护理的未来：大流行病的教训 | Lancet

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In early 2020, as part of a worldwide campaign to raise the profile of nursing, WHO, the International Council of Nurses (ICN), and Nursing Now published the first State of the World's Nursing report, setting out a global strategy for nursing. At the time, we highlighted how the report could inform policy dialogues and promote recognition of the potential of nursing to enable universal health coverage, and emphasised how crucial the subsequent years would be to show the impact of nursing. The COVID-19 pandemic has proven just how important these messages were. International Nurses Day was on May 12. This year it marked just over 3 years since COVID-19 emerged, a period in which huge demands were made of nurses. Health and health systems have not yet recovered. What is next for the future of global nursing?

The crucial and diverse ways nurses contribute to health systems were on full display during the pandemic. In Botswana, nurses developed strategic responses to mitigate the outbreak—running mobile clinics and managing redeployment to rural regions—demonstrating their ability to identify the needs of a community and develop systems that account for local factors. The UK has a network of more than 5000 research nurses, many of whom played a crucial role in developing vaccines and drug therapies for COVID-19. Nurses in Trinidad and Tobago rapidly upskilled to advance critical care capacity and strengthen the health system.

Yet nurses have not been rewarded in terms of pay or support. The pandemic has exacerbated a pre-existing global nursing workforce crisis. Wellbeing and morale of nurses globally is at a low, and intention to leave the profession is high. The pre-pandemic global shortage of nurses was estimated at 6 million, and the ICN suggests it could reach 13 million in coming years due to both increased demand and poor retention. One study in The Lancet Regional Health Western Pacific, including almost 140 000 nurses in China, reported that 34% of nurses felt burnt out and 56% disclosed symptoms of depression during the pandemic. A 2022 survey in Belgium found that 44% of nurses said that they intended to leave their jobs, with 27% considering a non-nursing career. Nurses worldwide have also been forced to take strike action against unfair pay and unsafe working conditions. Government responses to strike action have been varied. In some countries such as Germany, industrial action has led to agreements on safer staffing and better working conditions. Whereas, in January, a bill outlawing strikes by health workers was passed in Zimbabwe, and the UK Government recently took legal action against the Royal College of Nursing, declaring the planned strike action unlawful. Legal action does not address the workforce crisis, and only serves to exacerbate growing discontent in the profession.

Several changes are required. Optimised strategies are needed to address workforce shortages and improve working conditions that consider the collective trauma experienced by nurses during the pandemic to effectively protect and support them. Ensuring greater career opportunities in nursing will help to promote long-term recruitment and retention, safeguarding the sustainability of the profession. Nurses are vital caregivers. The pandemic served to reinforce this role in the public imagination. But nurses should also be recognised as scientists and leaders with a need for high-quality education, defined career pathways, and investment that reflects their responsibilities and roles in the health system. As such, funding for nursing education at all levels should be a priority. In the USA there has been a decline in enrolment for nursing degrees for the first time in 20 years, a decline attributed to a shortage of faculty in nursing education. Without adequate nursing educators, institutions cannot viably increase training capacity. Postgraduate degrees and research opportunities needed for such positions are limited, often relying on self-funding, and faculty positions are often poorly compensated. Universities and educational institutions must strengthen their nursing departments.

Nurses demonstrated their essential role in health systems throughout the pandemic, but this has not been reflected in workplace protection and support. The exacerbation of a pre-existing workforce crisis is leaving health systems more vulnerable and less resilient. Without an immediate and concerted renewal of commitments to nursing from all in the health and health sciences, there can be no effective recovery or strengthening of health systems for the future.

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2020年初，作为全球提升护理形象运动的一部分，世卫组织、国际护士理事会（ICN）和Nursing Now发布了首份《世界护理状况》报告，制定了全球护理战略。当时，我们强调了该报告如何为政策对话提供信息，促进对护理潜力的认识，以实现全民健康覆盖，并强调了随后几年对显示护理的影响至关重要。COVID-19疫情证明了这些信息的重要性。国际护士节是5月12日。今年是COVID-19出现后的第三年，这一时期对护士提出了巨大的需求。卫生和保健系统尚未恢复。全球护理的未来是什么？

在大流行期间，护士为卫生系统做出贡献的重要和多样的方式得到了充分展示。在博茨瓦纳，护士制定了战略对策，以减轻疫情-运行移动的诊所和管理重新部署到农村地区-展示他们的能力，以确定一个社区的需求，并开发系统，考虑当地因素。英国拥有一个由5000多名研究护士组成的网络，其中许多人在开发新冠疫苗和药物疗法方面发挥了关键作用。特立尼达和托巴哥的护士迅速提高技能，以提高重症护理能力并加强卫生系统。

然而，护士在工资或支持方面没有得到回报。疫情加剧了早已存在的全球护理人力危机。全球护士的幸福感和士气处于低位，离开这一职业的意愿很高。大流行前全球护士短缺估计为600万，国际护士网络表示，由于需求增加和保留率低，未来几年可能达到1300万。一项研究 《柳叶刀》西太平洋区域卫生包括中国近14万名护士在内，报告称34%的护士感到精疲力竭，56%的护士透露在大流行期间有抑郁症状。 比利时2022年的一项调查发现，44%的护士表示他们打算离职，27%的人考虑从事非护理职业。世界各地的护士也被迫采取罢工行动，反对不公平的薪酬和不安全的工作条件。政府对罢工行动的反应各不相同。在德国等一些国家，工业行动导致就更安全的工作人员和更好的工作条件达成协议。鉴于，1月份，津巴布韦通过了一项禁止卫生工作者罢工的法案，英国政府最近对皇家护理学院采取了法律的行动，宣布计划中的罢工行动非法。法律的行动并不能解决劳动力危机，只会加剧行业内日益增长的不满情绪。

需要进行几项修改。需要优化策略来解决劳动力短缺和改善工作条件，这些策略考虑到护士在大流行期间经历的集体创伤，以有效地保护和支持他们。确保更多的护理职业机会将有助于促进长期招聘和保留，保障职业的可持续性。护士是重要的照顾者。大流行病加强了这一角色在公众想象中的作用。但护士也应该被认为是科学家和领导者，需要高质量的教育，明确的职业道路，以及反映他们在卫生系统中的责任和作用的投资。因此，各级护理教育的资金应该是一个优先事项。在美国，护理学位的入学率出现了20年来的首次下降，原因是护理教育师资短缺。没有足够的护理教育工作者，机构无法切实增加培训能力。这些职位所需的研究生学位和研究机会有限，往往依赖自筹资金，教师职位的报酬往往很低。大学和教育机构必须加强护理部门。

在整个大流行期间，护士在卫生系统中发挥了重要作用，但这并没有反映在工作场所的保护和支持中。先前存在的劳动力危机加剧，使卫生系统更加脆弱，复原力更差。如果卫生和健康科学领域的所有人不立即一致重申对护理的承诺，就不可能有效地恢复或加强未来的卫生系统。

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