 21 , Japan Nursing Association 22 , Ministère des Solidarités et de la Santé 23 .

* National Health Service only, ** Infirmiers liberale in primary care.

Calculating shortages

Definitions of ‘shortages’ in workforce are policy contingent and vary between health care systems. Criteria of ‘hard to fill vacancies’ or trends in ‘volume of current vacant posts’ are often used to describe health systems experiencing financial and demand pressures 24 . The latter measure is used currently in the National Health Service (NHS) in the UK and has been reported to have an upward trend over the previous 3 years 25 . A more prosaic definition of national shortages is whether RNs are on a government’s occupation shortage list for inward migration, as they are for Australia 26 and the UK 27 but not for the US 28 , at the time of writing.

In contrast, there are those definitions of shortages that flow from staff planning projections. These calculate any gap between the numbers of nurses required (demand for) against the future number available to work (the supply). One such example is from WHO and the World Bank in which shortages are defined as lower than the minimum number of doctors and nurses per head of population required to achieve population health targets. 3 The targets in this case being 12 of the infectious disease, child and maternal health and non-communicable health specified in the Sustainable Development Goals 3 . Using national data, WHO/World Bank estimated the 7.6 million global shortfall by 2030 with disproportionate impact on Africa and low-income countries. However, many health care systems have other developments beyond minimum targets that create demand for nurses but few have undertaken nurse staffing planning projections at a national level. Only 5 of 31 high-income OECD member countries have modelled their demand for and supply of nurses to 2025. Of the five, four (Australia, Canada, Ireland and UK) predicted shortages and one, the US, predicted a surplus of qualified nurses 29 .

Models of supply of and demand for nurses

WHO offers a system-wide model for the supply and stock of all types of health professionals 2 . We have adapted the model to focus specifically on the supply and availability of qualified nurses (Fig. 1 ). This illustrates the inflows and outflows to the pipeline of supply, to the pool of RNs and to stock of nurses available for employment as nurses. The model applies at national and sub-national levels, where other patterns become more evident such as internal migration from rural to urban areas. All countries face similar problems in the supply of nurses and other health professionals in remote and rural areas 30 . There are some countries, which have an oversupply of nurses, e.g. Philippines as part of ‘export’ model—whereby working age women (often with children) enter other countries as migrants and work in the health system, sending money home to support their families 31 .

Model of the supply of nurses able and willing to participate in a national nurse labour market (adapted from WHO 2 ).

Model of factors increasing and decreasing the demand for nurses.

Shortages occur when demand for nurses outstrips the numbers of nurses available for employment. An overarching factor influencing demand is the economy; for example, vacant nurse posts were frozen following the 2008 global financial crisis in countries such as Iceland 9 and Kenya 32 . Many factors influence the demand for nurses and we offer a model of these in Figure 2 . However, the extent of the demand for nurses is country and time specific. For example, there was increased demand in Thailand in the late eighties when a strong economy was the catalyst for the growth in private hospitals 33 and currently in the US where state legislation specifies the ratio of RNs to in-patients 34 . The volume of internationally educated nurses in a country maybe an indicator of a shortfall against demand or may be the custom and practice for the supply of nurses. For example, the Netherlands has had less than 1% foreign-trained nurses in its workforce consistently over the past 15 years while others such as the UK, Australia and New Zealand have consistently had over 14% in the same period 5 .

What attracts nurses to jobs and why do they leave?

Individual : skills and interests, career plans, caring/family responsibilities, financial responsibilities.

Job characteristics : remuneration, other financial benefits (e.g. health insurance, pension), hours and pattern of working, type and volume of work, physical and/or emotional intensity of work, variety of work, team working, level of responsibility/autonomy, clinical and managerial support, professional support.

Organization : clinical and employer reputation, type (e.g. private, public), size of organization, size of specialties within an organization, infrastructure to support employees (e.g. child care facilities, meal and social facilities), access to professional and career development activities and/or funding for these.

Location : urban, sub-urban, rural, proximity to family and/or other services such as schools for children.

Macro and meso level factors in the home country with the perceived converse in the country of destination : weak economy, political instability and/or civil unrest, unemployment of nurses, low status of nurses, poor working conditions, few opportunities for nurses for career progression.

Personnel level factors : desire for different cultural, life and/or health system experience, perceived opportunity for better financial rewards, perceived opportunity for improved quality of life for family and children, following already established partner or family network in the destination country, opportunity for career advancement and/or education.

Trying to understand why nurses leave and what retains nurses in their jobs has been a perennial question; the first Lancet Commission into shortages of nurses in the UK was published in 1933 39 . Innumerable literature reviews on the subject in the intervening years demonstrate the interlocking range of factors at individual, organizational and the broader socio-economic level 40 . A recent umbrella review of systematic reviews investigating the determinants of nurse turnover (leaving their jobs) in high-income countries reported that most studies focused on ‘individual’ factors influencing ‘intention to leave’, i.e. plans rather than actual leaving 41 . Most of the evidence reported was at the individual level; high levels of stress and burnout, job dissatisfaction and low commitment was associated with intention to leave. The few studies looking at intentions to remain found this had a strong association with good supervisor support 41 . However, there was an absence of studies that considered the interplay of factors at multiple levels (e.g. individual, job characteristics, organizational characteristics and the wider labour market) on actual leaving rates of RNs or on any subgroups, such as those with caring responsibilities 41 . The International Council of Nurses has also noted there is a paucity of evidence that has considered turnover and retention of nurses in low-income countries 42 . We turn now to consider the evidence for action to solve the shortages and mal-distribution.

The WHO calls for greater investment in all human resources for health and advocates for policy attention across the system of production, regulation and employment 2 . Most commentators on nursing shortages make similar arguments that policy attention needs to be paid to all elements (known as policy bundles) and avoid policy making that relies on oversimplified linear thinking. The evidence to support this comes from high- and low-income countries where programmes that focused only on increasing the numbers entering nurse training, have failed to make an impact on increasing numbers entering the workplace or reducing gaps in priority areas with a history of shortages. Subsequent analysis has identified multiple reasons for this failure including: insufficient infrastructure for clinical education, weak regulation of education standards and few posts to apply for, see for example the review from Sub-Saharan African countries 43 . This is not to argue that increasing numbers entering nurse training is inappropriate, but should be seen as one lever among a policy bundle, including for example, retention measures. The UK and the US provide interesting comparisons, in that one (the UK) has reduced nurse training numbers over the past 15 years, has significant numbers of vacancies and plans to rely on internationally trained nurses over the next few years, while the other (the US) has significantly increased nurse graduates over the past 15 years and does not count nursing as a shortage occupation 44 .

Drawing on commentaries and WHO strategic direction statements for strengthening the nursing and midwifery contribution Table 3 describes policy actions to scale up and sustain the nursing workforce at different levels of the health care system.

Exemplars of policy areas to address improved supply, retention and productivity of nurses

The policy solutions have to attend to the demand as well as the supply side, i.e. to increase RN productivity (for example, working to the full extent of their license, task shifting to assistants, using technologies and community health workers) as well as to produce more and retain more RNs. However, documented evaluations of the impact of the implementation of policy bundles on the nursing workforce are rare not least because of the inter-sectoral nature of enactment and the relatively long period between policy decisions, implementation and outcome. Even where there are evaluations of implementation of policy actions to address shortages, such as the WHO strategy for remote and rural areas, these focus on the medical profession not nurses 45 .

At the micro level (organization/service delivery level), good human resource management practices are known to reduce the rates of voluntary turnover in all industries 46 . An umbrella systematic review considered interventions to reduce turnover rates of nurses (i.e. to retain them in their posts) in high-income countries 47 This review found relatively weak evidence for most interventions but there was strong evidence of positive impact for transition programmes and support for newly qualified nurses 47 . There was also evidence that nurse manager leadership styles that were perceived as encouraging work group cohesion were also effective in reducing turnover 47 . Positive working environments are those that not only ensure the nurses well-being but sustain or increase their motivation in their work. There is some evidence that many RNs (like many physicians) in high-income countries consider that they are not working to the full scope of their training and are undertaking work that could be undertaken by others 44 . However, task shifting, shifts in jurisdiction and changes in skill-mixes in teams raises questions of adequate preparation, patient safety and cost effectiveness—all of which require consideration within specific contexts. For example, a growing body of evidence in high-income countries demonstrates a relationship between RN staffing levels and patient safety in acute in-patient hospital settings. Recent research on in-patient hospital care in the UK demonstrates that lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital and that use of nursing assistants does not compensate for reduced RN staffing 48 . There are significant gaps in evidence for the most effect ways of increasing RN productivity as well as attracting and retaining RNs in the workplace that requires attention to be given to the macro and overarching issues in every health system.

