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The crisis of care

Shortages, overtime, burnout: In the third year of the pandemic, healthcare workers are not OK.

Remember back at the start of the pandemic, when people clapped for healthcare workers from their windows every evening? Hospitals posted signs proclaiming “Heroes work here.” Hotels, restaurants and ridehailing companies offered their services to first responders for free. Governments and health care systems doled out extra hazard pay. 

Two and a half years later, that special treatment has mostly ended. 

Globally, about 104 million people work in healthcare, including 29.8 million nurses and midwives, and 12.8 million physicians, according to a recent study in The Lancet

In the first 18 months of the pandemic, about 115,500 health workers died from Covid-19, according to the World Health Organization. The stress of being on the front line of the pandemic led some health workers to take early retirement or simply leave the sector, leading to a great loss in experience and institutional knowledge. The new graduating classes of nurses and doctors aren’t replacing the retiring health workers fast enough. 

It’s said that staffing shortages are often leading to unsafe nurse-patient ratios, which can lead to more avoidable mistakes being made. Wages for nurses haven’t kept pace with inflation, making alternative careers increasingly attractive. To make matters worse, Covid-19’s strain on the global supply chain has hit medical supplies, drugs and devices especially hard, leading to unprecedented price inflation.  

“Any one of these challenges is alarming on its own,” Stacey Hughes of the American Hospital Association wrote in a recent editorial for Fierce Healthcare. “But all of them occurring at once — in tandem with the highest inflation rate in nearly half a century — is a real crisis.”

In a survey of more than 11,000 nurses about their mental health this summer, the American Nurses Foundation (ANF) found that more than three-fifths (61%) reported not having adequate time to have meals or breaks. Nearly as many (59%) are asked to cover additional shifts and 58% are required to work past their scheduled shifts at least once a week.

Nurses report high levels of burnout

APNA, an Australian organization for nurses working outside of the hospital system, found similar trends in its 2021 Annual Report: 79% of nurses reported feeling burned out at least sometimes.

The increased stress is only making the staffing shortage even worse. When asked if they intend to leave direct patient care in the next six months, 19% of U.S. nurses replied yes, and 30% replied maybe. 

The top things nurses want, according to the ANF survey, are better pay or bonuses, and better staffing of nurses and support. Wages for nursing are higher than average in some countries, but the average healthcare worker faces serious risks that other workers don’t.

How nurses’ pay compares to average wages

To alleviate the shortages, many high-income countries are actively recruiting medical personnel from abroad. Even before the pandemic, the average share of foreign-trained doctors in OECD countries was 17.9%.

The Lancet report notes that the global density of nurses and midwives in 2019 was 38.6 per 10,000 people, and has increased steadily over the past 40 years. But there is a wide density gap between high-income countries and the rest of the world: High-income countries have on average 114.9 nurses per 10,000 people, while South Asia has just 9.7, Oceania 11.4, and sub-Saharan Africa 18.3.

To ensure effective healthcare coverage, we are short 30.6 million nurses and midwives globally, with half of those needed specifically in sub-Saharan Africa and south Asia, The Lancet authors write. That means the world needs twice as many nurses as it currently has.

The solution to the current crisis of care has to be a global one. When making a diagnosis, a doctor considers the patient as a whole. We cannot treat just one organ, ignoring the underlying unhealthy habits, and then be surprised when another part of the system fails. 

Not only do educational and training programs need to expand, especially in low- and middle-income countries, but there must be incentives to stem brain drain, The Lancet authors write. That brings us back to the greatest incentive of all: good pay.

Grace Dobush

Based in Berlin, Grace Dobush is the editor of the ReThink Quarterly. She has written for publications including Fortune, Wired, Handelsblatt and Quartz.