全球护理人员面临的挑战：是时候进行范式转换了

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On 20 March 2023, the International Council of Nurses (ICN) published a report, highlighting the critical global nursing workforce situation, and warning that it is projected to worsen (ICN, International Council of Nurses, 2023). The COVID-19 pandemic has exhausted the nursing workforce. Reports of occupational fatigue, stress and burnout are everywhere, leading to widespread dissatisfaction, and resulting in significant numbers of nurses leaving the profession (ICN, International Council of Nurses, 2023; Dall’Ora et al. (2020). The report suggests this situation should be considered a global health emergency (ICN, International Council of Nurses, 2023).

As the World Health Organisation has stated, functional healthcare systems cannot exist without adequate numbers of appropriately educated and skilled healthcare workers (WHO, World Health Organization, 2020). The global demand for this workforce is increasing, as health systems try to recover from the pandemic. While the need for this workforce is growing, recruitment has proved a major challenge for affluent nations, as evidenced by the UK’s recent student recruitment records, and the numerous unfilled nursing posts in the NHS, across all four UK countries (McCurdy, 2023, BBC News, Scotland, 2022, The Health Foundation, 2019, Buchan et al., 2020).

Despite many campaigns, and much policy discussion, about making nursing appealing to younger generations of people from diverse backgrounds, the profession’s attractiveness is declining in many affluent nations. Unfortunately, with many nursing positions remaining vacant in rich nations, governments turn to recruit nurses from international sources. Indeed, this strategy has been a ‘quick fix’ solution to a chronic political problem: of nursing being undervalued, low-paid, hard work, and a gendered profession. This editorial argues the importance of not only improving nursing’s professional image, but also of improving inclusivity. By doing so, countries could attract more nurse candidates, at both local and national levels, and affluent nations should not need to consider international recruitment. Perhaps rich nations should also learn a few tips from countries, where nursing remains an attractive profession.

1. Recruitment challenges at home

The most pressing practical issue has been how to make nursing an attractive profession, particularly in those countries facing recruitment challenges. Current patterns of international nurse recruitment reveal a growing dependency on an internationally educated health workforce in the UK, Europe, the Gulf States and North America. Many economically rich nations, such as the Netherlands, the USA, Germany, Australia, New Zealand, Canada, and the UK, have been consistently unsuccessful in attracting enough nurse candidates. Various student recruitment and retention strategies have been developed and implemented but have had minimal impact (Mooring, 2016). Retention of graduate nurses in their healthcare systems has proved another major challenge.

However, contrary to the pattern in affluent nations, nursing is a very attractive profession for a younger generation of women in countries like Nepal, India, and the Philippines. The reasons for these trends are perhaps contextual and complex, and dependent on women’s position in society, the image of the profession, and the opportunities available for women in national and international healthcare labour markets. A commonly suggested driver for the attraction is international opportunity. Unfortunately, this is not the case in rich Western countries. More work is needed to make nursing an attractive profession for future generations.

While India, the Philippines, and Nepal have remained major suppliers of nurses to countries in the Gulf, Europe and North America, they also have health worker retention issues at home, and are under pressure to scale up their nursing workforce to meet Universal Health Coverage (UHC) by 2013 (Liu et al., 2016).

2. Various recruitment and retention campaigns and their impact at national and international levels

Realising the chronic nursing shortage and increased demand for this workforce, the UK’s All-Party Parliamentary Group on Global Health published a report suggesting investing in nursing and strengthening this workforce could make a triple impact (APPG, 2016). As well as achieving UHC, given that it is a gendered profession, nursing employment empowers women, and improves gender equality, and makes a significant contribution towards economic growth. Although it has been fully acknowledged that nursing is a crucial profession, which can achieve these goals, any progress in making the necessary changes has been painfully slow. Most people involved in the healthcare and nursing sectors globally are fully aware of and the nursing shortage has an impact on them.