The first major gap is in relation to nursing workforce planning. Workforce planning at a national level is an inexact science and is often absent for nursing, which is in contrast with medical manpower planning. To plan for solutions, you need to understand the scale of the problem, which in the case of nursing, is limited by the significant evidence gaps. For example, at the national level, nursing workforce data is often incomplete and based on historical activity rather than projections. The 2016 WHO resolution on human resources for health urges all countries to have health workforce-related planning mechanisms and has introduced national health workforce accounts with core indicators, including ratio of nurses to population, for annual submission to the WHO Secretariat 1 . However, this could be considered the minimum requirement for benchmarking rather than proactively modelling the future demand for nurses, the availability and supply of nurses and planning to meet the gap or shortfall. This then flags the next gap—the evidence to base the planning decisions on.

The second major gap is the evidence informing policy decisions about interventions that work to attract, equitably distribute, retain and sustain a nursing workforce against the requirements of any health care system. It is noteworthy that the WHO guidance for scaling up and retaining all health care professionals 2 is predominantly evidenced from studies of doctors, thus further emphasizing this gap in the evidence. The demographic profile, status, education, career options and remuneration levels for these two professions are very different and assumptions that evidence from one professionally is automatically applicable and relevant to the other is contestable and at worst misleading.

Overlaying these gaps in knowledge there is an issue, common across many countries as noted by WHO 2 , that the profession of nursing has not been valued and given the policy attention congruent with its scale. Having a weak voice and influence in national and international health workforce policy development has inevitable consequences, which in this context means that fewer levers are available to address shortages and action is slow. At the time of writing, there is a global WHO-sponsored campaign called Nursing Now (2018–20) ( https://www.nursingnow.org/ ) that supports country-specific campaigns and activities to raise the profile of the nursing profession, develop leaders for governments and to make change at a systems level. This is involving nurses in policy making, particularly with regard to increasing and retaining the nursing workforce. The response to, and impact of, these calls for country-specific campaigns is yet to be evaluated.

This review has demonstrated that that the nature and size of the professionally qualified nurse workforce is shaped by the societal context of individual countries—political choices that influence decisions about resource allocation to health systems, demographics (labour market pressures on working age, particularly of women), image of nursing and its positional power in relation to medicine, demands for care/health and social inequalities. Understanding nursing shortages and acting on them requires attention to the gaps in knowledge and evidence but also the wider societal context of nursing.

This review was undertaken without external funding.

The authors have no potential conflicts of interest.

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• 2 Loma Linda University
• PMID: 29630227
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Nurses are a critical part of healthcare and make up the largest section of the health profession. According to the World Health Statistics Report, there are approximately 29 million nurses and midwives globally, with 3.9 million of those individuals in the United States. Estimates of upwards of one million additional nurses will be needed by 2020.

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Conflict of interest statement

Disclosure: Lisa Haddad declares no relevant financial relationships with ineligible companies.

Disclosure: Pavan Annamaraju declares no relevant financial relationships with ineligible companies.

Disclosure: Tammy Toney-Butler declares no relevant financial relationships with ineligible companies.

• Definition/Introduction
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Nursing Shortage or Exodus?

A new report claims that hospital practices are undermining nursing.

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Solving the nursing shortage, rn shortages negatively impact patient safety, the current state of nursing, tackling the nursing workforce crisis, the nursing shortage: foreign-educated workers are only a stopgap.

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• Published: 27 July 2024

Intent to leave academia: perceptions and challenges of nurse faculty

• Nouf Afit Aldhafeeri   ORCID: orcid.org/0000-0002-0885-1753 1 , 2 , 3 &
• Fadiyah Jadid Alanazi   ORCID: orcid.org/0000-0001-5457-8404 4  

BMC Nursing volume  23 , Article number:  506 ( 2024 ) Cite this article

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The shortage of nursing faculty is a significant global issue affecting the nursing profession. Faculty turnover can negatively impact the institution by decreasing the number of qualified nursing faculty and disrupting the educational process. The cost of replacing departing faculty and recruiting and training new faculty may increase.

To describe perceptions of nursing faculty of intentions to leave academia and to identify challenges that contribute to nurse faculty turnover in academic setting.

A descriptive naturalistic, qualitative approach is used to explore nurses perceptions and intentions to leave academia.

The themes identified were unexpected journey, with two sub-themes, lack of role clarity and lack of preparation/orientation, and work environment, with four sub-themes: low Salary, workload, lack of support and favoritism.

The urgency of addressing the factors that contribute to nurse faculty intending to leave academia cannot be overstated. The results of this study have direct implications for nursing schools’ administrators, where these findings can provide them with, valuable insights that they can be used to implement best practices and mitigate the problem of nursing faculty turnover.

Peer Review reports

The nurse faculty shortage is a significant and increasing concern in academic nursing communities with far-reaching implications for the nursing profession [ 1 ]. Nursing students’ educational and clinical requirements are inadequately addressed due to a shortage of qualified nursing faculty [ 1 ]. Critical problems within nursing academia revolve on the intent of nurse faculty members to withdraw from academia and the barriers they encounter. Nurse faculty play a central role in shaping the future of nursing by educating and mentoring the next generation of healthcare professionals. When qualified professionals leave academia, this leads to a significant deterioration in the quality of nursing education and poses a threat to the healthcare system. The departure of specialists from the academic field therefore means that new teaching staff must be trained and the workload for the remaining teaching staff increases.

Comprehending the underlying causes of the nurse faculty shortcoming will facilitate the development of mitigation strategies. Implementing research-based strategies, including supportive work environments, improved management practices, and competitive salaries, can help mitigate nursing faculty shortages, attract and retain skilled educators, and safeguard the nursing profession.

Recent studies have shown that more nurses are expressing their intention to leave the academic world [ 2 , 3 , 4 ]. Furthermore, a comprehensive investigation has been conducted to reveal factors that lead to the departure of nursing faculty members from academic institutions.

A 2017 Ethiopian study revealed that an unhealthy work environment, insufficient facilities, poor management, and dissatisfaction with salaries are the main contributing factors for faculty members to leave academia. Out of 217 faculty members, 164 expressed their intention to leave, with 71.3% identifying this as a critical issue. Inadequate basic amenities and compensation also played a significant role in their decision to leave the academic community [ 2 ].

A Finnish study in Finland found that 50% of 3,760 participants expressed turnover intention, primarily due to lack of professional commitment, dissatisfaction with the school system, and heavy workload. Addressing these issues is crucial as faculty turnover can negatively impact institutional progress. Investigating these issues can help create a healthy working environment and promote faculty retention [ 3 ]. Ulmen and Lloyd found that 23.3% of nursing faculty experienced burnout and compassion fatigue, negatively affecting their intent to stay in academia [ 4 ]. Factors such as high workload [ 5 ], poor work quality [ 6 ], unsupported environment [ 7 , 8 ], job dissatisfaction, and low commitment [ 8 ] contribute to faculty intent to leave academia. Addressing these predictors can help improve the work environment, reduce burnout, and enhance faculty satisfaction, retaining experienced faculty and ensuring quality education.

A study conducted by Roughton on the intentions of nursing faculty to leave identified several critical factors that influenced their decision, including retirement, workload, salary, career development opportunities, performance recognition, and work-life balance. These factors were all influenced by the six-domain model of the healthcare system, regulatory environment, financing system, education system, technology, and work environment [ 10 ]. Other factors that contribute to the retention of nurses include job satisfaction, education level, and age [ 11 ].

An alarming decline has been seen in the number of qualified nursing faculty members in the US. In 2019, the American Association of Colleges of Nursing (AACN) reported a faculty vacancy rate of 7.2% [ 12 ]. This vacancy rate denotes the proportion of faculty positions that remain vacant in nursing schools throughout the US. The academic milieu, salary, incivility, excessive burden, and faculty aging are among the numerous factors that contribute to lower faculty retention, as documented in the literature [ 13 , 14 , 15 ]. It is evident from the literature review that, even though a significant amount of research is dedicated to strategies for faculty retention, there is a need for additional research to concentrate on the retention of current faculty.

Faculty retention can begin with solid academic leadership within the institution and individual schools/colleges of nursing. Research shows that support and empowerment from deans and other leaders plays a critical role in improving faculty job satisfaction and fostering their intent to remain in their faculty role [ 16 , 17 ]. Mentoring for new faculty members is an effective strategy to increase faculty retention [ 18 , 19 ]. By providing guidance, support, and professional development opportunities, mentoring programs can help new faculty members navigate the challenges of their role and build a solid foundation for their academic careers. Mentoring can build confidence, foster teamwork, and enable the growth of new nurse faculty. The relationship between mentor and mentee promotes greater job satisfaction, making it an effective tool for faculty retention [ 18 , 19 ].

