ICN亚洲劳动力论坛强调全球护士供需差距不断扩大

ICN Asia Workforce Forum highlights widening gap in global supply and demand of nurses

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Nurse leaders gathered at a meeting in Thailand warned of the growing global nurse shortage at a time when the demand for nurses is increasing. The nurse leaders addressed the issue of nurse shortages and the linked subject of nurse migration, highlighting the widening gap in supply and demand of nurses.

Nurse leaders from 10 National Nurses Associations1 across Asia, representing eight million nurses, participated in the 21st Asia Workforce Forum (AWFF), co-hosted by International Council of Nurses (ICN) and the Nurses’ Association of Thailand and held in Bangkok, Thailand, 1-2 March 2023. The focus of the Forum was to discuss current nursing and health priorities across the region, and share strategies to effectively support nurses across Asia.

The Forum was convened at a time when the impact of the COVID-19 pandemic continues to challenge health system rebuild, whilst also having been a major cause of nurse stress, burnout and turnover. One key focus for the AWFF was to assess how the pandemic nurse workforce challenges can best be analysed and addressed. Participants reviewed and verified these challenges, and explored strategies for cooperation among countries. Nursing shortages, ageing populations and other key concerns were discussed.

Howard Catton, ICN Chief Executive Officer, who represented ICN at the meeting, described the paradox of the Forum’s discussions:

“Nurse shortages are biting hard across Asia and undermining universal health coverage, yet when countries put in place new facilities or models of care to increase access they need nurses to run them! Health for All is not going to happen without investment in nurses.

What we have heard at the Forum, directly from nursing representatives from India and the Philippines, who have traditionally been suppliers of nurses to the world, is a story of increasing shortages and demands for nurses in their countries. This should be an alarm bell for those higher-income countries who have relied on these countries as sources of nurses to address their own shortages that this will no longer be a viable or sustainable solution. Nurses must not be reduced to commodities. It is higher-income countries who are going on this global shopping trip, they are taking from shelves that are already very bare and can least afford to lose nurses.

The Global Strategic Directions for Nursing and Midwifery (GSDNM), developed by ICN and WHO provides a roadmap for addressing the shortages and need for investment in nursing but what we are hearing from some delegates at the Forum is that there are significant variations in awareness and implementation of the GSDNMs in different countries. This must be addressed.”

Prof. Dr. Siriorn Sindhu, President of the Nurses’ Association of Thailand added:

“The Nurses’ Association of Thailand was honoured to host this important Forum to discuss the many challenges and opportunities that nurses in the region are facing. We are grateful to ICN for bringing us together to learn from each other’s experiences and strategize about how to deal with issues confronting nursing in many countries. The need to invest in nursing, address the nursing shortage, ageing populations and other challenges are critical to the sustainability and growth of global health.”

At the end of the AWFF, participants released a communique which highlighted the important topics discussed. These included:

Participants at the Forum reported that all countries and regions face significant and increasing difficulties due to the growing shortage of nurses.

Ageing of the population in many of the countries participating in the Forum is another identified source of increased demand, and therefore increased requirement for nurses.

The Forum expressed deep concern about the detrimental impacts of increasing levels of active international recruitment by high-income countries on the ability of lower- and middle-income countries to maintain safe and accessible health services to their populations. ICN has been raising the alarm over the increase in international recruitment of nurses and the damage this causes on the already depleted nursing workforces in developing countries.

The Forum recognised that the pandemic has accelerated the need for effective primary care and chronic care, which will also be driven by ageing populations, and there is increasing recognition of the value of advanced practice nurses working in these areas, often as the main first point of contact for communities.

Participants agreed that securing sufficient and well qualified nurses is a critical and central step in supporting health system rebuild, and achieving UHC. There is an urgent need to support the recovery of the nurse workforce.

The Forum agreed that all national nursing associations must work with other stakeholders to improve retention, advance career development and professionalism of nurses by securing, recognising and rewarding excellence in nursing practice. Continuous professional development is the most effective way to retain competent nurses for patient-centred care, particularly when it is linked with a career structure with real prospects for promotion.

The Forum also agreed that it is critical that during the process of health system rebuild, and to enable recovery of the nursing workforce, senior nurses are fully involved in the policy-making process within their countries, and internationally, in order to ensure that the central role of the nursing workforce is fully represented.

The Forum agreed that not only investment in the nursing workforce is essential to improve global health, achieve UHC and deliver the SDGs but that it is also fundamental to patient safety and the security and sustainability of health systems. Investment in health is also a key enabler and accelerator of economic growth.

The Forum underscored that the Strategic Directions for Nursing and Midwifery (SDNM) 2021-2025 developed by WHO and ICN and adopted by the World Health Assembly (WHA) was the roadmap to both support our global nursing workforce and rebuild our health systems and must be implemented in all countries.

