Introduction
The story of Emma Swarbrick, a Queen’s Nurse in the United Kingdom, vividly illustrates the profound power of compassionate care to spark community transformation. She encountered an elderly couple, the Smiths, who were trapped in a distressing cycle: 148 ambulance calls and 78 A&E visits within a single year, all stemming from Mrs. Smith’s persistent, yet undiagnosed, abdominal pain. While numerous tests had revealed no definitive physical cause, Emma’s approach transcended routine clinical assessment.
Through dedicated, compassionate listening and a holistic evaluation, she uncovered that Mrs. Smith’s genuine pain was critically exacerbated by severe anxiety and malnutrition. These underlying issues had taken root after her husband’s recent health scare, leaving them both fearful of their inability to cope. Emma’s intervention was multifaceted: she meticulously built trust, provided education on chronic pain management and nutrition, and connected the couple with vital community support services. The outcome was transformative. The relentless ambulance calls and emergency visits ceased, saving the National Health Service thousands of pounds. More significantly, this nurse-led initiative restored the Smiths’ quality of life, dignity, and independence, demonstrating the potent synergy of “heart work” and “brain work” that defines impactful nursing.
This single act of transformative care, rooted in compassion yet executed with skill and insight, serves as a microcosm of nursing’s broader journey. This article charts the evolution of nursing, from the iconic lamp of Florence Nightingale illuminating the path to modern, evidence-based practice, to the complex, multifaceted roles nurses now play in contemporary global health missions. Nurses today are at the vanguard of disaster relief operations, pandemic responses, and the intricate processes of shaping international health policy. The purpose of this exploration is to illuminate how nursing’s foundational ethic of compassion, when coupled with continuously evolving expertise, groundbreaking innovation, and tenacious nursing advocacy, has fueled systemic change. It aims to solidify understanding of nursing’s indispensable and increasingly influential role in advancing global health nursing and achieving more equitable health outcomes worldwide. The narrative of nursing’s global impact is not merely a historical recounting; it is a testament to the profession’s dynamic adaptability. It showcases a remarkable capacity to translate enduring humanistic values into concrete, evidence-based actions that effectively address contemporary global health challenges. This journey from foundational principles to complex modern interventions underscores the untapped potential of the nursing workforce. Understanding this trajectory is crucial for policymakers and health leaders, as it highlights the strategic imperative of adequately supporting and empowering nurses to drive further innovation and achieve global health equity.
Historical Foundations of Compassionate Nursing
The roots of modern nursing are deeply entwined with individuals who combined profound compassion with a drive for reform and professionalization. Their pioneering efforts laid the groundwork for nursing to become a global force for health and healing.
Florence Nightingale: The Genesis of Evidence-Based Compassion
Florence Nightingale (1820-1910) is widely recognized as the founder of modern nursing, and her legacy is built on the powerful combination of compassionate care and rigorous, data-driven reform. During the Crimean War (1854-1856), she was confronted with horrific conditions at the British military hospital in Scutari. Rather than simply tending to the wounded, Nightingale meticulously collected and analyzed data on mortality rates. She famously utilized innovative statistical tools, such as her “coxcomb” polar area diagrams, to compellingly demonstrate that the overwhelming majority of soldiers were dying not from their battle wounds, but from preventable infectious diseases like cholera and typhus, rampant due to unsanitary conditions.
Her evidence-based interventions were revolutionary for the time. By implementing fundamental changes in sanitation, hygiene, ventilation, and nutrition, Nightingale and her team of nurses dramatically reduced the mortality rate at Scutari from a staggering 42% (some sources suggest even higher, up to 52%) to as low as 2% within six months. This monumental achievement underscored the power of systematic observation and data in transforming health outcomes.
Upon her return to Britain, Nightingale continued her relentless advocacy. Her influential reports, “Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army” (1858) and her most famous work, “Notes on Nursing: What It Is, and What It Is Not” (1859), codified her principles and became foundational texts for nursing practice and hospital administration. In 1860, she established the Nightingale Training School for Nurses at St. Thomas’ Hospital in London. This institution was pivotal in professionalizing nursing, establishing it as a respectable occupation for women and creating a model for nursing education that was replicated worldwide, spreading her evidence-based and compassionate approach to care across the globe. Nightingale’s influence extended beyond military and hospital nursing; she was a fervent advocate for public health reforms, including improved sanitation in India and the transformation of workhouse infirmaries in Britain into institutions of genuine medical care. Her work established a powerful precedent: that compassion, when guided by evidence and a commitment to systemic change, could transform not only individual patient outcomes but entire healthcare systems. The Florence Nightingale Museum in London stands as a testament to her enduring legacy.
Mary Seacole: Compassion in the Face of Adversity
A contemporary of Nightingale, Mary Seacole (1805-1881), offers another compelling narrative of nursing impact, characterized by resilience and compassionate care in the face of significant racial and gender discrimination. Born in Jamaica to a Scottish army officer and a free Black Jamaican woman who was a respected “doctress” skilled in traditional Creole and Afro-Caribbean medicine, Seacole inherited a deep knowledge of herbal remedies and nursing practices.
When the Crimean War broke out, Seacole, an experienced nurse who had managed cholera and yellow fever outbreaks in Jamaica and Panama, traveled to London to offer her services to the War Office and support Florence Nightingale’s efforts. However, her application to join Nightingale’s nursing contingent was rejected, a decision widely attributed to racial prejudice. Undeterred, Seacole funded her own journey to the Crimea. Near Balaclava, just two miles from the fighting, she established the “British Hotel,” a facility that served as a mess-table and canteen for officers but also a place of refuge and care for sick and convalescing soldiers of all ranks. She provided them with food, comfort, and her own herbal remedies, often venturing onto the battlefields herself to tend to the wounded under fire. Her bravery, determination, and compassionate care earned her the affectionate nickname “Mother Seacole” from the soldiers. Mary Seacole’s story broadens the historical narrative of nursing, showcasing the entrepreneurial spirit and unwavering dedication of a woman who overcame significant societal barriers to deliver care where it was most needed.
Early Missionary Nurses and Colonial Health Campaigns
The global expansion of nursing in the 19th and early 20th centuries was significantly influenced by missionary nurses and colonial health campaigns. These endeavors, while often driven by altruistic and compassionate motives to alleviate suffering and introduce Western medical practices, operated within complex and frequently problematic colonial frameworks. Organizations like the Colonial Nursing Association (CNA), proposed in 1895 by Mrs. Francis Piggott, aimed to supply trained professional nurses to Britain’s colonies and dominions. Between 1896 and 1966, over 8,400 nurses were placed by the CNA, primarily to support the health of white colonists.