Most research on faculty retention and intent to leave academia has relied primarily on quantitative methods. Aquino et al. conducted a quantitative study to explore burnout and intent to leave among nursing faculty in the US [ 20 ]. In particular, the study examined the differences between faculty with a PhD and those with a DNP degree. Participants considered novice faculty with five years or less of academic teaching experience experienced higher levels of stress, exhaustion, and burnout, possibly due to the demands associated with tenure-track requirements. However, the authors pointed out that a limitation of this study is that it did not include qualitative data collection. Therefore, to gain a deeper understanding of burnout in academia and the reasons for wanting to leave academia, it would be valuable to conduct interviews with participants and understand their feelings in depth. Such qualitative findings could shed further light on the experiences and motivations related to burnout and faculty turnover.

Turnover rates among nursing faculty pose challenges to maintaining a stable workforce, potentially disrupting nursing education and affecting healthcare delivery quality. Further qualitative research is needed to understand faculty perceptions of academia and their intentions to leave their positions in Saudi Arabia. This will contribute to nursing knowledge and help nursing administrators develop effective strategies to address this issue. Further studies are needed to understand faculty perceptions and develop effective strategies.

Significance of the study to nursing administration

The study is relevant to nursing administration, particularly in Saudi Arabia, as it provides insight into the views of nursing faculty who intend to leave academia. Faculty turnover has a significant impact on nursing education as it can affect student performance and reduce revenue for nursing schools. Therefore, nursing administrators need to explore and address the factors that contribute to faculty intentions to leave academia in order to address the nursing faculty shortage.

The results of this study are promising and can provide valuable insight to nursing schools’ administrators. By understanding the perceptions of nursing faculty regarding their intent to stay in or leave academia, administrators can identify areas for further improvement and development to improve faculty retention. The results of this study serve as a promising foundation for best practices and a guide for further implementation of effective interventions to support faculty members and encourage their retention to remain in their academic roles. Nurse leadership can help create a stable and supportive environment that foster faculty satisfaction and engagement to ensure quality education for nursing students and contribute to a sustainable nursing workforce.

The aim of this study was to describe how nursing faculty members perceive their intention to leave academia. The second objective was to describe perceptions of academic challenges that contribute to nursing faculty leaving academia.

Operational definition:

For the purpose of this study, the term nursing faculty member refers to any faculty member who holds an academic rank or position or classification and teaches courses in nursing, both theoretical and clinical.

This study was conducted among nursing faculty in Saudi Arabia. The researchers used social media platforms (WhatsApp) to reach the participants who met the inclusion criteria for the study. In this social platform, there is a group of nurse faculties from all nursing colleges. A message with a link to the screening questions was sent to the group. All faculty members who were eligible were contacted personally to arrange a meeting. Interviews were conducted using semi-structured interview questions [Appendix 1 ] to gather in-depth knowledge and allow participants to express their feelings, challenges, and reasons for leaving academia. The interview questions were formulated based on the literature review, focusing on participants’ unique perspectives. This approach allows for a comprehensive understanding of participants’ perspectives and experiences, making their voices an integral part of the research. Participant interviews were planned and arranged in collaborative between the researchers and the participants. Interviews were digitally recorded via the Zoom platform to ensure that no valuable information was lost in the analysis. All recorded interviews were transcribed verbatim. Participants were asked to keep the video camera open during the interview to establish a good rapport with the participants and to easily record non-verbal reactions.

Study subjects

The inclusion criteria were nurse faculty currently teaching in Saudi Arabian nursing schools who were thinking of leaving academia based on the screening question, who had been employed as a nursing faculty for at least one year member, and who could communicate in English, as English is the acceptable language in all nursing programs. We excluded faculty who have employed in nursing for less than one year and faculty who are not employed in nursing and who cannot communicate in English.

Study design

The researchers used a descriptive qualitative design that supports a naturalistic approach to understand the perceptions of nursing faculty regarding their intention to leave academia in Saudi Arabia. This study approach captures the unique perspectives and underlying motivations that influences nurses’ decision to leave academia. The naturist approach allows the researcher to maintain the authenticity of the data and present the participants’ experiences without preconceived notions or manipulation of the study variables [ 21 ]. Consequently, this study provided a comprehensive understanding of the experiences of nurses intending to leave academia, their challenges in the broader context of their socialization, and the various influences on their academic role from a holistic perspective.

Sample size

This study reached data saturation with eight participants. The purposeful selection of respondents allowed for an in-depth understanding of a phenomenon. After the five participants, the data was repeated with the same information, and the authors determined that the data was saturated at eight participants.

Sampling technique

In order to recruit participants and comprehensively represent the target participants, a purposive sample was drawn. This type of sampling would help the researcher to search for participants who met the inclusion criteria. This sampling procedure helped to obtain rich information about faculty leaving academia and the challenges that formed the themes of the study.

Data collection and instruments used

Data collection begun after IRB approval was obtained. The researchers used social media to recruit participants (WhatsApp), briefly describing the purpose of the study and providing a link to screen participants, in which they answered two questions and provided the researchers with their contact information. Over the course of three months, data was gathered through one-on-one online interviews, with the utmost respect for the privacy and time of the participants. A professional transcriptionist transcribed the digital audio recordings verbatim and reviewed them for accuracy. To ensure complete comprehension, nonverbal indicators, including body language, were observed, and documented as necessary. Our data had additional enhancements and bias was eliminated by taking notes during the interview.

Demographic information and an informed consent form were obtained from each participant prior to the interview. Zoom was employed to conduct the individual interviews, which was favorable for the participants. The estimated time for each interview was 30 to 45 min. Interviews were recorded via Zoom so that they could for later be transcribed verbatim coded. The interview questions began with general, open-ended questions to build rapport and trust with the participants, followed by questions related to targeting the participants’ beliefs about leaving academia. Then, additional probing questions were asked based on the participants’ responses. The interview procedure was designed to gather data until saturation was reached.

Data management and analysis plan

After the data had been collected and transcribed by a professional transcriptionist, the researchers checked the transcription for accuracy. The data obtained from the transcriptions were then analyzed using a five-step process described by Barritt et al. [ 22 ]. This process was designed to systematically analyze qualitative data and identify significant themes and patterns within the data. The researchers read the transcript and identified significant elements, statements, or ideas that emerged from the interview data. The researchers then began to group similar ideas or concepts and assigned preliminary themes to these groupings. To ensure the accuracy and validity of the analysis, researchers solicited input and clarification from participants, which can add depth to the analysis. The researchers compared the narratives of different participants to identify common themes that emerged across many interviews and to find unique themes. Finally, the researchers examined the literature on nurse faculty intending to leave.

Study rigor

Lincoln and Guba’s four criteria of credibility, dependability, confirmability, and transferability were implemented to ensure the study’s rigor [ 24 ]. The credibility of the findings was established through member checks. These checks involved sharing transcript summaries and initial interpretations with participants, seeking feedback and validation, and ensuring accurate representation of participants’ perspectives. Participants with experience who intended to leave academia were chosen to maintain trustworthiness and data rigor. The dependability of the data was enhanced by following the audit trail and field notes and storing all reflections throughout the audit. The data were reviewed and confirmed to ensure that they matched with the participants’ responses. To further enhance the confirmability of the findings, two expert researchers verified the accuracy of the data analysis. Personal biases and assumptions were documented in journals. To ensure the transferability of the findings, participants from various nationalities, regions, years of experience, and positions were included in this study. Member-checking, peer debriefing, audit trials, and reflexivity were used to verify data accuracy [ 25 ].

Confidentiality

The researchers ensured that any involvement in the study was entirely voluntary. Researchers protected the privacy of the participants by using numerical identifiers instead of their actual names. The researchers confirmed that no information about the university would be recorded or shared. All research-related materials, such as notes, transcripts, consent forms, reflection journals, and audio recordings, were maintained securely stored on a computer that require password for access. Only approved researchers were able to access this computer. To prevent any unintended interruptions, the researcher used a waiting room feature during the Zoom interview session.

Characteristics of participants

The researchers invited 83 participants from different Saudi nursing schools. Only eight participants responded to the screening tool; however, data saturation was achieved. Interviews lasted between 30 and 45 min (mean = 35 min). Participants were Saudi and non-Saudi faculty members. Participant’s data included two faculty members from northern Saudi Arabia, two from western Saudi Arabia, one from central Saudi Arabia, and one from eastern Saudi Arabia. Most of the sample was female ( n  = 7). One participant was from a private school and the rest were from public schools (Table  1 ).

The process of data analysis was meticulously conducted and resulted in the generation of two main themes that answered the research questions comprehensively.

Unexpected journey

The theme “Unexpected journey” with two sub-themes, namely lack of role clarity and lack of preparation, answered the main research question, “: What are the nursing faculty’s perceptions of intent to leave academia? (Table  2 )”.