全文翻译（仅供参考）

在泰国召开的一次会议上，护士领袖们警告说，在护士需求不断增加之际，全球护士短缺问题日益严重。护士领导讨论了护士短缺问题和护士迁移的相关问题，强调了护士供需差距的扩大。

来自亚洲10个国家护士协会1的护士领导，代表800万名护士，参加了由国际护士理事会（ICN）和泰国护士协会共同主办的第21届亚洲劳动力论坛（AWFF），该论坛于2023年3月1日至2日在泰国曼谷举行。论坛的重点是讨论该地区当前的护理和卫生优先事项，并分享有效支持亚洲护士的战略。

该论坛召开之际，新冠肺炎疫情的影响继续对卫生系统重建构成挑战，同时也是护士压力、倦怠和离职的主要原因。AWFF的一个关键重点是评估如何最好地分析和应对大流行性护士队伍的挑战。与会者审查并核实了这些挑战，并探讨了各国之间的合作战略。讨论了护理短缺、人口老龄化和其他关键问题。

代表ICN出席会议的ICN首席执行官Howard Catton描述了论坛讨论的悖论：

“护士短缺正在亚洲各地造成严重影响，并破坏了全民健康覆盖，然而，当各国建立新的设施或护理模式以增加获得服务的机会时，他们需要护士来管理他们！如果没有对护士的投资，就不可能实现全民健康。”。

我们在论坛上直接从印度和菲律宾的护士代表那里听到的，是他们国家护士短缺和需求不断增加的故事。对于那些依靠这些国家作为护士来源来解决自身短缺问题的高收入国家来说，这应该是一个警钟：这将不再是一个可行或可持续的解决方案。护士不能沦为商品。正是高收入国家在进行这场全球购物之旅，他们正在从已经非常稀少的货架上撤下，而且最不可能失去护士。

国际护士组织（ICN）和世界卫生组织（WHO）制定的《全球护理和助产战略方向》（GSDNM）为解决护理投资短缺和需求提供了路线图，但我们在论坛上从一些代表那里听到的是，不同国家对GSDNM的认识和实施存在显著差异。必须解决这一问题。”

泰国护士协会主席Siriorn Sindhu教授补充道：

“泰国护士协会很荣幸主办这次重要论坛，讨论该地区护士面临的许多挑战和机遇。我们感谢ICN让我们一起学习彼此的经验，并就如何应对许多国家护理面临的问题制定战略。需要投资护理，解决护理短板年龄、人口老龄化和其他挑战对全球健康的可持续性和增长至关重要。”

在AWFF结束时，与会者发布了一份公报，强调了讨论的重要议题。其中包括：

论坛与会者报告说，由于护士日益短缺，所有国家和地区都面临着越来越大的困难。

参加论坛的许多国家的人口老龄化是需求增加的另一个原因，因此对护士的需求也增加了。

论坛对高收入国家日益增加的积极国际招聘水平对中低收入国家向其人口提供安全和可获得的保健服务的能力产生的不利影响深表关切。ICN一直对国际护士招聘的增加以及这对发展中国家本已耗尽的护士队伍造成的损害发出警报。

论坛认识到，大流行加速了对有效初级护理和慢性护理的需求，这也将受到人口老龄化的推动，人们越来越认识到在这些领域工作的高级执业护士的价值，他们往往是社区的主要第一接触点。

与会者一致认为，确保足够和合格的护士是支持卫生系统重建和实现全民健康的关键和核心步骤。迫切需要支持护士队伍的恢复。

论坛一致认为，所有国家护理协会都必须与其他利益攸关方合作，通过确保、认可和奖励护理实践中的优秀表现，提高护士的保留率、促进职业发展和专业化。持续的专业发展是留住合格护士进行以患者为中心护理的最有效方式，尤其是当它与具有真正晋升前景的职业结构相联系时。

论坛还一致认为，在卫生系统重建过程中，为了恢复护理人员队伍，高级护士必须充分参与本国和国际的决策过程，以确保护理人员队伍的核心作用得到充分体现。

论坛一致认为，对护理人员队伍的投资不仅对改善全球健康、实现全民健康和实现可持续发展目标至关重要，而且对患者安全以及卫生系统的安全和可持续性也至关重要。卫生投资也是经济增长的关键推动者和加速器。

论坛强调，由世界卫生组织和国际护士组织（ICN）制定并由世界卫生大会（WHA）通过的《2021-2025年护理和助产战略方向》（SDNM）是支持我们的全球护理人员队伍和重建我们的卫生系统的路线图，必须在所有国家实施。

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