These colonial nurses were often tasked with upholding ‘imperial hygiene,’ using personal and public hygiene practices to create physical and cultural boundaries between the colonizers and the colonized populations, as well as the colonial environment itself. While they established health services and introduced new medical techniques, their work was intrinsically linked to the agendas of imperial powers, sometimes leading to the imposition of Western cultural norms and a disregard for indigenous healing practices. In the United States, early forms of organized home care, such as the Ladies Benevolent Society founded in Charleston, South Carolina, in 1813, provided care to the sick poor, including free Black individuals and poor whites, often driven by religious faith and a desire for social uplift. This period reflects the dual nature of early global nursing efforts: a genuine desire to extend compassionate care and improve health, juxtaposed with the often-unacknowledged complexities and power dynamics of colonialism and cultural imposition.
The Emergence of Public Health Nursing in the 20th Century
The late 19th and early 20th centuries witnessed the rise of public health nursing, a transformative movement that shifted the focus from individual acute illness to the health and well-being of entire communities, with a keen understanding of the social determinants of health. Two figures stand out in this evolution: Lillian Wald in the urban landscapes of New York City, and Mary Breckinridge in the remote mountains of rural Kentucky.
Lillian Wald (1867-1940) was a visionary who, in 1893, after witnessing the dire living conditions and lack of healthcare access among immigrant families on New York’s Lower East Side, co-founded the Henry Street Settlement. She coined the term “public health nursing” to emphasize the community value of nurses whose work was built upon an understanding of the multifaceted problems—social, economic, and medical—that accompanied poverty and illness. Wald’s model of care was holistic and revolutionary; Henry Street nurses lived and worked among the industrial poor, offering healthcare in their homes for free or for what they could afford, alongside social services and education in everything from English to music. By 1913, the Settlement had expanded dramatically, with 92 nurses making 200,000 home visits annually. Wald was a tireless advocate, instrumental in placing nurses in public schools, and helped found the National Organization for Public Health Nursing and Columbia University’s School of Nursing. Her advocacy extended to children’s rights, labor protections, and women’s suffrage, demonstrating the power of nursing advocacy to drive broad social reform. The (https://www.henrystreet.org/) continues its work today.
In a vastly different setting, Mary Breckinridge (1881-1965) addressed the profound healthcare needs of isolated mountain communities in southeastern Kentucky. Motivated by personal tragedy—the loss of her two young children—and a strong sense of social justice, she founded the Frontier Nursing Service (FNS) in 1925. At the time, this region had some of the highest maternal and infant mortality rates in the nation. Breckinridge envisioned a service where highly trained nurse-midwives, often traveling on horseback, would provide comprehensive maternal and child health care, as well as general nursing services, directly in people’s homes across a vast 700-square-mile area.
The FNS nurses, “Mrs. Breckinridge’s nurses,” delivered thousands of babies and attended to countless other ailments, dramatically improving health outcomes. The Hyden Hospital and Health Center was established in 1928, and when World War II disrupted the flow of British-trained midwives, Breckinridge founded the Frontier Graduate School of Midwifery in 1939, ensuring a sustainable supply of skilled professionals. The legacy of the FNS, now Frontier Nursing University, is a testament to nurse-led innovation in creating accessible, high-quality care models for underserved populations.
These pioneers of public health nursing demonstrated that nurses could be powerful agents of change, moving beyond individual patient care to address the root causes of illness and advocate for healthier communities. Their work fundamentally reshaped the understanding of nursing’s role and potential for systemic impact.
Table 1: Pioneering Nurses and Their Enduring Global Impact
Nursing at the Frontlines of Global Crises
Throughout history, nurses have consistently been at the forefront of human suffering, demonstrating extraordinary courage, adaptability, and compassion in the face of war, displacement, pandemics, and natural disasters. Their roles in these critical situations extend far beyond clinical tasks, often encompassing psychosocial support, community organization, and advocacy under the most challenging circumstances.
Nurses in Wartime and Refugee Settings
The crucible of war has long highlighted the indispensable role of nurses. During the American Civil War, an estimated 20,000 women and men served as nurses, and their commendable service provided a strong rationale for the establishment of formal nursing training programs. The World Wars of the 20th century saw an unprecedented mobilization of nurses. American Red Cross nurses and members of the Army and Navy Nurse Corps served with distinction on multiple fronts, establishing and staffing field hospitals, evacuation hospitals, hospital trains, and ships, often under direct fire and in grueling conditions. The diaries of nurses like Peggy Arnold, who served with the British Red Cross in France during WWI and tragically died from pneumonia possibly contracted from patients, and Dorothea Crewdson, offer poignant firsthand accounts of the “groans, and moans, and shouts” of the wards, the constant presence of suffering, and the immense personal toll on caregivers. Similarly, Dorothy, another WWI VAD, chronicled the “topsy turvy life” of night shifts and the emotional resilience required. During the Vietnam War, between 5,000 and 11,000 American nurses, many of whom were young recent graduates, faced overwhelming casualties and intense psychological stress while providing critical care. The legacy of nurses in wartime continues, with organizations like the International Council of Nurses (ICN) running campaigns such as #NursesforPeace to highlight the ongoing risks faced by healthcare workers in conflict zones today and to advocate for their protection.
The plight of refugees and displaced populations has also consistently called upon the expertise and compassion of nurses. The 1956 Hungarian refugee crisis, following the Soviet suppression of the uprising, marked the first major emergency in which the United Nations High Commissioner for Refugees (UNHCR) became operational. Austrian Red Cross nurses and other NGO personnel were instrumental in providing initial care and support as approximately 200,000 Hungarians fled, mostly into Austria. While specific details on nursing roles in this crisis are sparse in the available records, the scale of the humanitarian response implies a significant nursing presence.
Later, during the Vietnamese “Boat People” exodus from the 1970s and 1980s, nurses worked in challenging refugee camp conditions across Southeast Asia, including Hong Kong, Malaysia, and the Philippines. These camps often faced overcrowding and resource limitations, demanding immense adaptability from healthcare providers.
The 1994 Rwandan Genocide and the subsequent Goma refugee crisis in Zaire (now the Democratic Republic of Congo) presented an almost unimaginable humanitarian catastrophe. Nurses from organizations like the International Committee of the Red Cross (ICRC) and Médecins Sans Frontières (MSF) confronted massive outbreaks of cholera and dysentery that swept through the densely populated refugee camps, leading to extremely high mortality rates. Personal accounts, like that of MSF’s Rachel Kiddell-Monroe in Goma, reveal the ethical dilemmas faced by aid workers, as camps were often controlled by individuals responsible for the genocide, forcing organizations to grapple with the implications of providing aid in such a politicized and dangerous environment. Despite these challenges, nurses provided life-saving care, managed treatment centers, and worked to contain devastating epidemics.