Lack of role clarity

The initial perception of the faculty was exhaustion from working in the academic environment. Although the faculty members wanted to be in academia because of their passion as educators and their belief that they are good educators, they were surprised after almost 3 to 4 years of experience. They thought about leaving the academic world. The majority of faculty members were taken aback by the demands of academia and did not anticipate that they would consider departing. One participant said, “ I thought I would come to teach some materials. Teach some components. Give some lectures, and that is it. However, the academia is mixed between teaching, documenting, and doing administrative duties .” In addition, participants pointed to role ambiguity, a term used to describe the lack of clarity or understanding about one’s responsibilities and expectations in a particular role. Participants mentioned, ” All we need is an organization for the rules of academic staff from the beginning.” They also stated, “I thought it would be organized and easy to work, and I would have at least a job description; however, I felt I liked working in a bizarre environment. For example, I was often unsure about whether I was expected to focus more on research or teaching, and this lack of clarity made it difficult for me to prioritize my tasks.”

Lack of preparation/orientation

Faculty are concerned that once they start working in academia, they have no preparation to ease their transition. One participant said, “It was not clear to me the role of the faculty at that time, I found there were some management sides not only teaching ………, you know, paper quality work, and I thought it was maybe a piece of cake, compared to the clinical site. It might be more accessible. I thought so .”

Other participants said, “I have three years now. I did not see myself involved in academia yet, not at all.” Another participant mentioned that “ they expect us to do everything at the beginning. Without orientation, for example, the quality of work. This is a big commitment and has too many details. They let me be the head of the quality committee without knowing anything. I was stressed about how to meet their expectations or goals.” The participants felt that “the organization…. need to prepare new faculty for the work environment and/or the roles of the academic staff.”

Following their completion of their degrees abroad, some Saudi Arabian faculty members returned to their respective institutions with a fervor for their professions. Nevertheless, they are considering leaving from academia after encountering the workload without adequate preparation.

Work environment

The second research question “What challenges in academia contribute to nurse leaving academia?”, addressed the theme of work environment and its sub-themes, including low salaries, workload, lack of support and favoritism. Most participants expressed dissatisfaction with the working environment in academia.

Low salaries

Several individuals expressed discontent with their current pay and were actively seeking other alternatives, such as employment in the private sector or with other firms.

One participant explained, “ Comparing to the salaries that I would receive, it is very compelling for me…to have an appealing offer. Why not? Why would I stay in a place where I’m feeling stressed out when I’m feeling left out, left behind, ignored, overlooked, and disrespected? Not appreciate it. At the same time when I can go somewhere else and get more respect .” Another participant mentioned that “ the salaries are not equivalent to the stress and the effort that we spend, and the time that we spend working on many things.” A female faculty member contemplates the prospect of venturing into areas that need a female workforce to fulfill the goal of promoting female empowerment by 2030. Participant 5 said, “I am thinking about going to companies or something in business, private sector because they have many chances, or on top of opportunities because they are looking for a female. They have the positions.”

The majority of the participants emphasized that nursing faculty have a lot to do. Participants noted that they have to take care of quality, teaching, administrative work and the development of original research. One participant explained “…. stress because of the workload. We have an extra teaching load. We have administration loads. So even if I am not in an administration position, I need to work in the administration work .” Another participant stated, “ I teach up to fourteen credits per semester. I have no time ”. Other participants expressed that the workload “ keeps me away from teaching students as well as conducting research and community services. ” In addition, participants were also unsatisfied with the distribution of work and committees among staff. They recognized that the workload came from the administrative staff and the head of department because they “dumping the responsibilities onto you.” Another participant stated that “ they let me be the head of the quality committee without knowing anything .”

Lack of support

When we asked participants about the factors that affected their feelings about leaving academia, almost all participants agreed that there was a lack of support in addition to the heavy workload. One participant mentioned that “ we need motivation. Even if we have Ph.D., we need support from the administration in terms of career guidance and mentorship.” Another participant explained: “we need support not only financial but can be research support and allowances such as funding for conferences and research materials.” Participants needed the support to be close to them and to understand their feelings. Participants mentioned that “ the support is important, and we also need to have people who believe these are things, or situations need to be changed…you need to be close to the faculties and understand their issues .”

Other participants added that the allowance and promotion are rigorous, which limits motivation to stay academically. “ The promotion process is complicated, and the allowances they did not give you all the time you have to complete your credit hours and apply for that every semester.” Participants felt that they needed support and appreciation for their work. One participant said, “ The lack of appreciation, or even sometimes respect, sometimes of the managers they do not even have appreciation or respect to what you are doing .” Participants emphasized the need to be involved in decision making to support them and to ensure that the faculty are satisfied and working effectively. One participant said: “Shared a decision making is important,……. it will support us….”

Some participants expressed concern about favoritism in the work environment. For example, when some managers do not believe in the abilities of faculty members, they do not assign them work and allow other faculty members to serve on many committees. This has led to a sense of marginalization and demotivation among faculty members. One participant stated, “ Some people will have some favorite group of people; you will see these people if I would say the higher administration . ” Another participant said that “ having them as best will be involved in everything, and others will be excluded.” These issues not only affect faculty morale but can but also affect the quality of work and overall productivity.

Saudi and non-Saudi faculty members teach nursing students at Saudi Universities. The nurse faculty shortage is a global issue; administrators need to retain them and increase faculty retention. Investigating the reasons for faculty attrition intentions will help find a solution to the faculty shortage problem. Two main themes emerged from the data analysis: an unexpected journey with sub-themes of lack of role clarity and lack of orientation/preparation; the second theme was work environment with sub-themes of low salaries, workload, lack of support and favoritism. These findings emphasize the need for improved role clarity, better orientation and preparation for new faculty, and a supportive work environment to increase faculty retention and address the issue of nurse faculty shortage.

The theme of the unexpected journey related to the transition from clinical practice to academia explains the sense of shock of the participant who did not expect this journey. Overall, the participants was ready to work and excited to put all their effort into the academic world. However, after years of experience, they were faced with an unexpected journey. This theme relates more to faculty with one to three years of experience who are considered new faculty. Several research studies have found similar experiences to this current study that examined the experiences of nursing faculty [ 11 , 26 , 27 ]. Study participants explained their journey as frustrated and unprepared for their academic work and needed a clearer understanding of their role as faculty members.

The sub-theme represents the participants’ feeling that their role is unclear, that they are struggling and that their work is frustrating. The faculty role is different from the clinical and practicum role. Therefore, the transition from a practitioner role to an academic role caused a lack of role clarity. This finding is similar to several studies looking at nurses’ experiences in an academic setting in which a lack of role clarity has a negative impact on faculty members [ 26 , 27 , 28 ]. Participants in this study stated that they felt lost when they did not have a clear understanding of their academic responsibilities and expected role. Similar results were found [ 27 , 31 ] where first year faculty members experience role uncertainty and deal with a lack of self-confidence. These previous studies supported our current finding where faculty thought their role was only teaching and they experienced a lack of clear role descriptions [ 31 ]. These findings have significant implications for nursing education and practice as they point to the need for clearer role definitions and support for faculty moving from clinical to academic roles.

The lack of orientation/preparation

The participants in this study felt compelled to leave academia when they experienced a lack of orientation and preparation for work in academia. Most nursing degree programs prepare students for clinical work in the hospital, not for faculty work in academia. Therefore, participants did not feel prepared for teaching work, which increased their willingness to leave academia. The findings of the current study are similar to those of several studies in which new faculty struggle with a lack of orientation and preparation for academic roles [ 26 , 28 , 32 , 33 , 34 ]. One study has shown that preparing faculty members for their jobs increases their intention to stay in academia [ 19 ]. The fact is that most Bachelor of Science Nursing (BSN) degree programs prepare students clinically, rather than theoretically, to work in an academic setting, which can lead to a stressful transition into academia and potentially leaving the profession [ 35 , 36 ]. Many researchers support the idea that orientation programs and preparing faculty for the academic.

environment can significantly increase satisfaction and help retain faculty in academia [ 37 , 38 ].

The topic of work environment was comprehended within the framework of inadequate compensation, excessive workload, insufficient assistance, and favoritism. The work environment was a contributing factor in the participants’ decision to abandon academia, as they emphasized in this study.

Several participants stated that they were dissatisfied with their current salaries. These findings were consistent with previous studies [ 2 , 10 ]. Ibrahim et al., highlighting the pervasive problem of low salaries in practice. Ibrahim et al., found that more than half of faculty members are dissatisfied with their salaries [ 2 ]. Roughton found that faculty members reported that they receive inadequate salaries [ 10 ]. This situation is not unique to Saudi Arabia and could lead nursing faculty members to leave academia and seek outside opportunities where they can receive higher salaries.