A further global effort to make nursing an attractive profession, is the WHO declaring 2020 ‘Nurses and Midwives’ Year.’ For this, the WHO prepared a comprehensive report on the ‘State of the World’s Nursing 2020.’ The International Council of Nurses and the WHO jointly planned the ‘Nursing Now’ Global Campaign (2018–2022) (WHO, World Health Organization, 2020). This was for professional solidarity, and to improve the profession’s image, linking this with achieving UHC by 2030. Just as the campaign was launched, with its various activities and strategies in place, the COVID-19 pandemic hit the world, disrupting most of the activities planned for 2020. Instead, resources globally were diverted towards the COVID-19 response. Now the Nursing Now campaign has begun to pick up its momentum. However, anecdotal reports indicate that its messages are still to reach frontline professionals, nurse educators, and nurse employers and policy makers. It raises important questions of how effective and inclusive these campaigns are, and if nurse leaders can raise awareness of, and disseminate messages to, wider professional circle. There is an urgent need to find ways of reaching frontline professional colleagues, and identifying if such a campaign has any relevance in their professional lives, impact on nurse recruitment and retention. It is vital that we improve professional inclusivity.

Amongst many other efforts in the UK, one national level policy attempt to invite students, from diverse and socially disadvantaged backgrounds in the UK, is by widening access to higher education, including nursing education. This has been a praiseworthy social inclusion policy, but the true impact of this is not fully understood yet. No study has been conducted to examine it (Adhikari, 2023). Yet, in this academic year, all the UK countries have not been able to recruit the target number of nursing students, which has raised a major concern.

3. Improve inclusivity and the time for a paradigm shift

There is a huge diversity, and division, within professional nursing: in professional class, race, nationality, religion, gender identify and more (Adhikari et al., 2023, Smith et al., 2006). Now is the time to listen to a wider range of voices, and opinions. More work is urgently needed to address the global nursing workforce crisis for post pandemic recovery. Improving inclusivity can improve the profession’s image, making nursing an attractive career choice for people from wider backgrounds. More nurses are urgently needed across the world, to recover and rebuild healthcare systems, and to meet the Sustainable Development Goal of UHC by 2030. It is the time for a paradigm shift.

全文翻译（仅供参考）

2023年3月20日，国际护士理事会（ICN）发布了一份报告，强调了全球护理劳动力的严峻形势，并警告说，预计情况将恶化（ICN，国际护士理事会，2023年）。COVID-19大流行已耗尽护理人员。关于职业疲劳、压力和倦怠的报告随处可见，导致广泛的不满，并导致大量护士离开职业（ICN，国际护士理事会，2023年;Dall'Ora等人（2020年）。该报告建议，这种情况应被视为全球卫生紧急情况（ICN，国际护士理事会，2023）。

正如世界卫生组织所指出的，如果没有足够数量的受过适当教育和熟练的医疗保健工作者，功能性医疗保健系统就不可能存在（WHO，世界卫生组织，2020）。随着卫生系统努力从大流行病中恢复，全球对这一劳动力的需求正在增加。虽然对这类劳动力的需求在不断增长，但事实证明，招聘工作是富裕国家面临的一大挑战，英国最近的学生招聘记录以及英国所有四个国家的NHS中大量未填补的护士职位都证明了这一点（McCurdy，2023年;BBC新闻，苏格兰，2022年;健康基金会，2019年;Buchan等人，2020 年）。

尽管有许多运动和许多政策讨论，使护理吸引来自不同背景的年轻一代，但在许多富裕国家，这一职业的吸引力正在下降。不幸的是，由于许多护理职位在富裕国家仍然空缺，政府转向从国际来源招聘护士。事实上，这一战略是对一个长期政治问题的“快速解决”方案：护理被低估，低收入，艰苦的工作，和性别的职业。这篇社论认为，不仅提高护理的专业形象，而且提高包容性的重要性。通过这样做，各国可以在地方和国家两级吸引更多的护士候选人，富裕国家不需要考虑国际招聘。也许富裕国家也应该向一些国家学习一些技巧，在这些国家，护理仍然是一个有吸引力的职业。