In contemporary refugee health settings, nurses continue to play pivotal roles in delivering primary healthcare, often within parallel or ad-hoc structures established by NGOs and international organizations like the (https://www.unhcr.org/) and (https://www.icrc.org/). Their responsibilities include clinical care, health education, disease surveillance, and care coordination, frequently addressing complex physical and mental health needs exacerbated by displacement and trauma. The consistent presence and adaptability of nurses in these diverse crises underscore their role as a uniquely versatile and resilient component of the global health workforce. Their ability to provide not just clinical care but also psychosocial support and community organization is often critical to mitigating suffering and fostering recovery.
Pandemic responses: The 1918 flu, HIV/AIDS, COVID-19
Pandemics have repeatedly tested the resilience of health systems and highlighted the indispensable role of nurses. During the 1918 Influenza Pandemic, with no specific antiviral treatments or antibiotics available, skilled nursing care was considered a primary treatment. Nurses were responsible for meticulous patient observation, monitoring vital signs, applying ice packs and sponge baths to reduce fevers, and providing nutrition. The pandemic struck during World War I, leading to severe nursing shortages as thousands of graduate nurses were deployed to military camps. Public health district nurses, alongside volunteers and nurses from organizations like the Henry Street Settlement, provided crucial care in homes and makeshift hospitals. Nurses like Aileen Stewart Cole, one of the first Black women to join the Army Nurse Corps during this period, served in incredibly challenging conditions, often in isolated and impoverished communities where the disease spread rapidly. Tragically, hundreds of nurses succumbed to the flu themselves, dying in the line of duty.
The HIV/AIDS pandemic, emerging in the early 1980s, presented a new and terrifying challenge. Nurses were at the forefront from the very beginning, often providing care when others hesitated due to fear and stigma. They were instrumental in developing compassionate, patient-centered models of care, famously exemplified by Ward 5B at San Francisco General Hospital, the first dedicated inpatient AIDS unit in the U.S., which was largely nurse-led. This “San Francisco Model” emphasized comfort, symptom management, palliative care in an era before effective antiretroviral therapies, and profound psychosocial support for patients and families facing immense discrimination. Nurse scientists also conducted critical research that advanced understanding of the disease and its management. Today, nurses continue to lead in HIV care, managing antiretroviral therapy (ART) clinics in sub-Saharan Africa and PrEP (pre-exposure prophylaxis) clinics globally. The graphic memoir Taking Turns: Stories from HIV/AIDS Care Unit 371 offers poignant oral histories of nurses on these early wards.
More recently, the COVID-19 pandemic once again thrust nurses into the global spotlight. The global nursing workforce, numbering around 29.8 million in 2023, faced unprecedented challenges, including overwhelming patient loads, exposure to a novel and dangerous virus, and immense psychological trauma. Despite their critical role, a concerning report from the WHO and ICN indicated that only 42% of countries had provisions for mental health support for nurses during this period. The pandemic exacerbated existing inequities in the global nursing workforce, with organizations like the ICN and WHO advocating fiercely for adequate personal protective equipment (PPE), fair compensation, safe working conditions, and priority access to vaccines for nurses.
Across these pandemics, a clear pattern emerges: nurses have been indispensable, adapting their skills, providing compassionate care under extreme pressure, and often advocating for their patients and for sound public health measures. However, these crises have also starkly revealed and often worsened pre-existing weaknesses in health systems, particularly the chronic underinvestment in nursing workforce support, safety, and well-being. The lack of adequate protection, resources, and mental health support for nurses working in such crises directly contributes to increased burnout, moral distress, and attrition, thereby weakening the health system’s capacity to respond effectively to both current and future emergencies.
Disaster relief: Earthquakes, tsunamis, and cyclones
Natural and human-made disasters demand rapid, skilled, and compassionate responses, and disaster nurses are consistently among the first to provide critical healthcare in the aftermath. The specialty of disaster nursing involves traveling to affected areas to deliver emergency medical services, assess injuries and illnesses, administer first aid, stabilize critically ill patients, and collaborate with broader emergency response teams.
The history of organized disaster nursing in the United States can be traced back to the late 19th century, with American Red Cross nurses responding to catastrophic events such as the yellow fever epidemic in Jacksonville, Florida (1888), the Johnstown flood in Pennsylvania (1889), and the Galveston hurricane in Texas (1900). These early responses, often led by figures like Clara Barton, laid the foundation for more formalized disaster relief efforts.
More recent history is replete with examples of nurses’ critical roles. During Hurricane Katrina in 2005, nurses provided essential care amidst widespread devastation and system collapse in the U.S. Gulf Coast. Following the Great East Japan Earthquake and Tsunami in 2011, which also triggered a nuclear accident, disaster nurses were integral to the complex medical and public health response. Similarly, volunteer nurses were crucial in the aftermath of the massive earthquakes that struck Turkey and Syria in 2023.
The 2004 Indian Ocean Tsunami provided stark lessons about disaster preparedness and the impact on healthcare infrastructure. In Aceh, Indonesia, one of the hardest-hit regions, 189 nurses and 64 midwives were among the confirmed dead, a devastating loss to the local health system. The tsunami exposed the critical lack of medical disaster plans, including supply stockpiles and systems for deploying and supporting personnel. Surviving local nurses were simultaneously victims who had lost loved ones and homes, and essential responders. International relief nurses were deployed, often working in makeshift conditions and rotated regularly to prevent burnout, while nursing associations from countries like Canada, Norway, and Japan provided aid in the form of treatment kits, uniforms, and emergency cash. The experience highlighted the need for better support systems for local healthcare workers in disaster zones, who are often overlooked as victims themselves.
Numerous organizations, including the American Red Cross, the RN Response Network, National Disaster Medical Teams, Doctors Without Borders (MSF), and the International Medical Corps, rely heavily on disaster nursing professionals. Their work demands not only exceptional clinical skills but also profound emotional resilience, cultural sensitivity, and the ability to improvise in chaotic, resource-scarce environments. These events consistently underscore the urgent need for robust disaster preparedness strategies, which must include comprehensive support systems for the nurses who place themselves in harm’s way to care for others. Investing in disaster preparedness and global health security must therefore specifically include strategies for supporting and sustaining the nursing workforce, recognizing them as indispensable first responders and a critical component of resilient health infrastructure.