All participants agreed that the heavy teaching and non-teaching workload influences their intention to leave. Workload is one of the biggest factors that challenge nursing faculty and cause them to consider leaving academia. This finding is similar to the results of previous studies [ 3 , 5 , 10 ]. Bettini et al. mentioned that prospective educators who reported that their work is unmanageable are emotionally exhausted, which leads them to consider leaving their job [ 5 ]. Similarly, Räsänen et al. found that the main factors were high workload and unequal distribution of work between teachers [ 3 ]. Roughton mentioned that nursing teachers believe that their workload is higher than that of non-nursing teachers, which is increased due to the shortage of teachers [ 10 ]. Thus, the workload could cause nursing faculty members to leave academia.

Most participants agreed that lack support and appreciation would influence their intention to leave academia. These findings are consistent with the results of some studies [ 2 , 10 , 39 ]. Yedidia et al. described that nursing faculty were dissatisfied with the availability of administrative support in their school and the relationship with their school administration, which contributed to their intention to leave [ 39 ]. In addition, faculty were not satisfied with the availability of professional development and rewards. Roughton and Ibrahim et al. found that lack of recognition for performance was a major reason for leaving [ 10 , 2 ].

This is another new finding of this study. Participants expressed that some of their managers favored other faculty members. Participants felt that this was because they wanted to get the work done quickly or that these faculty members supported their decisions even though they knew they were wrong. Favoritism in academia can have a negative impact on individuals, leading faculty to consider leaving academia. Favoritism can cause to unfair treatment of staff and create an environment where certain individuals or groups are given preferential treatment while others are overlooked or disadvantaged. Studies show that favoritism in the work environment can cause to employees’ disengagement [ 40 , 41 , 42 ]. Favoritism can be seen as incivility on the part of the supervisor and undermines the principles of fairness and meritocracy that are critical to maintaining the integrity of academia [ 40 , 41 ]. When faculty that they were members feel that favoritism is at play, it can reduce motivation. Faculty who felt overlooked despite their qualifications and efforts lost their enthusiasm for the work and may have been inclined to leave academia.

Implication for nursing administration and nursing leadership

Nursing faculty members’ intention to leave school can affect student performance and reduce nursing schools’ revenues. In order to reduce the nursing faculty shortage, strategies need to be developed to investigate and manage intent to leave. The knowledge gained from this study can help nursing administrators develop plans to retain, mentor, and support nursing faculty. The nursing administrator must understand the needs of faculty members in order to prepare them and create a supportive environment that fosters their confidence and teaching ability.

The findings of this study address the perceptions and challenges of dealing with the intention to leave among nursing faculty members. Addressing the factors of intent to leave factors may improve faculty retention, satisfaction, and performance, which could impact student performance and increase revenue for schools of nursing. The study has some limitations in its recruitment process regarding the use of social media for recruitment. This procedure could limits access to participants who were not active in social media.

Data availability

Due to the participants confidentiality, data are available from the corresponding author upon reasonable request.

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Acknowledgements

The researcher would like to acknowledge the mentorship and guidance of Dr. Stephanie Jeffers, PhD, RN. Also, the researcher would like to thank the King Abdullah International Medical Research Centre (KAIMRC) in Riyadh, Saudi Arabia and the participants for their participation in this study. The authors extend their appreciation and acknowledgement to the Deanship of Scientific Research at Northern Border University, Arar, KSA for funding this research work. We are grateful to Ms. Atika Al Sudairi, Office of Research for her assistance with the copy-editing phase.

The authors extend their appreciation to the Deanship of Scientific Research at Northern Border University, Arar, KSA for funding this research work “through the project number"NBU-FFR-2024-161-02”.

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Public Health Department, College of Nursing, Northern Border University, Arar, Saudi Arabia

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N.A did the conceptualization, introduction, interviews, analysis, and discussion. F.A did the methodology part, the results, the interviews and the data analysis, discussion. All authors edited, reviewed, and approved the manuscript prior the submission.

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Aldhafeeri, N.A., Alanazi, F.J. Intent to leave academia: perceptions and challenges of nurse faculty. BMC Nurs 23 , 506 (2024). https://doi.org/10.1186/s12912-024-02137-y

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What’s Really Behind the Nursing Shortage? 1,500 Nurses Share Their Stories

• Survey Results
• What Is the Nursing Shortage?
• Reasons Nurses Quit
• Hope For the Future
• What Nurses Need Now
• How to Take Action

Winner of the Gold Award for the Digital Health Awards, Best Media/Publications Article, Spring 2022

Update 10/10/2022

The findings of  Nurse.org's 2021 State of Nursing Survey revealed some harsh truths about the profession but also spoke to the strength, perseverance, and passion that nurses have for their work. Nurse.org has relaunched the State of Nursing survey in 2022 with the aim to capture a complete picture of the true state of the profession - from how nurses feel about work, how nurses are being treated, how nurses feel about the future of nursing, nurse's mental wellbeing and what nurses think needs to change within the profession. Take the survey now (it takes less than 10 minutes.)

>> Take Nurse.org's NEW 2022 "State of Nursing Survey" and let your voice be heard about issues in nursing that matter most. 

January 26, 2022

If the past two years have taught the world anything, it's that nurses are NOT okay. The truth is that despite the 7 pm cheers, the commercials thanking nurses for their dedication and selflessness, and the free food from major retailers – the overwhelming majority of nurses are burnt out, underpaid, overworked, and underappreciated.  

With millions of nurses worldwide, Nurse.org wanted to truly understand the current state of nursing and give nurses a voice to share their thoughts, feelings, and apprehensions about the nursing profession. We surveyed nearly 1,500 nurses to find out how they felt about the past year and get to the real reasons behind the nursing shortage . The responses were heartbreaking, but not without hope.  

What We Found: Nurses Are Struggling

Nurses are struggling. Regardless of practice specialty, age, or state of practice – the answers were all the same. Nurses, NPs, and APRNs are all struggling and need help.  

Only 12% of the nurses surveyed are happy where they are and interestingly, 36% would like to stay in their current positions but changes would need to be made for that to happen. Nurses report wanting safe staffing, safer patient ratio assignments, and increased pay in order to stay in their current roles.  

Nurses didn’t hold back when discussing their feelings regarding the current state of nursing:  

• 87% feel burnt out 
• 84% are frustrated with administrators 
• 84% feel they are underpaid 
• 83% feel their mental health has suffered 
• 77% feel unsupported at work 
• 61% feel unappreciated 
• 60% have felt uncomfortable having to work outside of their comfort zone in the past year 
• 58% of nurses have felt frustrated with their patients 
• 58% of nurses have felt unsafe at work in the past year 

The numbers don’t lie. It’s astounding that a profession continually recognized for its compassion, strength, and resilience is suffering . And the suffering is universal.  

One nurse responded with the following, “I have been an RN for 34 years and in my specialty of nursing for 31 years and I am burned out.” 

What Is the Nursing Shortage and Why is it Happening?

You’ve likely heard about the nursing shortage, but what does that mean and why is it happening? 

According to the U.S. Bureau of Labor Statistics (BLS) , the employment of registered nurses is projected to grow 9% from 2020 to 2030.  Approximately 194,500 openings for registered nurses are projected each year, on average, over the decade. However, this number was projected prior to the pandemic, and before the mass exodus of bedside clinical nurses. As a result, it’s likely substantially lower than what the real demand for nurses will look like.

The American Nurses Association (ANA) reports that the increased need for nurses spans beyond the current pandemic. In fact, they sent a letter to the U.S. Department of Health and Human Services (HHS) on September 1, 2021, urging the country to declare the current and unsustainable nurse staffing shortage to be a national crisis. 

The ANA attributes the needs for thousands of nurses to the following:  

• The Affordable Care Act made access to health care services possible for more people
• Increased focus “primary care, prevention, wellness, and chronic disease management” 
• Aging baby-boomer population
• Growing interest in community-based care

Why Are Nurses Really Leaving The Bedside? 

However, those stats don’t address some of the systemic issues nurses face every day, particularly in the midst of a pandemic. That’s why we asked nurses why they are really leaving the bedside.

What we heard is that, overwhelmingly, the number one reason nurses want to leave the bedside is because of unsafe staffing ratios. This leads to a never-ending cycle of shortages: nurses face unsafe staffing ratios so they decide to leave the bedside, this results in even fewer nurses available to care for patients, so the downward cycle continues.

Essentially, nurses are dealing with an increased workload with fewer resources. Typically, pre-covid ICU nurses would experience a 1:1 or 2:1 patient-to-nurse ratio. Now ICU nurses throughout the country are experiencing a 3:1 or 4:1 patient-to-nurse ratio which exacerbates staff burnout and unsafe nursing practices.  

One nurse reported, “With increased patient census, staffing ratios are very unsafe especially with high acuity patients. Having 4+ critically ill patients not only puts licenses at risk but the patients do not benefit at all. We’re just running around doing tasks, not providing adequate care.”

Unsafe Staffing Ratios Are Just Part of the Problem

While a big piece of the puzzle, unsafe staffing issues are, unfortunately, one part of a long list of issues plaguing nurses today. 

