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State of the World's Nursing 2020: Investing in Education, Jobs and Leadership Report

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State of the World's Nursing 2020: Investing in Education, Jobs and Leadership Report STATE OF THE WORLD’S NURSING NURSING OF THE WORLD’S STATE STATE OF THE In collaboration with: WORLDʼS NURSING 2020 2020 Investing in education, jobs and leadership in education, Investing Investing in education, jobs and leadership STATE OF THE 2020 Investing in education, jobs and leadership State of the world's nursing 2020: investing in education, jobs and leadership. ISBN 978-92-4-000327-9 (electronic version) ISBN 978-92-4-000328-6 (print version) © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/ licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. State of the world's nursing 2020: investing in education, jobs and leadership. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. 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Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. The production of this document has been made possible through funding support from the UHC Partnership (Belgium, European Union, France, Ireland, Japan, Luxembourg, United Kingdom and WHO), Germany and Norway. Cover images Row 1 (left to right): © Vladimir Gerdo/TASS via Getty, © Irene R. Lengui/L’IV Com, © Tanya Habjouqa Row 2 (left to right): © Jaime S. Singlador/Photoshare, © AKDN/Christopher Wilton-Steer CONTENTS Foreword ............................................................. vii Message from the Co-Chairs .............................................viii Contributors and acknowledgements ........................................ix Glossary ............................................................... x Executive summary ......................................................xi CHAPTER 1 Introduction ............................................................... 1 CHAPTER 2 Nursing in a context of broader workforce and health priorities ............ 5 2.1 Role of the health workforce in achieving the 2030 Agenda .................. 5 2.2 Who is a nurse? .................................................... 8 CHAPTER Nursing roles in 21st-century health systems ...............................11 3 3.1 Role of nursing in achieving universal health coverage .......................11 3.2 Role of nursing in dealing with emergencies, epidemics and disasters. .15 3.3 Role of nursing in achieving population health and well-being .................16 CHAPTER 4 Policy levers to enable the nursing workforce ..............................19 4.1 Pre-service education and training ......................................19 4.2 Workforce inflows and outflows ........................................25 4.3 Equitable distribution and efficiency .....................................27 4.4 Regulation .........................................................32 CHAPTER Current status of evidence and data on the nursing workforce ............. 35 5 5.1 Nursing workforce availability, composition and distribution ..................37 5.2 Equity in availability of and access to the nursing workforce ..................43 5.3 International nurse migration and mobility ................................47 5.4 Regulation of nursing education and practice ..............................49 5.5 Education and nursing workforce supply .................................52 5.6 Regulation of employment and working conditions .........................55 5.7 Governance and leadership. .59 5.8 Assessing the current trajectory towards 2030 SDG outcomes ...............61 CHAPTER 6 Future directions for nursing workforce policy ............................ 67 6.1 Strengthening the evidence base for planning, monitoring and accountability .....68 6.2 Mobility and migration ...............................................69 6.3 Developing and supporting the nursing workforce ..........................72 6.4 Building institutional capacity and leadership skills for effective governance ......82 6.5 Catalysing investment for the creation of nursing jobs .......................84 6.6 Research and evidence agenda ........................................87 CHAPTER 7 Conclusion ................................................................ 91 References ............................................................93 Annex 1. Who is a nurse? ................................................108 Annex 2. Methods ......................................................110 Web Annex. Nursing roles in 21st-century health systems https://apps.who.int/iris/bitstream/handle/10665/332852/9789240007017-eng.pdf Contents iii Tables 5.1 Number of nurses globally and density per 10 000 population, by WHO region, 2018 . 38 5.2 Changes in nursing stock due to better data and actual increase between 2013 and 2018 . 38. 5.3 Nurses as a percentage of health professionals (medical doctors, nurses, midwives, dentists and pharmacists), by WHO region . 39 5.4 Percentage of female nursing personnel, by WHO region . 41 5.5 Density of nursing personnel per income group (2018) . 46 5.6 Percentage of nursing personnel foreign born (or foreign trained) per income group . 48 5.7 Percentage of responding countries reporting existence of nursing regulations on education and training, by WHO region . 50 5.8 Production of graduate nurses, by WHO region and income group . 53 5.9 Percentage of countries responding on existence of nursing regulations on working conditions, by WHO region . 56 5.10 Leadership and governance indicators: percentage of countries with chief nursing officer position and nursing leadership development programme, by WHO region . 60 5.11 Simulation of projected stock of nursing personnel from 2018 to 2030 under three scenarios, by WHO region . 63 A2.1 List of 36 indicators used for the State of the world’s nursing 2020 report . 111 A2.2 Estimates of shortage of nursing personnel (millions) in countries below the Global Strategy threshold by income level: 2018 and 2030 (three scenarios) . .116 Boxes 3.1 Nursing contribution to patient safety . 12 3.2 Nurse-led model of community care for ageing populations . 14 4.1 Australia: engaging underrepresented populations in the nursing workforce . 21 4.2 Cost of nursing education . 22 4.3 Addressing the shortage of nurse educators . 24 4.4 Global skills partnerships . 26 4.5 Examples of economic demand for nurses in high-income countries . 27 4.6 Expanding access via nurse prescribing in Poland . 28 4.7 Example of a specialist nursing role in the African Region . 29 4.8 Rural retention guidelines . 31 4.9 Examples of harmonization of education standards and licensure examination . .33 5.1 Equity within countries . 46 6.1 Scotland health labour market analysis . 68 6.2 East, Central and Southern African Health Community: national collaboration on nursing data reporting using NHWA indicators . 70 6.3 Germany’s approach to managing migration . 71 6.4 Technology in nursing
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