Health ministers around the world are being urged to sign off on plans to create 6m more nursing jobs by 2030, amid warnings that Covid-19 has exacerbated a global shortage and could spark a “brain drain” from the developing world.

Delegates meeting virtually this week at the World Health Assembly, the key decision-making body of the World Health Organization, are expected to adopt a resolution calling on countries to transform the nursing profession through more investment, support and training.

The WHO director general, Dr Tedros Adhanom Ghebreyesus, called on countries to invest in healthcare workers, nearly 50% of whom are nurses and midwives, saying the pandemic had reminded everyone “that these are incredible people doing incredible jobs under incredible circumstances”.

“We owe them so much, and yet globally health and care workers often lack the protection, the equipment, the training, the decent pay, the safe working conditions and the respect they deserve,” he said in his opening remarks. “If we have any hope of achieving a healthier, safer, fairer future, every member state must protect and invest in its health and care workforce as a matter of urgency.”

The WHO’s strategic directions call on countries to improve nursing and midwifery training, create more jobs and ensure that countries, once they have enough people in position, are able to retain them. The WHO estimates that the current global nursing workforce of 27.9 million leaves it 5.9 million short of what is needed – and that the shortage is “overwhelmingly” felt by low- and middle-income countries.

The strategy to be endorsed this week has been described as “a once in a generation opportunity to turn things around” for the profession, which now faces losing even more workers due to the pandemic.

The International Council of Nurses (ICN) has likened the Covid-19 effect as a “mass traumatisation of the nursing workforce” and suggested the profession could see a “mass exodus” that could increase the global shortage to nearly 13 million.

It noted that the pandemic had “obviously increased risks to the health workforce, including occupational infections, stress and burnout from months of caring for Covid-19 patients. In some countries, nurses have in addition faced physical violence and psychosocial stigma.”

A nurse in Italy comforts a colleague at a shift change during the first Covid wave at a Cremona hospital.
A nurse in Italy comforts a colleague at a shift change during the first Covid wave at a Cremona hospital. The pandemic has accelerated the number of nurses leaving the profession due to burnout and stress. Photograph: Paolo Miranda/AFP/Getty

A survey found that 90% of ICN’s national associations of nurses were “somewhat or extremely concerned that heavy workloads, and insufficient resourcing, burnout and stress related to the pandemic response are the drivers resulting in increased numbers of nurses who have left the profession, and increased reported rates of intention to leave this year and when the pandemic is over”.

Sheila Tlou, co-chair of the Nursing Now campaign and former health minister of Botswana, said she had warned developing countries already suffering from an inadequate number of nurses that they could face a post-pandemic loss of key workers.

Referring to countries in the west that had lost nurses, she said: “Guess where they are going to get them [replacement workers] from? Our home. And it will be one of those brain drains.

“We have had brain drains before but I think this one will be massive because I can see the richer countries offering more to entice people to come,” she said.

Tlou said that even before the pandemic nurses had been crucial in Botswana’s fight against HIV/Aids. “They [other countries] would say to me, ‘how do you do it?’ and I would say, ‘I have nurses’,” she said.

Barbara Stilwell, director of Nursing Now, which campaigns to raise the status and profile of nursing, welcomed the WHO plan but also called for a more radical rethink of nurses’ roles.

“Nurses are in many ways much more versatile when it comes to healthcare delivery and when they have advanced-practice nursing education they can also deliver an amazing amount of care in specialist clinics and primary healthcare,” she said. “So I believe they’re a ‘best buy’ and I do think everywhere we should be re-looking at the health workforce. It’s time to be radical.”