 Nurses are leaving the bedside because of issues like: 

• Inadequate staffing ratios 
• Not getting equal pay for equal experience 
• Not receiving hazard pay during a pandemic 
• Not having adequate back up 
• An inability to take breaks, sick days, or even turn down extra shifts 

To learn more about the nursing shortage and learn ways you can get involved, check out the full report here . 

Despite All This, Nurses Still Have Hope

70% of nurses still think that nursing is a great career and 64% still think that new nurses should join the profession. 

“If you’re a student considering becoming a nurse, please know that you are not walking into a doomed profession. You will never meet anyone who is more determined, more resourceful, or more ready to jump in and lend a helping hand than a nurse." 

--– Nurse Alice Benjamin, MSN, APRN, ACNS-BC, FNP-C, CCRN, CEN, CV-BC, Chief Nursing Officer and Correspondent at Nurse.org

If you’re a nurse, you know that nursing isn’t just a profession, it’s a calling. It’s devastating to see that so many nurses are suffering in their quest to heal and give care, but it’s heartening to know they are not without hope. 

What Nurses Need Now 

If you’re a nurse, know that your job is simply to put yourself first. If we want to solve the nursing shortage (and we do!), it can't happen without nurses recognizing that they are NOT the problem. 

"The problem is not with nurses or nursing; the problem is that nurses have been so busy taking care of others that no one has taken care of them. And we’re here to change that--and by entering the nursing profession, you will be part of the solution too”

 – Nurse Alice Benjamin, MSN, APRN, ACNS-BC, FNP-C, CCRN, CEN, CV-BC, Chief Nursing Officer and Correspondent at Nurse.org 

The truth is nurses need a lot more to be incentivized to stay practicing clinically at the bedside. Nurses reported needing:  

• Higher pay 
• Safe nurse-to-patient ratios 
• Hazard pay 
• REAL mental health resources 
• Adequate staff support 
• Support programs for new nurses

4 Ways to Support Nurses and Take Action

While we may not be able to make this change at an individual level, collectively, we can amplify the voice of nurses and shed some light on the issues that they are facing every day. Together, we have the power to create meaningful, lasting change for current and future nurses.  Here's how to get involved: 

1. Sign the Pledge

Sign the pledge seen below and encourage your friends & colleagues to do the same. While you’re at it, print it out and post it in your break room. 

2. Spread the Word 

Change can’t happen unless we get the word out about what’s really going on. Share what you’ve heard and what you’ve experienced, and encourage others to do the same. 

3. Contact Your Elected Officials 

It’s time for elected officials to stand up for nurses. Write them a letter. Call their office. Demand change for nurses. Click here to get the contact information for your local and state Officials. 

4. Download and Share the Report

Get even more in-depth insights into what’s going on with the state of nursing and the issues that nurses face today, click here to download the full State of Nursing report or read about the best and worst specialties for nurses during COVID . 

“If you are a current nurse considering leaving the profession, be assured that you are not alone in your struggles. If all you’ve had the energy for is keeping your head down and getting through your shifts, sleeping, and getting up to do it all over again, know that you are doing enough. It’s not your responsibility to solve the nursing shortage.” 

– Nurse Alice Benjamin, MSN, APRN, ACNS-BC, FNP-C, CCRN, CEN, CV-BC, Chief Nursing Officer and Correspondent at Nurse.org 

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

Plus, get exclusive access to discounts for nurses, stay informed on the latest nurse news, and learn how to take the next steps in your career.

By clicking “Join Now”, you agree to receive email newsletters and special offers from Nurse.org. You may unsubscribe at any time by using the unsubscribe link, found at the bottom of every email.

The U.S. Nursing Shortage: A State-by-State Breakdown

• Nursing shortages continue to affect every state, especially in the southwestern U.S.
• A lack of educators, more nurses leaving the workforce, and the rising demand for healthcare is driving the shortage.
• These factors combine to create a cycle, with overwork leading to more burnout.

The nursing shortage in the U.S. is still a concern. A lack of nurse educators keeps nursing schools from being able to admit enough students to address the shortfall. A shortage of nurses means more burnout and more nurses choosing to leave the profession, contributing to the shortage.

In addition, the aging of Baby Boomers means that more nurses are retiring at a time when an aging population has a greater need for healthcare providers. The COVID-19 pandemic exacerbated the nursing shortage. Learn more about the nursing shortage by state and what legislators are doing to address it.

To best understand the shortage on a national scale, we gathered the most recent available data on the number of registered nurses employed in each state from the U.S. Bureau of Labor Statistics (BLS). We then compared these figures to state population estimates to illustrate the nursing shortage on a state-by-state basis. The table below provides a ranking of states, starting with those with the lowest nurse-to-state population ratios.

Popular Online RN-to-BSN Programs

Learn about start dates, transferring credits, availability of financial aid, and more by contacting the universities below.

Local Nurse Employment vs. National Nurse Employment

Major cities with higher populations tend to always need more nurses, with most city hospitals offering many open positions. According to data from the BLS , the following five states have the lowest local concentrations of nurse employment vs. national nurse employment:

• Utah (0.68 location quotient)
• District of Columbia (0.82 location quotient)
• Nevada (0.82 location quotient)
• Idaho (0.83 location quotient)
• Texas (0.86 location quotient)

Metropolitan areas tend to maintain the highest location quotients of local nurse employment to national nurse employment:

• Bloomsburg Berwick, Pennsylvania (3.14 location quotient)
• Morgantown, West Virginia (2.90 location quotient)
• Rochester, Minnesota (2.77 location quotient)
• Ann Arbor, Michigan (2.37 location quotient)
• Iowa City, Iowa (2.26 location quotient)

From the BLS data: The location quotient is the ratio of the area concentration of occupational employment to the national average concentration. A location quotient greater than one indicates the occupation has a higher share of employment than average, and a location quotient less than one indicates the occupation is less prevalent in the area than average.

Larger cities tend to suffer more from nursing shortages due to higher population densities. Simply put, there needs to be more new nurses entering the field to properly manage the volume of people who need healthcare within most large cities.

Factors Contributing to the National Nursing Shortage

According to StatPearls there are many factors contributing to the national nursing shortage, including:

• Lack of educators and schooling: Nursing school enrollment hasn’t kept up with projected demand. There’s also a need for more nursing school instructors. Without enough teachers, thousands of people interested in joining the nursing workforce are unable to do so without degrees.
• High turnover: For years, nurse turnover has climbed at a steady rate. In some cases, nursing graduates quickly enter the workforce and find that the profession is not what they anticipated. In other scenarios, nurses may work for a while, experience burnout, and leave the profession.
• An aging workforce: The rate of retirement for nurses is growing rapidly, as over half of the RN workforce is currently over 50 years old .

State legislators are addressing the nursing shortage . Hospitals and schools are also taking action to combat the nursing shortage and prevent a future deficit.

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The Need For Public Health Nurses On The Rise

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• About the WSWS

Acute shortage of nurses deepens healthcare crisis across US

T.j. garrison 1 august 2024.

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There is an acute shortage of nurses in hospitals and care facilities across the United States, with the total deficit of nurses numbering in the hundreds of thousands since the beginning of the pandemic. A 2023 survey by AMN Healthcare found that 94 percent of nurses said there is a shortage of nurses in their area, with half saying the shortage is “severe.” This crisis is trending in an increasingly dangerous direction, with up to 900,000 nurses expected to drop out of the workforce by 2027, in large part from burnout.

The shortage of nurses in the US is already at its worst in four decades and, even counting new nurses entering the workforce, is expected by the Bureau of Labor to widen by hundreds of thousands of nurses per year. The International Council of Nurses (ICN) last year described the global nurse shortage as a “global health emergency.”

Nurses working at care facilities, and particularly hospitals, are already working in conditions of chronic understaffing. This exacerbates the widespread burnout of nurses, including the 47 percent of nurses reporting high levels of burnout in the average US hospital, according to the publication STAT, and the two out of three nurses nationwide who report having to take care of too many patients, according to a nationwide “State of Nursing Poll 2024” by Incredible Health.

The WSWS spoke to a nurse who works at Nashoba Valley Medical Center in Ayer, Massachusetts. Nashoba is one of two facilities, the other being Carney Hospital in Dorchester, that  Steward Health Care  has announced will be closed by the end of August. Dallas-based Steward filed for bankruptcy in May. The for-profit healthcare giant’s predatory and parasitic financial dealings have enriched its executives to the tune of $1 billion, while healthcare workers and patients are paying the price.

The nurse said, “Well, all the social workers on the unit I work on, the GPU (Geriatric Psychiatric Unit), all quit, about a month ago, so there’s no social workers on the unit.

“The way it works, is if you have 15 patients or under, you get three nurses. And if you go over 15, we’re supposed to have four nurses on the 3 to 11 shifts. So, over the course of the last year, people have quit, and they haven’t refilled the positions. I think the last person that they hired was in maybe November or December.”