Case Studies: Nursing Innovations Around the World
Nursing’s global impact is powerfully demonstrated through innovative, often nurse-led, programs that address specific health challenges in diverse settings. These initiatives showcase the profession’s adaptability, commitment to compassionate care, and ability to drive systemic change from the ground up.
Community-driven maternal-child health programs in sub-Saharan Africa
Sub-Saharan Africa continues to face a disproportionate burden of maternal and newborn mortality, with many deaths being preventable through timely and skilled care. Nurse- and midwife-led community programs, frequently involving Community Health Workers (CHWs), are proving crucial in improving maternal and child health (MCH) outcomes by enhancing access to care, providing vital health education, and ensuring skilled attendance at birth.
Amref Health Africa has been a significant force in this area, focusing on training midwives and CHWs, improving access to reproductive health services, preventing malaria and HIV, and promoting hygiene and sanitation. Their ambitious “Stand Up for African Mothers” campaign aimed to train 15,000 midwives, recognizing their pivotal role in safe childbirth and broader MCH. Innovations include eLearning programs, such as the USAID-funded Afya Timiza Project in Kenya, which allow nurses and midwives to upgrade their skills without leaving their communities. This initiative has demonstrably improved the identification and prevention of neonatal deaths in Kenya. Amref also supports community health units and CHW training to bolster antenatal care and immunization coverage. Inspiring stories emerge from their work, such as that of Patricia, a midwife in Zambia, whose dedication inspired her daughter Esther to become a nurse-midwife, and Hellen, a midwife student in South Sudan, who is already making a significant impact in her community through her training. Lydia, a nurse facility-in-charge at the Amref Kibera Health Centre in Kenya, exemplifies nurse leadership in crisis management and community health.
While not in Sub-Saharan Africa, the model employed by BRAC in Bangladesh offers relevant insights. Their MANOSHI program utilizes CHWs for door-to-door antenatal care (ANC) visits in urban slums, providing examinations, counseling, and referrals. Rigorous evaluation has shown that women receiving four or more ANC visits from BRAC CHWs were 25% more likely to have a facility-based delivery and experienced significantly improved postnatal care (PNC) and essential newborn care (ENC).
In Ethiopia, a comprehensive intervention to strengthen health systems, including upgrading facilities for Basic and Comprehensive Emergency Obstetric Care (BEmOC/CEmOC) and training non-clinical physicians and midwives, resulted in a remarkable 64% decline in the maternal mortality ratio (MMR) over a three-year period. Despite such progress, challenges persist; a 2023-2024 study in Eastern Ethiopia found that while 15.68% of women experienced adverse maternal outcomes, factors like folic acid intake and partner support significantly reduced risks, underscoring the continued need to strengthen CHW programs and address socioeconomic determinants.
UNICEF also plays a critical role by supporting countries in providing essential packages of maternal and newborn services, delivered through primary healthcare systems and well-trained CHWs, thereby enhancing community-centered primary healthcare.
These examples highlight a clear trend: nurse- and midwife-led community-based programs are essential for advancing MCH in Sub-Saharan Africa. Their success hinges on innovative training methods like eLearning, effective task-sharing with CHWs, strong local partnerships, community engagement, and sustained investment. These initiatives demonstrate nurses not only delivering care but actively designing and leading solutions tailored to community needs, thereby overcoming systemic barriers to health. The Amref Health Africa, (https://www.brac.net/), and UNICEF Health websites offer further information on these impactful programs.
Mobile clinics and tele-nursing in remote regions
Overcoming geographical barriers to healthcare access is a significant challenge, particularly in remote and underserved regions. Nurses are at the forefront of innovative solutions, including mobile health clinics and telenursing services, to bring care closer to those who need it most.
Mobile Health Clinics have emerged as a vital strategy for delivering primary and preventive care, diagnostic services, chronic disease management, and health education directly to communities with limited access.
In Guatemala, the “Nursing Heart” program, a nurse-led initiative involving advanced nursing students, has utilized mobile clinics to perform over 4,000 cervical cancer screenings using the Visual Inspection with Acetic Acid (VIA) method in more than 40 rural communities since 2011. Approximately 4% of women screened show abnormal or cancerous cells, with many receiving immediate treatment or referral, demonstrably saving lives.
In India, Mobile Medical Units (MMUs) are recognized as effective in reaching underserved populations for primary care and early screening. The Siemens Sanjeevan mobile clinic, for example, has improved access to primary healthcare services.
Across Africa, mobile units have been deployed for diverse purposes, including cancer diagnosis and treatment (e.g., skin and cervical cancers), HIV counseling and testing in South Africa, and even using camels to transport deployable clinics to hard-to-reach nomadic populations. Amref Health Africa’s One Health clinics in Kenya adapted during severe flooding to provide daily services, becoming the sole source of support for many communities.
Tele-nursing and Telehealth leverage technology to bridge distances, offering numerous benefits such as increased accessibility to specialist consultations, reduced travel time and costs for patients, and improved health outcomes, particularly in remote settings. The International Council of Nurses (ICN) defines telenursing as a service enabling nurses to provide care to rural or remote populations, effectively promoting healthy lifestyles and self-care.
The Yukon Telehealth System in Canada, for instance, provided timely access and cost savings but also highlighted challenges such as underutilization and the need for updated equipment.
In Africa, telemedicine adoption is growing but remains uneven, facing hurdles like limited internet connectivity, high implementation costs, lack of digital literacy, and insufficient awareness. While South Africa is advancing in specialist teleconsultations and Kenya in mHealth applications for maternal health and HIV care, a study in Ethiopia revealed low positive attitudes towards telenursing among nurses, underscoring the critical need for adequate training, resources, and change management strategies.
These nurse-driven innovations demonstrate a proactive approach to healthcare delivery. Mobile clinics physically take services to isolated populations, while telenursing transcends distance through technology. The success of these models is often contingent on addressing infrastructural limitations, investing in training for both providers and users, ensuring cultural acceptance, and developing supportive policy frameworks. They represent a significant step towards achieving health equity by ensuring that quality care is not determined by geography.
Nurse-led mental health initiatives in post-conflict zones
Post-conflict zones present profound mental health challenges, with populations often experiencing high rates of post-traumatic stress disorder (PTSD), depression, and anxiety due to widespread violence, loss, and displacement. In these highly traumatized and resource-limited environments, nurses, particularly mental health nurses, are playing a crucial role in establishing and delivering essential psychosocial support and care.