1.国内招聘挑战

最紧迫的实际问题是如何使护理成为一个有吸引力的职业，特别是在那些面临招聘挑战的国家。目前的国际护士招聘模式显示，在英国，欧洲，海湾国家和北美，越来越依赖于受过国际教育的卫生劳动力。许多经济富裕的国家，如荷兰，美国，德国，澳大利亚，新西兰，加拿大和英国，一直未能吸引足够的护士候选人。已经制定和实施了各种学生招聘和保留策略，但影响甚微（Mooring，2016）。在他们的医疗保健系统中保留毕业护士已被证明是另一个重大挑战。

然而，与富裕国家的模式相反，护理对尼泊尔，印度和菲律宾等国家的年轻一代女性来说是一个非常有吸引力的职业。这些趋势的原因可能是有背景的和复杂的，取决于妇女在社会中的地位、职业的形象以及妇女在国家和国际保健劳动力市场上的机会。通常建议的景点驱动因素是国际机会。不幸的是，在富裕的西方国家，情况并非如此。需要做更多的工作，使护理成为对后代有吸引力的职业。

虽然印度、菲律宾和尼泊尔仍然是海湾、欧洲和北美国家的主要护士供应国，但它们在国内也存在卫生工作者保留问题，并且面临着到2013年扩大其护理劳动力以满足全民健康覆盖（UHC）的压力（Liu et al. 2016 ）。

2.各种征聘和留用运动及其在国家和国际一级的影响

意识到长期护理短缺和对这一劳动力的需求增加，英国全球卫生各党派议会小组发表了一份报告，建议投资于护理和加强这一劳动力可以产生三重影响（APPG，2016）。除了实现全民健康保险之外，鉴于护理是一个有性别区分的职业，它还增强了妇女的权能，改善了性别平等，并为经济增长做出了重大贡献。尽管人们已经充分认识到护理是一个至关重要的职业，可以实现这些目标，但在做出必要的改变方面的任何进展都是痛苦的缓慢。全球大多数从事医疗保健和护理行业的人都充分意识到护理短缺对他们的影响。

为了使护理成为一个有吸引力的职业，世界卫生组织宣布2020年为“护士和助产士年”。为此，世界卫生组织编写了一份关于“2020年世界护理状况”的综合报告。国际护士理事会和世界卫生组织共同策划了“Nursing Now”全球运动（2018-2022）（世卫组织，世界卫生组织，2020）。这是为了专业团结，并改善专业形象，将其与到2030年实现全民健康覆盖联系起来。就在该活动启动之际，随着各项活动和策略的实施，COVID-19疫情席卷全球，打乱了计划于2020年举行的大部分活动。相反，全球资源被转用于COVID-19应对。现在，“现在护理”运动已经开始恢复势头。然而，轶事报告表明，它的信息仍然是达到前线专业人员，护士教育工作者，护士雇主和政策制定者。它提出了重要的问题，如何有效和包容这些运动，如果护士领导人可以提高认识，并传播信息，更广泛的专业圈。迫切需要找到接触一线专业同事的方法，并确定这种运动是否与他们的职业生活有关，对护士招聘和保留的影响。提高专业包容性至关重要。

在英国的许多其他努力中，一个国家层面的政策尝试邀请来自英国不同和社会弱势背景的学生，是通过扩大高等教育，包括护理教育的机会。这是一项值得称赞的社会包容政策，但其真正影响尚未得到充分了解。尚未进行研究对其进行检查（Adhikari，2023）。然而，在本学年，所有英国国家都未能招收目标数量的护理专业学生，这引起了人们的严重关注。

3.提高包容性，是时候进行范式转变了

有一个巨大的多样性，和分工，在专业护理：在专业等级、种族、国籍、宗教、性别认同等方面（Adhikari等人，2023 ， Smith等人，2006 ）。现在是听取更广泛的声音和意见的时候了。迫切需要开展更多工作，以解决全球护理人员危机，促进大流行后的复苏。提高包容性可以改善职业形象，使护理成为对来自更广泛背景的人有吸引力的职业选择。世界各地迫切需要更多的护士，以恢复和重建医疗保健系统，并实现到2030年全民健康覆盖的可持续发展目标。是时候进行范式转变了。