Understaffing also puts patients’ wellbeing in danger. In the years since the beginning of the pandemic, medical errors have been on the rise, with a 19 percent rise in adverse effects (medical mistakes) reported in 2022 by the Joint Commission, a non-profit that accredits health organizations. This is due to both staff shortages and the reliance on temporary workers. Eighty-eight percent of nurses are concerned that the staffing crisis is taking a toll on patient care quality, according to the Incredible Health poll.

The Nashoba nurse raised how this is affecting patients. “We’ve had patients that have been stuck on the unit for six months, eight months, you know; some of them who probably never should have been brought there in the first place,” he said. “Because generally, the criteria to be sectioned to a psychiatric unit is you have to be a danger to yourself or others,” but some of the people should be in a skilled nursing facility.

“In my unit, they’re taking just straight-up Med-Surg [medical-surgical unit] patients and saying they should be in psych. ‘Oh yeah, this person has multi-organ failure. Their kidneys don’t work; they have a mass on their pancreas and their liver is shut down. So, they’re depressed. We need to put them on the GPU.’”

The pandemic has also inflicted enormous mental trauma for nurses who have been at the forefront of the COVID crisis. Nurses were forced to work in dire conditions in which containment of the virus and even mitigation measures were ultimately abandoned by the federal and state governments.

Not unrelated to the reactionary anti-science social climate that has been fomented during the pandemic has been the rise in patient violence and abuse of nurses. Half of nurses polled by Incredible Health say they face violence and abuse by patients, with 26 percent saying it is driving them out of the profession.

Lack of adequate staffing, high levels of exploitation and challenging care conditions have also resulted in an increase in accidents and drowsy driving for nurses. As the WSWS detailed in a recent article about an accident that saw an  exhausted nurse  drive off the top of a parking garage in Massachusetts, 95 percent of automotive crashes involving nurses are the result of drowsy driving. A 2019 study revealed that the incidence of drowsy driving has doubled among nurses in the last 30 years. This has doubtless become a more serious problem since the outbreak of the pandemic.

Nurse-to-patient ratios and the staffing crisis have been at the forefront of strikes and petitions to state governments by nurses in the last four years, although they have only received vague concessions from employers. The political establishment has done nothing to enforce what laws exist or have been recently passed on staffing levels.

Staffing problems are not an accident, but a deliberate policy put forward to run hospitals as leanly as possible to maximize profit. Both the Democrats and Republicans defend the for-profit healthcare system, putting forward programs like Obamacare which incentivizes hospitals to slash costs and cut staff in accordance with the wishes of insurance company and healthcare monopolies. Workers are routinely told there is no money for the hiring of new staff or livable wages while $1 trillion is spent on war and healthcare giants rake in hundreds of billions. 

Healthcare workers are fighting back, striking and voicing their opposition across the country. In 2023, half of the 33 major strikes in the US were from healthcare workers. This year, there have been only three strikes of healthcare workers over 1,000 workers. This is not because conditions have improved, but because the trade unions have turned to more aggressive measures to keep opposition at bay. 

Nurses unions have come to rotten deals with the healthcare companies, often resulting in flimsy, unenforced agreements on staffing that are left by the wayside as soon the dust settles from major strikes. It is not from a lack of militancy that nurses have been unable to force healthcare companies to properly staff hospitals and other medical facilities. Instead, it is the betrayals of unions, the corporate controlled political establishment and the criminality of the capitalist profit system itself which is to blame.

In addition, the capitalist drive to a third world war is incompatible with public health and the long-term survival of the world’s population. Tens of millions of lives were sacrificed during the pandemic through what became a deliberate policy of promoting the disease’s spread to keep big business and the stock market satisfied. The pandemic has revealed that the ruling class is hostile to public health and is willing to let hundreds of millions, or even billions, die in furtherance of the conquest of profit.

Appeals to any faction of the ruling class will do nothing to ameliorate this situation in the US and around the world. The Biden-Harris administration’s strategy has been to work together with the labor unions and corporations to isolate and betray the growing militancy of workers across many different sectors.

Nurses must unite independently of the big-business parties and the union apparatus in the building of independent rank-and-file committees to connect the fight of nurses with that of workers across all industries, both in the US and internationally. Only in this way can healthcare workers bring to bear the immense social power necessary to cast off the profit system and establish genuine socialized medical care to provide for the needs of workers and patients alike.

• Exhausted Massachusetts nurse drives off top of parking garage 4 June 2024
• Trainee nurse killed in Sydney public housing explosion after complaints of gas leaks were ignored 10 June 2024
• Healthcare workers speak out against the genocide in Gaza as Palestinian healthcare system crumbles 20 November 2023
• New York hospital fires Palestinian-American nurse for referring to Gaza genocide while accepting award for outstanding care 30 May 2024

Health Care’s Rebuke of Reckless Reporting

The health care community stands together to express grave concerns about the recent Bloomberg article, " The Miseducation of America’s Nurse Practitioners ." The authors failed to write a balanced story by cherry picking negative information and failing to report the enormous contributions nurse practitioners (NPs) make to patient care and across the health care system.

The authors have omitted the fact that NPs have consistently risen to meet our nation's health care challenges. This includes risking their lives with other health care professionals to treat patients during the pandemic despite a limited supply of personal protective equipment (PPE); setting up mobile clinics or going door to door in disadvantaged communities to provide care; being among the first clinicians to treat patients with opioid use disorder in hundreds of rural counties; and providing care in rural counties, after other clinicians left and hospitals closed, to ensure continued access.

Unfortunately, these types of hit pieces can be written about any profession, but distinctly have no place in our nation’s health care system. This type of journalism not only disparages an honorable profession at a time in which our country is struggling to build our nation’s workforce, but also frightens patients from seeking needed care.

The following points were either provided by AANP or could have been found by the authors if they were seeking to provide readers with any type of balanced article:

• The authors only included one study, which they appeared to discredit by saying it included international NPs. In fact, the authors were provided more than  50 studies  that definitively demonstrate that NPs in the United States provide high-quality primary, acute and specialty health care services across the lifespan and in diverse settings.
• The National Academies of Science, Engineering and Medicine’s report on the future of nursing found that: “Such restrictions limit access to care generally and to the high-quality care offered by APRNs. Those supporting these restrictions maintain that nonphysician providers are less likely to provide high-quality care because they are required to receive less training and clinical experience. However, evidence does not show that scope-of-practice restrictions improve quality of care (Perloff et al., 2019; Yang et al., 2020). Rather, these regulations restrict competition and can contribute to higher health care costs (Adams and Markowitz, 2018; Perloff et al., 2019).” (National Academies of Sciences, Engineering, and Medicine. 2021.  The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity .)
• The American Enterprise Institute wrote: “Can NPs provide health care of comparable quality to that provided by primary care physicians? Our studies showed that beneficiaries who received their primary care from NPs consistently received significantly higher-quality care than physicians’ patients in several respects. While beneficiaries treated by physicians received slightly better services in a few realms, the differences were marginal. These results held when vulnerable populations of Medicare beneficiaries were analyzed separately and compared to those cared for by physicians, aligning with the findings of many other studies conducted over the past four decades.” (American Enterprise Institute. 2018.  Nurse Practitioners: A Solution to America’s Primary Care Crisis .)
• The Brookings Institution wrote: “Opponents contend that quality of care may suffer under the direction of a nonphysician practitioner, citing the shorter length of training and clinical experience required. Their argument is that restrictions are necessary to protect public health. However, academic literature finds no evidence of harm to patients associated with less-restrictive Scope of Practice (SOP) laws. When no harm is present, the restrictions serve only to generate artificial barriers to care that ultimately provide physicians with protection from competition, prevent the attainment of system-wide efficiencies, and constrain overall provider capacity.” (The Hamilton Project. Brookings. 2018.  Improving Efficiency in the Health-Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants .)
• The National Academies of Science, Engineering and Medicine’s nursing home report found that: “Numerous reviews have identified key outcomes resulting from APRN provided care in nursing homes, including improved management of chronic illnesses, improved functional and health status, improved quality of life, reduced or equivalent mortality and hospital admissions, improved self-care, reduced emergency department use and transfers, lower costs, increased time spent with residents, and increased resident, family, and staff satisfaction.” (National Academies of Sciences, Engineering, and Medicine. 2022.  The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff .)
• NPs typically complete at least six years of formal nursing education and pass national board certification prior to getting licensed and entering practice. NPs enter their graduate degree programs as registered nurses having already completed formal undergraduate Bachelor of Nursing programs, which include clinical rotations. During graduate school, NPs complete academic coursework and additional clinical rotations that prepare them to independently diagnose, manage patient care and prescribe medications and other treatments.
• NP programs are nationally accredited and the national accreditation bodies are held accountable to the U.S. Department of Education (DOE). NPs complete hands-on, supervised patient care clinical rotations that are embedded in their graduate programs and must adhere to accreditation standards. NP students must demonstrate they have integrated this prior knowledge and skill — and do not progress, or graduate, simply based on hours spent in rotation. NPs are required to pass national certification board exams and retain board certification throughout their careers.
• The authors mistake confidence for competence. It’s not unusual for some professionals in any discipline to lack confidence after graduation. For example, a recent survey by the American Academy of Pediatrics found that only 42% of pediatric residents who graduated in 2022 felt prepared for primary care practice, a significant decline from 69% in 2015.
• Citing a fringe medical group as a source, which frequently encourages the disparagement of other health care professions and engages in fear mongering in effort to restrain trade by reducing perceived competition, is reckless.
• In a Medicare Payment Advisory Commission (MedPAC) focus group, patients cited a variety of reasons for choosing an NP or physician associate (PA) as their regular primary care provider, including switching from a physician to an NP or PA as their primary care provider when their physician retired, choosing to see an NP in their practice when they had communication issues with their physician or generally preferring NPs and/or PAs to physicians.
• NPs provide a substantial portion of the high-quality, cost-effective care that communities nationwide require. According to MedPAC, APRNs and PAs comprise approximately one-third of our primary care workforce, and up to half in rural areas. NPs are essential to providing equitable access to care for all communities, including a substantial portion of health care in rural areas and areas of lower socioeconomic and health status.