In Liberia, a country scarred by years of civil war, the Carter Center’s Mental Health Program has made significant strides by training local nurses and physician assistants as mental health clinicians. Having exceeded its initial goal of training 150 clinicians by 2015 (with 166 trained by August of that year), these graduates now serve in primary care clinics, hospitals, prison systems, and refugee support services across all 15 counties. They were instrumental in Liberia’s psychosocial response during the Ebola epidemic and continue to expand access to mental health care, with some alumni also becoming educators, ensuring the sustainability of these efforts.
Sierra Leone, another nation deeply affected by conflict and subsequent disasters like the 2017 mudslide, has a very limited number of mental health nurses – reportedly only 20 for the entire country. Despite these constraints, these nurses have demonstrated remarkable impact. During the mudslide disaster, they immediately deployed to deliver Psychological First Aid (PFA), provided psychiatric liaison services in hospitals, and advocated for patients with complex needs. Initiatives like the King’s Sierra Leone Partnership support the training of mental health nurses and service development, while the Mental Health Coalition Sierra Leone advocates for community-based psychosocial support and the integration of mental health into national policies.
In Northern Uganda, which endured a long and brutal conflict, War Child Holland’s “TeamUp” intervention, a movement-based mental health promotion program for conflict-affected children, has shown positive outcomes. Evaluations in the Bidibidi refugee settlement indicated improvements in children’s psychosocial wellbeing, attitudes toward school, and a reduction in traumatic stress symptoms. While nurse involvement isn’t explicitly detailed in these specific evaluation snippets, such community-based psychosocial support programs often rely on or collaborate with nurses. TPO Uganda is another organization providing Mental Health and Psychosocial Support (MHPSS) in the region, including training for partners and community awareness initiatives.
Across Africa and Asia, the International Committee of the Red Cross (ICRC) implements community-level MHPSS programs in conflict-affected areas like the Democratic Republic of Congo, Mali, and Nigeria. These programs often utilize lay counselors trained and supervised by MHPSS teams, which can include nurses, to deliver individual and group psychological support. Globally, the World Health Organization (WHO) and the Inter-Agency Standing Committee (IASC) MHPSS Reference Group work to strengthen interagency coordination and service delivery in humanitarian emergencies. However, studies consistently highlight the ongoing need for more nurse-led mental health interventions in primary care within Low- and Middle-Income Countries (LMICs), alongside efforts to combat stigma and address shortages of trained personnel and resources.
These case studies underscore the critical role of nurse-led and nurse-involved mental health initiatives in post-conflict recovery. They demonstrate innovation in training local capacity, delivering culturally sensitive psychosocial support, and advocating for the integration of mental health into broader primary care systems, often under extremely challenging conditions. The ability of these programs to scale up and achieve sustainable impact is often contingent on strong local partnerships, consistent community engagement, and dedicated investment in the training and ongoing support of nurses and allied mental health workers. These nurses are not just treating symptoms; they are helping to rebuild the psychosocial fabric of war-torn societies.
Policy, Advocacy & Leadership
The evolution of nursing from a vocation of compassion to a profession driving systemic change is powerfully evident in its growing influence on health policy, its robust advocacy efforts, and the increasing number of nurses assuming leadership roles on national and international stages. Nursing organizations play a pivotal role in this transformation, amplifying the voices of millions of nurses worldwide.
The role of nursing organizations (ICN, WHO’s Office of Chief Nurse)
Several key organizations are instrumental in shaping the global nursing landscape, advocating for the profession, and influencing health policy.
The International Council of Nurses (ICN), founded on July 1, 1899, by visionary leaders like Ethel Gordon Fenwick, stands as the world’s first and widest-reaching international organization for health professionals. Born out of the women’s suffrage movement, its initial aim was to create a global network of national nursing associations to elevate standards of nursing education and professional ethics for the public good. For over 120 years, the ICN has served as the global voice of nursing, representing millions of nurses through its federation of more than 130 national nursing associations (NNAs). Key milestones include holding the first international nursing conference in 1901, establishing the first international definition of a “nurse,” introducing International Nurses Day (celebrated annually on May 12th, Florence Nightingale’s birthday), and developing the globally recognized ICN Code of Ethics for Nurses, first adopted in 1953 and regularly updated. The ICN also champions leadership development through programs like the Global Nursing Leadership Institute (GNLI), established in 2008, and the Leadership for Change program (1996), and supports advanced practice nursing through its International Nurse Practitioner/Advanced Practice Nursing Network (2000). Through position statements, campaigns like #NursesforPeace and its focus on Universal Health Coverage (UHC), and active advocacy on issues such as nurse safety, fair pay, workforce shortages (particularly highlighted during the COVID-19 pandemic), the ICN consistently works to advance the profession and promote health for all. The ICN’s official history provides further details on its impactful journey.
The World Health Organization (WHO) has recognized the critical importance of nursing and midwifery since its establishment in 1948. Early priorities focused on addressing nursing shortages, improving training standards, and clearly defining the roles of nurses and midwives within health systems. The Primary Health Care movement of the 1970s-1990s further solidified the central role of nurses and midwives in community health and leadership. A significant development was the establishment of the Office of the Chief Nurse in 2017 by WHO Director-General Dr. Tedros Adhanom Ghebreyesus. Elizabeth Iro of the Cook Islands served as the first WHO Chief Nursing Officer (2017-2022), followed by Dr. Amelia Latu Afuhaamango Tuipulotu from the Kingdom of Tonga, appointed in December 2022. Earlier, figures like Dr. Amelia Mangay-Maglacas, as WHO Chief Nurse Scientist, were pivotal in establishing initiatives such as the Global Network of WHO Collaborating Centres for Nursing and Midwifery Development. Key WHO initiatives driven by or significantly involving its nursing leadership include the Global Strategic Directions for Nursing and Midwifery, the comprehensive State of the World’s Nursing reports, the Nursing and Midwifery Global Community of Practice (a virtual network for collaboration), and the Global 25×25 Basic Emergency Care (BEC) campaign, which aims to train nurses and midwives in 25 countries in emergency care by 2025. The WHO Office of the Chief Nurse and the broader WHO Nursing and Midwifery program provide vital global guidance and support. A detailed history can be found in https://iris.who.int/bitstream/handle/10665/259535/9789241511902-eng.pdf.
These organizations, through their sustained efforts in standard-setting, education, advocacy, and leadership development, provide the essential global infrastructure for advancing the nursing profession. Their effectiveness, however, relies on the active engagement of nurses at all levels and robust collaboration with governments, other health professions, and civil society. This collective action is fundamental to translating the potential of the nursing workforce into tangible improvements in global health.
Influencing health policy at national and international levels
Nurses are increasingly recognized not just as implementers of health policy but as crucial contributors to its development and reform. Their unique position at the point of care provides invaluable insights into the practicalities and impacts of health policies on patients, families, and communities. This frontline experience is a powerful catalyst for nursing advocacy.
