The global nursing and midwifery workforce makes up nearly 50 per cent of the health workforce and plays a critical role in healthcare systems worldwide and the overall well-being of our populations.

Ironically, not only is the recognition wanting but this is also one of the most underpaid and understaffed professions in the healthcare system.

Shortages of nurses and midwives

In 2020, the first State of the World's Nursing (SOWN) report published by the World Health Organization (WHO) revealed the global nursing workforce at 27.9 million. SOWN estimated a current global nursing shortfall of 5.9 million. Furthermore, 17 per cent of nurses were expected to retire in the next 10 years.

This shortage of human resources coupled with poor remuneration of nurses makes it difficult to attract enough professionals to the field which in turn affects nurse to patient-care ratio which leads to constant burn-out. All these factors compromise the quality of care patients receive in healthcare facilities.

These shortages are worse in low and middle-income countries (LMICs) due to limited health allocation. The situation is getting dire with the migration of nurses seeking greener pastures in high-income countries. This is slowing down the gains made in nursing care in LMICs.

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Another critical challenge of the profession is inadequate resources and poor working conditions that the nurses operate in. Lack of or inadequate personal protective equipment and clinical supplies are barriers to access to quality care. Even with these challenges, nurses are still expected to step up to the challenge and ensure patients are getting the best care.

It is important to recognise that it is not merely a time to extend messages of goodwill to our nurses and midwives but instead a moment to reflect on how well we prioritise their welfare and the general investment in the health care system. 

So what can governments and other stakeholders do to address these challenges?

Investing in their welfare

Given the substantial social and economic value that the nursing profession contributes to society, we need to invest more in nurses to secure the future of healthcare. The first place to start is ensuring that our nurses and midwives are well remunerated.

Despite being the primary contact of care for patients, the pay disparities between nurses/midwives and other healthcare workers are big. Shouldn’t the fact that a nurse spends the most contact hours with a patient count? We need to do better.

Financial incentives, such as salary increases and benefits like housing assistance or scholarship programs, can motivate nurses to stay in the profession and perform well. Additionally, career growth opportunities and evolving responsibilities can help retain skilled professionals.

Further, nurses need equal leadership opportunities at county and national levels, where they not only hold key leadership positions but actively contribute to policy formulation and implementation. 

Supporting nurses working in primary care

While providing favourable employment terms is a priority for nurses to be motivated to stay in the profession, providing them with well-equipped facilities and unique career growth paths is critical. We need to provide avenues for professional advancement that appreciates the realities of the practice contexts. Programmes that are customised for practicing nurses like the Advanced Practice Nursing and Midwifery offered at the Aga Khan University are a big game changer.

Using an innovative work-based part-time basis, the program allows nurses to progress their careers by getting an opportunity to study while they continue to provide healthcare services in their practice areas and the communities they serve.

These programs upskill nurses and midwives, allowing them to enhance critical thinking, problem solving and innovation. In addition, the programs emphasize primary health care and health promotion which are key ingredients in enhancing universal health coverage. 

Retaining skilled and experienced nurses in primary care settings, where their presence is most needed, should be a priority for countries like Kenya that are working on the implementation of universal health coverage which is hinged on well-staffed primary care facilities.

Beyond salaries and training

To motivate healthcare workers for optimum performance, we need to take care of their overall well-being beyond putting more money in their pockets. There are many opportunities to do that. Employers can for example offer programmes that support their mental health.

It could range from providing nurses with psychological support, regular team-building activities to help them engage with their colleagues within nursing and outside or one one-on-one coaching, among others. These approaches will promote mental well-being, build collaborations and enhance professional growth for nurses.

Personal development programmes can also help build the morale of our nurses and midwives. Programmes on financial management, for example, will assist nurses plan their finances better enabling them to be in a better position to perform at work and get fulfilment in their role.

Supporting nurses and midwives with their wellness on the other hand will ensure that nurses are healthy and able to perform their duties to the optimum. How many health institutions provide free wellness check-ups for their nurses? Is it not ironic that these critical healthcare professionals go for years without doing their wellness check-ups yet they work in healthcare institutions?

Nurses and midwives are key to the entire healthcare system as patients seeking care will spend over 90 per cent of their time with them.

In fact, in some healthcare facilities especially low-resource areas, nurses are the sole healthcare providers serving as both doctors and nurses. We therefore need to do better to take care of the welfare of nurses and midwives.

The writer, Prof. Eunice Ndirangu, is the Dean, School of ​Nursing and Midwifery, East Africa​, Aga Khan University.