Generalizations, sensationalism and cherry-picking should not be used by news sources to disparage NPs or other professions that are caring for patients and their families throughout the nation. Taking only individual negative outcomes or perceptions and then generalizing them to an entire profession that cares for patients in over a billion patient visits per year is irresponsible and dangerous. We stand together in rebuking this type of fear mongering by these reporters, Bloomberg News or any group seeking to advance an agenda with these despicable tactics.

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Clinician mental health, nursing shortages and the COVID‐19 pandemic: Crises within crises

1 Faculty of Nursing, Chiang Mai University, Chiang Mai Thailand

Apiradee Nantsupawat

Around the world, nurses are working under enormous pressure providing care to sick and dying patients during the pandemic. Many are faced with increased stress, and other negative effects on their mental health. They are also faced with the possibility of infection and death from COVID‐19. Before the pandemic there was a global shortage of nurses, but this is likely to be exacerbated by the increased demands of caring during COVID‐19 as well as the usual care of non‐COVID patients. One serious concern is that the pandemic and multitudinous effects on the nursing profession will exacerbate nursing attrition and their poor mental health into the future. Another serious concern is whether the profession will be able to attract sufficient numbers of nurses to care for populations into the future. Governments and health policymakers everywhere need to invest in nursing and health care and pay attention to the needs of health systems to ensure a healthy population. It is argued that without this, economies will not recover and prosper, and health systems will not be able to provide quality care.

Today, perhaps like never before, the world is facing a healthcare crisis because of the triple whammy of nursing shortages, the COVID‐19 pandemic, and the incipient effects of these on the mental health of clinicians. The shortage is likely to be exacerbated due to the pandemic as well as other factors like nurse ageing and continuing nurse attrition. The shortage was deemed a global nursing crisis in 2002 and is a complex problem spanning major areas for action, including policy development and intervention, health sector funding, policy and planning for the workforce, nursing regulation, leadership, and nursing recruitment and retention (Oulton 2006 ). Despite many calls to action for governments to deal with the shortages and the excellent strategies developed by the International Council of Nurses (ICN) and Nursing Now, in concert with the World Health Organization and others, we have yet to see real progress and investment in nursing. ICN reports that National Nursing Associations around the world have collaborated strongly and responded to the call for leadership to co‐ordinate responses to the pandemic. But this is not enough. All governments need to step up to the mark with real investment in, and support of, the profession.

Reports from around the world tell of nurses, along with other health professionals, being exhausted. Many are dispirited after a year of caring for high patient workloads with COVID‐19 and seeing too many people die, as well as trying to deal with the usual caseloads of people needing interventions. Many are fed up trying to manage their lives, juggling family and work responsibilities, working extra shifts because of the acute nursing shortages, and facing unresolved ethical issues in practice. Nurses have to deal daily with distancing from the ones they love, and with illness and death. And too often, nurses have had to put their excellent skills into situations that are new to them, in unplanned urgent situations outside of their usual scope of practice, not a new phenomenon in nursing. These critical issues will not be relieved until a significant number of the world’s population is vaccinated, and more nurses are available to care for populations.

We need to find ways to support clinicians to have the necessary self‐care while doing their job, and adequate staffing is essential for this. Hospitals were close to maximum capacity with severe nursing shortages (American Nurses Association, 2019 ) before the COVID‐19 pandemic took hold. Many countries are suffering economic downturns due to the pandemic, but unless investment is made in the education of more nurses, and the ongoing training and support of current nurses, then economies will continue to suffer. It is simply untenable to expect that there will be economic prosperity and recovery in countries that do not have good population health and health systems, and this requires an adequate and competent health workforce.

There is no doubt that nurses are, for the most part, resilient creatures and have quickly adapted their skills to improve nursing practice during this pandemic, often making do with shortages. But innovation and willingness to do the hard work cannot continue without let up, without support, counselling, proper resources and recognition, and without significant investment in nursing and health care within and across countries. We simply cannot expect nurses to continue to ‘make do’ and especially when they are not being listened to, nor being adequately protected to carry out their work

It is difficult to estimate the true effects on nurses because of the impacts of the pandemic, nursing shortages and scarcity of resources. And we cannot predict when this pandemic will end. We assume that with the ongoing pandemic and short‐staffing many nurses not been able to take much‐needed leave to rest and recuperate. This will only compound the negative effects on their mental and physical health and well‐being. Nurses already work unsociable shift work hours that have an existential and real impact on their lives. And the risks and fear of COVID‐19 infection have not abated. Sadly, an unknown high number of nurses have been infected with the virus and at least 22 00 have died (ICN 2021 ). This figure will undoubtedly grow. A few studies have found that nurses are suffering from post‐traumatic stress disorder, anxiety, high stress, depression or moral suffering, but there is an urgent priority for research funding to uncover the extent of the problem. Davidson et al. ( 2020 ) warned of the spike in suicide in nurses and physicians before this pandemic. Clearly, there is an urgent need for the promotion of mental health in the profession, including mental health screening and short and long‐term psychological and social support (Jun et al. 2020 ). This will not only promote and sustain their well‐being but also help to prevent their attrition from the workforce.

Nursing is a highly respected profession in many countries, but we do not yet know what the effects of the pandemic will be on the successful recruitment of more people into nursing in future. Will young people avoid nursing because of the risk to their health and well‐being, scared to get infected and seeing the plight and hard work of nurses in the media? And will the rapid movement of nursing education to online learning assist or deter more people from entering nursing courses in the future? Of importance is that there may be an underestimation of new nurses in health systems, and we do not yet know the extent of the number of student nurses who have not been able to graduate due to interruptions to their studies throughout the pandemic.

We are yet to understand the extent of increased attrition from the global workforce due to the pandemic. Nurses have risen to the call to assist during these critical times and, in some countries, the number of nurses available to care has actually increased due to retired nurses recalling back to duty. Student nurses have also been asked to bolster the workforce. In this issue of INR, nursing colleagues from Lebanon report over 600 nurses leaving the country during COVID‐19 but this was compounded by a massive explosive disaster. Said & El‐Shafei ( 2021 ) in Egypt found there is a higher intent to leave the workforce among nurses with high stress caring for patients with COVID‐19 in fever hospitals than in those of nurses working in general hospitals. It is important for researchers to uncover clear evidence world‐wide about this to assist in workforce decision‐making.

In our opinion, calling nurses heroes has not helped the professional image of nursing. They certainly are to be recognized and rewarded for the critical work they have done and continue to do. But many insist they are trying to do their job. Calling them heroes but expecting them to not have enough quality personal protective gear or to practice in poor working environments negates their ability to achieve what they are educated to do, and puts their lives at risk.

In conclusion, there is no doubt that nursing in the time of COVID‐19 is having a profound effect on the mental health of nurses, especially clinicians on the front lines of the pandemic, and governments need to be seriously concerned with investing in nursing. Nurses everywhere need to give voice to these concerns in appropriate forums and at decision making tables. After all, the health of nations is dependent on the work of the profession, and we simply cannot afford to lose more nurses from the profession.

Turale S. & Nantsupawat A. (2021) Clinician mental health, nursing shortages and the COVID‐19 pandemic: Crises within crises . International Nursing Review 68 , 12–14 [ PMC free article ] [ PubMed ] [ Google Scholar ]

Corresponding author

Contributor Information

Sue Turale, Email: hc.nci@rotiderni .

Apiradee Nantsupawat, Email: [email protected] .

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