Nursing organizations are key conduits for this influence. The ICN and its National Nursing Associations (NNAs) worldwide actively lobby governments and international bodies like the WHO and the United Nations, advocating for policies that support the nursing workforce and promote public health. ICN utilizes position statements to articulate nursing perspectives and recommendations on a wide array of health issues, from patient safety and mental health to access to clean water and the management of communicable diseases like tuberculosis.
The WHO, in turn, develops global health strategies and guidelines, and supports its member states in formulating evidence-based national health policies, often with significant input from its nursing leadership and expert committees. For example, WHO’s International Code of Marketing of Breast-milk Substitutes (1981) and the Framework Convention on Tobacco Control (2003) are landmark global health treaties whose implementation is supported by nurses worldwide.
Academic and professional bodies also contribute to policy influence. Sigma Theta Tau International (Sigma Nursing), for instance, holds special consultative status with the UN Economic and Social Council (ECOSOC). This status allows Sigma to participate in UN committees, attend international conferences, and submit written statements, providing a direct nursing voice on global health issues, sustainable development, and human rights.
A compelling example of national-level policy influence is the “Triple Impact” report published in 2016 by the All-Party Parliamentary Group (APPG) on Global Health in the UK. This report powerfully argued that strengthening nursing globally would improve health outcomes, promote gender equality (as nursing is a predominantly female profession), and support economic growth. It included specific recommendations for the UK government and international agencies to invest in nursing education, leadership, and workforce development. Such reports, backed by parliamentary groups and evidence, can significantly shape government priorities and funding allocations.
The book “Case Studies in Global Health Policy Nursing” further illustrates the diverse ways nurses engage with policy, covering topics such as HIV, access to clean water, and the localization of the nursing workforce in various international contexts. These examples demonstrate that whether through direct lobbying, research, participation in governmental advisory bodies, or grassroots activism, nurses are making their voices heard and contributing to more effective and equitable health policies. The ability of nursing organizations to unify the profession, build strong coalitions with other stakeholders, and present compelling, evidence-based arguments is critical to their success in the policy arena. This organized advocacy, coupled with the direct involvement of nurses in political processes, is key to translating frontline knowledge into systemic and lasting change.
Success stories of nurses turned policymakers
The transition of nurses into policymaking roles represents a powerful pathway for translating frontline experience into impactful health governance. Several nurses have risen to prominent political and policy positions, bringing their unique understanding of patient needs and health system realities to the highest levels of decision-making.
Dr. Sheila Tlou of Botswana stands as a remarkable example of nurse leadership in global health policy. A distinguished nurse, PhD holder, and specialist in HIV/AIDS and women’s health, Dr. Tlou served as Botswana’s Minister of Health from 2004 to 2008. During her tenure, she spearheaded a comprehensive national HIV/AIDS program that achieved near-universal (90%) uptake of antiretroviral therapy (ART). This initiative led to a dramatic reduction in mother-to-child HIV transmission from approximately 30% in 2003 to 8% in 2008, and a fall in AIDS-related maternal mortality from 34% to 9%. Her impact extended regionally and globally as she later served as the UNAIDS Regional Director for Eastern and Southern Africa (2010-2017), providing leadership for the AIDS response in 21 African countries. Dr. Tlou currently co-chairs the Global HIV Prevention Coalition and the Nursing Now Global Campaign, continuing her advocacy for health and nursing.
Dr. Amelia Latu Afuhaamango Tuipulotu, the current Chief Nursing Officer at the World Health Organization (appointed December 2022), also has a strong background in policy. She was the first female Minister of Health for the Kingdom of Tonga. Her doctoral work in nursing directly informed the development of Tonga’s National Professional Standards for Registered Nurses, which were subsequently mandated within the Nurse Practitioners and Midwives Act 2021, passed during her time in the Legislative Assembly. She also successfully led Tonga’s national responses to the 2019 measles outbreak and the COVID-19 pandemic.
In Canada, Kamal Khera, a registered nurse, briefly served as the federal Minister of Health, demonstrating that nurses can reach top cabinet positions in high-income countries as well. In the United States, Congresswoman Lauren Underwood, a registered nurse, is a prominent voice in health policy. She co-founded and co-chairs the Black Maternal Health Caucus, actively working to address racial disparities in maternal health outcomes, and was involved in the implementation of the Affordable Care Act.
Historically, nurse activists like Lavinia Dock, a co-founder of the American Nurses Association and author of an early nursing manual on medication, and Mary Eliza Mahoney, the first African American licensed nurse in the US and founder of the National Association of Colored Graduate Nurses, were instrumental in shaping healthcare reform and advocating for the rights of both nurses and marginalized patient populations.
The call for greater nursing representation in policy continues. For instance, nurses in Lagos, Nigeria, are actively advocating for ministerial and cabinet appointments, arguing that their absence from high-level decision-making roles hinders improvements in healthcare delivery and the welfare of nursing professionals.
These success stories, both historical and contemporary, powerfully illustrate that nurses in policymaking positions bring invaluable perspectives that can lead to more effective, equitable, and patient-centered health systems. The increased representation of nurses in such roles is not merely a matter of professional advancement but a strategic imperative for improving global health outcomes. When nurses lead, their profound understanding of health realities translates into policies that genuinely serve the needs of diverse populations.
Table 2: Major International Nursing and Health Organizations: Shaping Global Nursing Policy & Practice
Building a Global Nursing Workforce
A robust, skilled, and adaptable global nursing workforce is the cornerstone of effective health systems worldwide. Achieving this requires concerted efforts in education, fostering cultural competence, ensuring ethical practice, and developing strong mentorship and leadership pipelines.
Education and exchange programs that spread best practices
International education and exchange programs are vital mechanisms for disseminating best practices, cultivating a globally-minded nursing workforce, and strengthening health systems, particularly in resource-limited settings. Participation in such programs has been shown to positively impact nursing students’ professional and personal development, enhancing their cultural awareness and skills in areas like health counseling.
Several prominent programs facilitate this global exchange:
The Fulbright Program, particularly through its Fulbright-Fogarty Fellowships in Public Health, promotes crucial research in resource-limited environments, fostering international collaboration and knowledge creation. Studies indicate that while these awards encourage international mobility, their impact on scientific productivity can vary based on the economic status of the scholar’s home country, with a notable increase in US-home country collaborations.
The Erasmus+ Program enables extensive student and staff mobility within higher education across Europe and beyond, with the explicit aims of improving skills and fostering intercultural awareness. A study involving nursing students from Malta participating in Erasmus+ exchanges highlighted significant enhancements in their self-empowerment, self-esteem, and intercultural awareness.
