Spotlight on nursing issues: Howard Catton

Added: 2026-05-13

[00:00:00]Today's an important day. It is International Nurses Day and globally the International Council of Nurses estimates a shortage of about 5.8 million nurses with production levels still below World Health Organization recommendations. For more on this we're joined by the International Council of Nurses CEO Howard Catton. Howard, good evening. Thank you so much for your time. Really do appreciate it. South Africa suffers from a problem not unique to the rest of the world and that is a low output of nursing graduates and those who enter the profession and in part in South African case it has been because nursing colleges in particular have been closed down and specialized nursing education and training is not as readily available today as it was years back. Is that a global pattern and is that perhaps the reason why we're nearly 6 million in the red in terms of human capital in the sector?

[00:00:53]Um good evening. Very good to be with you and a very happy International Nurses Day to you to nurses right the way around the world. This is a day where we celebrate and we thank nurses for the incredible work that they do every day of the year.

[00:01:09]But you're absolutely right.

[00:01:12]It's not just a South African problem.

[00:01:14]It's around the world that countries are simply not investing enough in their nursing workforce. There are about 30 million nurses around the world but as you said we estimate with WHO a shortage of nearly 6 million nurses. The global shortage of health workers is estimated to be 11 million. So half of our shortage is nurses.

[00:01:41]Bottom line is that we need to invest and countries need to invest. We need to educate more nurses and that requires nursing schools. It requires faculty. It requires support for people who want to be come nurses, but it also means as important that we retain those nurses that we educate. We're not doing enough to provide nurses with decent working conditions, safety and protection at work. Violence against nurses is a huge is a huge issue. The opportunities for career progression, all the things that all of us would expect to be important in our jobs to retain us, to make us feel valued. There's much more that we can do to look after the nurses we have. And this is more than a numbers game.

[00:02:37]5.8 million is it it's a huge number, but if those people who are losing are the experienced nurses, the specialists, the ward sisters, it's not just a person, it's a person with fantastic experience which is walking out the door as well, and that's what we also need to retain. Yeah. Howard Pass also ask this.

[00:02:55]What we've seen in years has been the use of what are I mean, the name varies country to country and place to place, but community health practitioners who don't necessarily have the exact technical aptitude and expertise that a nurse in a hospital might have, but who fills the gap between communities and nurses in hospitals in an important way in primary health care. How important is the use of community health practitioners in in in making sure that some of the strain has been taken off of the shoulders of nurses in hospitals.

[00:03:31]Yeah, you raise a really important point here. With that scale of shortage that we've talked about, it can be tempting for governments to look for quicker fix short-term solutions and looking at the opportunities to train quickly other health care workers with just a few weeks training, perhaps, can be a tempting alternative to recruiting and hiring a registered nurse. Looking to recruit nurses from overseas, as many high-income countries are doing, is also a short-term fix. Now, let me be absolutely clear, our community health worker colleagues are really important members of the health care team, and we need to value them. Many of them are not receiving the pay and the conditions that they should have. But, they are a very different worker to a registered nurse. Registered nurses are educated now two three years. They work to high standards, codes of ethics, they're regulated. We know, the evidence shows us that if you don't have the right numbers of registered nurses, the safety risks to patients, medication errors, trips and falls, infection, cross-infection, these things can all increase. So, we must not be adopting a strategy to substitute registered nurses with others, because that will impact on the skill mix and ultimately on the quality, as well. In the same way that high-income countries shouldn't rely on recruiting from lower-income countries.

[00:05:10]They should be educating to be self-sufficient in their own workforce.

[00:05:14]>> that, because let's talk about that, because there seems to be some sort of reverse osmosis process that goes on with the talent pool of nurses, where nurses who are qualified and skilled will go from low-income countries to high-income countries, because there's better remuneration there. And remuneration is one of the thorny issues when it comes to the nursing profession, particularly in the developing world, where, you know, income increases hasn't kept up with global inflationary rates, and very importantly has made the sector unattractive in those markets, and qualified nurses and operating and working in countries where they are paid their dues leaving poorer countries worse off so to speak. What is it that the World Health Organization and other bodies like yourself and the global community can collectively do to ensure that we don't have this movement from a high concentration to a low concentration movement of the talent pool?

[00:06:09]Look, this is another really critical issue. First thing to say is that everybody has the right to move and migrate. If you're working in a country where you're very low paid, you're not being you're not having good working conditions and there's an opportunity to go to another country and you know travel or quadruple your income to have career progression, people are going to be are going to be tempted and are going to move and are going to migrate and they have the right to be able to do that.

[00:06:41]But that should not let off the hook the countries who are not doing enough to retain their own nurses with good working conditions. But there's a really significant economic issue here as well which I don't think we're talking enough about. When high-income countries recruit from lower-income countries, they're effectively outsourcing their education costs. They're not paying the money to provide education to support those new new nurses.

[00:07:13]Other countries have made that investment in nursing education but then they're hired by a high-income country and there isn't any reinvestment. There isn't any proportionate give back. The World Health Assembly will be discussing this issue again next week and we've written from ICN to many of the member states to say that if you're really committed to meaningful ethical recruitment, if you recruit, if you take, if you're going to say that you're doing that ethically, you have to demonstrate what you have given back is proportionate and it's meaningful as well. We have a global code of practice that governs how recruitment takes place. We think it needs to be strengthened. We think it needs more teeth. And just to give you a sense of this, the UK have est- It's been estimated the UK is saving 14 billion in education costs that they're not paying that uh through recruiting from overseas. There are numbers from Canada runs into billions as well. So, these are hugely significant amounts of money and we're saying that if you've recruited, give some of that back, reinvest it into the countries that you have recruited from and reinvestment in nursing schools, in jobs, in good working conditions to help those countries hold on to their nurses.

[00:08:43]Yeah. Uh Howard, we're going to have to leave it there. Thank you so much for your time and insights on this. Really do appreciate it. Howard Catton is the CEO of the International Council of Nurses commemorating their International Nurses Day.