The nursing workforce and global economic recession

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There is a truism that health workforce policy is about “getting the right staff with the right skills in the right place at the right time”. The reality, of course, is more messy and less measurable. There is rarely universal agreement on what “right” means in any given context. Workforce planning and policy can focus overmuch on form rather than function, on easily measured staff inputs rather than on achieving more complex outcomes. Plans and numbers can become the end result, rather than the means to improve care.

In a context of growing shortages of nurses in many countries, and against a backdrop of global economic crises, this edition of Collegian takes a multi country look at some of the critical nursing workforce challenges that must be addressed if policy makers are to steer an effective way through the ever present tension of cost versus quality, of limited resources and unlimited demand.

The papers highlight the need for firm analysis to back up advocacy; they also provide cautionary notes about the possibility of a “magic bullet” solution in health care workforce policy. It is clear that the multi faceted workforce challenges facing health systems require co-ordinated and aligned health workforce policies (Buchan, 2004; Buchan & Aiken, 2008). For developed countries, international recruitment has the potential to rapidly increase numbers, but these staff may not have the right skills, or be in the right place (Buchan, 2009), and it is argued that increases in pre-registration intakes will be required in some countries (Preston, 2009); however, if they aim for staffing growth whilst neglecting the need for sufficient education capacity they are being programmed for failure (Potempa, 2009), and if they do not provide a supportive work environment in which leadership can thrive and job satisfaction can be derived, they are missing the point (Duffield et al, 2009). In the less well resourced countries of the world, the health workforce challenge is of a higher magnitude, but the principles remain the same—it is not just about numbers, it is about having skilled staff deployed effectively in teams to meet priority health needs (Parfitt, 2009).

The health workforce challenge is now on the policy agenda to a degree never before witnessed. Policy makers have woken up to the fact that health is labour intensive and is about “human” resources, and that health reform will not succeed unless the workforce supports change, and is the main agent for change. The real point is that the nursing workforce issues discussed in this edition of the Collegian are not just nursing “problems”—they are rooted in health systems limitations and failures. Nurses can often identify what is wrong and how it can be fixed, but they need to work with others to achieve the sustainable solutions that are needed. Nurses have a right to be involved, not as the source of the “problem” but as major stakeholders in delivering the best solutions.

These solutions will have to be implemented at a time of unprecedented upheaval in global financial markets. This brings a huge additional challenge – finding the money – but may also give new opportunities to nurses. Firstly, the more that nursing can argue that it is a cost effective way of delivering care, the more this argument will penetrate through the white noise of economic vicissitude to be heard with clarity by those with the money—the policy makers and donor agencies.

Secondly, to the extent that any career can be “recession proof”, nursing will not be going out of business. Lessons from previous economic recessions suggest that nurses fare relatively well at a time of rising unemployment rates, in the short term at least. Their skills are always in demand—particularly in countries where the need for care is increasing because the population is ageing. There may also be financial support for health systems in some countries where governments are aiming to spend their way out of trouble—such as the UK and Australia.

It is easy to overstate similarities between health system workforce challenges. Tajikistan and Australia face a different scale of problems, and can marshal different levels of resources. Even so, the fundamentals are the same: treat staff with respect, identify the scope for positive change, make sure that staff have been part of this process, and then allocate resources effectively to enable them to deliver change in a sustained manner. The vagaries of global financial markets may impact differently on different countries – at this point, the USA and UK are in recession, whilst Australia looks like it may avoid it – but the reality is that we are all in this together.

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References 

1. Buchan J. What difference does (“good”) HRM make?. Human Resources for Health. 2004;2(6):http://www.human-resources-health.com/content/pdf/1478-4491-2-6.pdf
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2. Buchan J, Aiken L. Solving nursing shortages: A common priority. Journal of Clinical Nursing. 2008;17(24):3262–3268
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