SEED Global Health adopts a model of deploying US physicians, nurses, and midwives as year-long educators in African partner countries (Malawi, Sierra Leone, Uganda, and Zambia). This initiative has directly contributed to the training of over 34,000 health professionals and has been instrumental in strengthening local institutions through curriculum development, support for accreditation processes (e.g., for a new nursing school in Northern Uganda), and the establishment of new nursing roles, such as advanced practice nursing positions in Malawi and Eswatini.
Sigma Theta Tau International (Sigma Nursing) actively supports global nursing through a variety of initiatives, including research grants, leadership education programs like the Global Nursing Leadership Competency Framework, and significant engagement with the United Nations to influence global health policy and support the Sustainable Development Goals (SDGs).
While these programs offer substantial benefits in terms of knowledge transfer and capacity building, it is crucial to approach them with a commitment to equitable partnership and long-term sustainability. Ethical considerations, such as avoiding “brain drain” from Low- and Middle-Income Countries (LMICs) and ensuring that programs genuinely strengthen local health systems rather than primarily serving the interests of individuals or institutions from high-income countries, are paramount. Models that emphasize co-development, mutual benefit, and the long-term empowerment of local health workforces, like those championed by SEED Global Health and Partners In Health (which focuses on training local staff), offer pathways to more sustainable and ethical global engagement. Further information can be found via the Fulbright Program, Erasmus+,(https://seedglobalhealth.org/), and(https://www.sigmanursing.org/).
Cultural competence and ethical considerations
In the increasingly interconnected landscape of global health nursing, cultural competence is not merely a desirable attribute but an ethical imperative for providing effective, respectful, and patient-centered care. Cultural competence in nursing involves a deep understanding of cultural differences and the conscious integration of these insights into attitudes and behaviors to promote positive cross-cultural interactions, reduce health disparities, and foster trust between patients and healthcare professionals. Key elements include a critical awareness of one’s own cultural values and implicit biases, an open and accepting attitude towards cultural diversity, a commitment to acquiring knowledge about different beliefs and practices, and the ability to communicate effectively across cultural divides. Language barriers often present a significant challenge in these interactions.
The International Council of Nurses (ICN) Code of Ethics underscores this, emphasizing respect for human rights, including cultural rights, the right to life and choice, dignity, and care that is unrestricted by considerations of age, color, culture, ethnicity, disability, gender, sexual orientation, nationality, politics, language, race, or social status.
Ethical conflicts frequently arise in international nursing practice due to differing cultural values and resource disparities. Navigating decisions around end-of-life care, for example, requires extreme sensitivity to diverse cultural perspectives on death, dying, autonomy, and family involvement. In low-resource settings, nurses often face agonizing ethical dilemmas related to the allocation of scarce resources such as ventilators, ICU beds, and essential medications. The scope of practice for nurses in global health missions may also expand significantly beyond their typical roles in their home countries, presenting further ethical and professional challenges.
International research involving human participants carries a potential for exploitation if not conducted with rigorous ethical oversight, cultural sensitivity, and genuine respect for local communities and their values. Guiding principles for such research include respect for persons, beneficence (doing good), non-maleficence (doing no harm), justice, respect for community, and contextual caring. For expatriate nurses working in humanitarian missions, challenges can include experiences of disrespect, perceived lack of cultural competency from international staff by local colleagues, and the risk of adverse patient outcomes if local expertise and knowledge are not heeded. This highlights the critical need for comprehensive pre-deployment training for international staff, which should incorporate the perspectives and experiences of national staff to foster mutual respect and effective collaboration.
Ultimately, a lack of cultural competence can directly lead to negative patient outcomes, exacerbate health disparities, and erode trust in healthcare providers and systems, particularly in diverse global settings. Ethical practice in global health demands that nurses navigate these complex terrains with cultural humility, a commitment to ongoing learning, and an unwavering dedication to justice and equity.
Mentorship and leadership development
Developing strong nurse leaders and fostering robust mentorship programs are critical strategies for advancing the nursing profession, improving health systems globally, and ensuring the sustainability of the nursing workforce. Mentorship offers a dynamic, supportive relationship that benefits not only the mentee through guidance, career development, and stress reduction, but also the mentor by re-energizing their passion for nursing and providing fresh perspectives. Importantly, effective mentorship programs have demonstrated positive outcomes for nurse retention, job satisfaction, and intention to stay within the profession, which are crucial in addressing global nursing shortages.
International organizations like the World Health Organization (WHO) and the International Council of Nurses (ICN) consistently emphasize the importance of nurse leadership development. Sigma Nursing has developed the Global Nursing Leadership Competency Framework, a valuable tool that allows nurses at all career stages to self-assess their leadership skills and plan for development. The ICN’s Global Nursing Leadership Institute (GNLI) is another key initiative aimed at strengthening policy leadership among nurses worldwide.
Despite these efforts, a significant disparity exists in leadership development opportunities globally. While many high-income countries have established leadership initiatives, only about 25% of low-income countries offer structured leadership development programs for nurses. This gap hinders the potential of nurses in these regions to influence health policy, manage health services effectively, and drive innovation.
Investing in comprehensive, culturally sensitive nursing education and continuous professional development worldwide is a fundamental strategy for achieving health equity and building resilient health systems capable of addressing diverse population needs. Addressing the disparity in leadership opportunities in LMICs is not just a matter of professional development but a critical component of global health equity, ensuring that nurses from all regions are empowered to contribute their expertise to shaping the future of healthcare.
Practical Guidance for Nurses Seeking Global Impact
For nurses inspired to extend their impact beyond traditional bedside roles and engage in the global health arena, a multitude of pathways exist. Navigating these opportunities requires careful planning, skill development, and an understanding of the logistical and ethical complexities involved.
Identifying opportunities: fellowships, NGOs, public-health agencies
Nurses seeking to contribute to global health nursing can explore a variety of avenues:
Fellowships: These often provide structured, mentored experiences focusing on research, capacity building, or specialized clinical skills. Examples include the Penn Global Nursing Fellowship, which has supported projects in community mental health in India and nursing capacity building with Partners In Health, and the Fulbright-Fogarty Fellowships in Public Health, which promote research in resource-limited settings.
Non-Governmental Organizations (NGOs) and Non-Profits: Numerous NGOs offer opportunities for nurses, ranging from volunteer placements to long-term employment. Organizations like International Medical Aid, IVHQ (International Volunteer HQ), and Kaya Responsible Travel facilitate volunteer nursing programs abroad. Renowned organizations such as Doctors Without Borders (MSF) and the International Medical Corps actively recruit nurses for emergency response, direct service delivery, and program management in crisis-affected and underserved regions. Operation Smile, focused on cleft care, engages nurses in surgical missions and training initiatives globally.
Public Health Agencies: International bodies like the World Health Organization (WHO) and national ministries of health offer roles for nurses in policy development, program coordination, health surveillance, and research.
These opportunities vary widely in terms of duration, required experience, and whether they are volunteer or paid positions. Platforms such as GoAbroad.com’s Nursing Volunteer Programs section and the WHO Careers portal can be valuable resources for identifying current openings. Successfully engaging in global health nursing requires not only clinical skills and compassion but also a significant degree of adaptability, resourcefulness, and an entrepreneurial spirit, especially when navigating unfamiliar systems and securing necessary resources.
Developing cross-cultural communication skills
Effective cross-cultural communication is a cornerstone of successful and ethical global health nursing. It extends beyond mere language proficiency to encompass a deep understanding and respect for diverse cultural beliefs, values, and practices related to health and illness. These skills are vital for accurate patient assessment, clearly explaining complex medical issues, providing culturally appropriate health education, and building the trust essential for therapeutic relationships.
Key components of cross-cultural communication for nurses include:
Understanding Verbal and Nonverbal Cues: Recognizing that spatial distance, tone of voice, physical contact, gestures, and eye contact carry different meanings across cultures.
Cultural Humility: Approaching interactions with an attitude of respect, openness, and a willingness to learn, acknowledging one’s own biases and the limits of one’s own cultural perspective.
Active Listening: Truly hearing and understanding the patient’s perspective, concerns, and understanding of their health situation.
Utilizing Resources: Employing qualified medical interpreters when language barriers exist (a legal requirement in the U.S. for federally assisted healthcare facilities serving patients with limited English proficiency). Language learning apps, such as Care to Translate, can also be helpful supplementary tools.
Employing Frameworks: Using structured communication models like the LEARN framework (Listen, Explain, Acknowledge, Recommend, Negotiate) can facilitate more effective and respectful patient interviews.
Numerous training programs and courses are available to help nurses develop these critical skills, focusing on topics like cross-cultural collaboration and understanding implicit bias.
Navigating licensure, credentialing, and funding pathways
The practicalities of working internationally involve navigating complex regulatory and financial landscapes.
Licensure and Credentialing: Nursing licensure requirements differ significantly from one country to another. There are no universal standards. Nurses educated outside the United States who wish to practice as RNs or LPNs in the U.S., for example, must typically have their credentials evaluated by an organization like the Commission on Graduates of Foreign Nursing Schools (CGFNS International, now TruMerit).
This process generally involves a review of educational qualifications, verification of foreign licenses, passing the NCLEX examination (RN or PN), and demonstrating English language proficiency through standardized tests. Nurses planning to work or volunteer abroad must meticulously research and comply with the specific licensure and registration requirements of the host country and any employing organization. The(https://www.cgfns.org/) (now TruMerit) is a key resource for foreign-educated nurses seeking U.S. licensure.
Funding Pathways: For nurses looking to initiate or participate in global health projects, securing funding is often a critical step. Opportunities exist through various grants. For instance, the Dr. Martha Pitel Global Nursing Research Grant, offered by Sigma Nursing, provides $10,000 to support collaborative nursing research focused on health disparities globally. The University of California, San Francisco (UCSF) Center for Global Nursing offers a Seed Award of up to $10,000 for UCSF nurses and advanced practice providers to launch global health initiatives, particularly encouraging early-career investigators.
These examples illustrate that dedicated funding sources are available, but competition can be keen, requiring strong proposals and a clear articulation of project impact.
Engaging in global health is a profoundly rewarding endeavor, but it demands thorough preparation. Nurses must critically evaluate opportunities for their ethical grounding, potential for sustainable impact, and commitment to genuine partnership with local communities. The aim should always be to build local capacity and foster self-reliance, rather than engaging in short-term interventions that may inadvertently perpetuate dependency. The increasing interest of nurses in global health signals a growing recognition of the profession’s global responsibilities, which in turn necessitates more robust institutional support from universities, professional organizations, and employers to facilitate ethical, effective, and sustainable global engagement.
Table 3: Pathways to Global Nursing Impact: Opportunities and Considerations
Challenges & Future Directions
While nursing has made monumental strides in its global impact, the path forward is not without significant challenges. Addressing existing workforce issues, ethically integrating rapidly evolving technologies, and preparing for emerging global health threats like climate change will define the next era of nursing influence.
Workforce shortages, burnout, and resource constraints
The global nursing workforce faces a persistent and multifaceted crisis. Current estimates indicate a global shortage of approximately 5.8 million nurses in 2023, a figure projected to be 4.1 million by 2030 if current trends continue. This shortage, however, is not evenly distributed. A staggering 78% of the world’s nurses are concentrated in countries that represent only 49% of the global population, leading to profound inequities in access to care. Low- and middle-income countries (LMICs) bear the brunt of this disparity, facing immense challenges in educating, employing, and retaining their nursing workforce.
Compounding the issue of absolute numbers is the pervasive problem of nurse burnout, which was significantly exacerbated by the COVID-19 pandemic. Chronic understaffing, excessive workloads, inadequate pay, the escalating threat of workplace violence, and insufficient mental health support (with only 42% of countries reporting provisions for nurses’ mental well-being) are driving nurses out of the profession. The ICN’s 2024 survey found that 48.4% of National Nursing Associations reported a significant increase in nurses leaving their jobs. This exodus not only deepens shortages but also leads to a loss of experienced mentors for early-career nurses, particularly in high-income countries facing waves of retirements.
Resource constraints, especially in LMICs, further cripple the ability of nurses to provide quality care. Limited access to essential medicines, complex cancer treatments, diagnostic tools, and even basic personal protective equipment (PPE) were starkly highlighted during the COVID-19 pandemic. Furthermore, recent trends of reduced foreign aid and shrinking national health budgets in some regions threaten to reverse hard-won progress and further strain already fragile health systems.
The ICN’s landmark reports, including “Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness” (March 2023) and the International Nurses Day 2025 report “Caring for Nurses Strengthens Economies”, meticulously detail these challenges. They issue an urgent call for systemic changes, including significant investment in nursing education, fair compensation, safe staffing levels, improved working conditions, robust mental health support, and policies that genuinely value and protect the nursing profession. Addressing the well-being and sustainability of the nursing workforce is not merely an operational concern but a strategic imperative for achieving robust, equitable, and resilient health systems capable of meeting the complex health challenges of the 21st century and beyond.