Introduction by Croakey: As the largest occupational group in healthcare, nurses are “an indispensable force” for tackling inequities in access to health services and making progress towards health-related Sustainable Development Goals (SDGs), according to the publishers of a report released this week.
The nursing workforce is also critical for advancing gender equality through the strengthening and empowerment of a highly feminised profession, they say.
The 2025 edition of the State of the World’s Nursing, released by the World Health Organization and International Council of Nurses, brings a timely opportunity to reflect on progress and persistent challenges in nursing and midwifery, according to the authors below, who include contributors to the report.
In examining some of the challenges facing the Pacific Region in particular, they highlight the impact of countries such as Australia and Aotearoa/New Zealand recruiting nurses and midwives from underserved regions.
“With drastic cuts to international aid budgets, nurses are more important than ever, especially in low-income and potentially vulnerable communities. In addition to providing direct healthcare, nurses help build communities, advocate for disadvantaged people and provide leadership in times of uncertainty,” they say.
Michele Rumsey, Michael Larui, Kerri Gianesi and Chris Rossiter write:
The global shortage of nurses – estimated at 5.8 million nurses – is a critical challenge highlighted in the second World Health Organization State of the World’s Nursing report, published on International Nurses Day on 12 May.
While the nursing workforce is increasing and the shortages are decreasing – by 2030, the world is projected to have a shortage of 4.1 million nurses – significant challenges exist in terms of unequal distribution, limited resources, migration dynamics, and working conditions.
Inequitable density and distribution of nurses nationally and globally has been spotlighted in the media since the COVID-19 pandemic.
Although the global nursing workforce is growing, 78 percent of nurses serve only 49 percent of the global population.
Many low- and middle-income countries face declining nurse densities due to attrition, retirement, migration, and population pressures, undermining progress toward Universal Health Coverage.
Restricted spending on health development, increasing threats to health and security, exacerbated by the current political climate is proving that decades of progress is under attack.
Pacific Region
Nurses are at the centre of the healthcare system, offering a vital point of care service to diverse populations in widespread communities. This is particularly true for unique environments such as the Pacific Region.
The Pacific is home to 22 Island Countries, comprising over 22,000 individual islands, spanning 8 time zones. Each Country has quite inimitable cultural, geographical, and economic contexts that shape their healthcare needs.
For example, Samoa only has four inhabited islands whereas Fiji has 110. Papua New Guinea’s estimated population is over 10 million, where Tuvalu is under 10,000. This also means their challenges are almost impossible to capture in large reports such as the State of the World’s Nursing Report.
The actual state of nursing in Pacific Island Countries is hidden within larger countries’ data in the Western Pacific Region.
The new report shows that nurses are 55 percent of the regulated health workforce in the Western Pacific Region, with 91 percent of these nurses being women, and 33 percent under the age of 35.
Yet, in Pacific Island Countries in 2025, nurses and midwives are 86 percent of the regulated health workforce, increasing from 75 percent in the 2020 report.
In remote island communities, nurses may be the only health professional for hundreds of kilometres.
The Western Pacific Region has the highest estimated nursing stock globally, largely due to large workforces in Australia, New Zealand, China and Japan.
Aggregate data do not capture the significant struggles of Pacific Island Country nurses whose collective nursing density is just 9.7 nurses per 10 000 people, and as low as 5.1 nurses in PNG.
In the 2025 report a higher percentage of data was collected, enabling more detail than the 2020 report, including some separation in data between Pacific Island Countries and other countries in its regional summaries.
This data reveals very critical, and urgent concerns, including little progress on nursing shortages, worrying indicators of inadequate working conditions and pay, nurse migration, and continued failures to fully enable nurses as leaders working to their full scope of influence.
In smaller nations, nurses face ongoing challenges in terms of recruitment, retrenchment and professional development.
While nurses can progressively take on advanced roles in well-resourced health settings, health systems in lower-income countries often lack the frameworks to support career progression.
Only 56 percent of Western Pacific Region countries have a nursing leadership development programme.
This makes Pacific Island Country nurses more vulnerable to out-migration to countries such as Australian and New Zealand, depleting the local workforce of skilled professionals.
Migration impacts
Migration of nurses is influenced by numerous individual factors, such as better job opportunities, improved working conditions, increased remuneration and career development.
The increasing reliance on foreign-born nurses in destination countries is creating an economic and professional loss from Pacific Island Countries to Australia and New Zealand.
Often, nurses from Pacific Island Countries may not obtain professional recognition within destination countries and will work below their normal scope of practice. Nurses working in these less skilled roles represent a loss of health workforce capacity within Pacific Island Countries, contributing to the ‘brain drain’ or ‘deskilling’ of qualified health professionals.
Migration is not always international. Most Pacific Island Countries health services are concentrated in urban centres, leaving rural and remote populations with limited access to much-needed care.
So, once nurses become qualified they tend to migrate from their home provinces or islands and begin working in urban centres, perpetuating the disadvantage of outer islands and remote communities.
With drastic cuts to international aid budgets, nurses are more important than ever, especially in low-income and potentially vulnerable communities. In addition to providing direct healthcare, nurses help build communities, advocate for disadvantaged people and provide leadership in times of uncertainty.
As the International Council of Nurses states: “caring for nurses strengthens economies”. Supporting nurses drives productivity in healthcare by reducing turnover and improving retention of nursing expertise.
Educating nurses enhances population health, improves patient safety and reduces morbidity and mortality. Protecting nurses from occupational risks reduces burnout, supports their mental health, decreases occupational injury and disability, and minimises early retirement and workers’ compensation costs.
WHO Collaborating Centres worldwide are essential to this work. Dr Tedros, Director-General of the WHO, states that they “are an incredibly valuable asset that brings many millions of dollars of in-kind contributions to WHO’s programmes around the world. Without [Collaborating Centres] WHO would simply not be able to do the work we do.”
The WHO CCNM UTS [World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development at University of Technology Sydney] works in strong partnerships with nurses and midwives in Pacific Island Countries to push for stronger health systems.
Leadership matters
Part of this is running a Pacific Leadership Program together with the South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) and funded by the Australian Government Department of Foreign Affairs and Trade (DFAT).
With over 200 senior nurses and midwives from across the region since 2009, the Pacific Leadership Program aims to empower nursing leaders, enhancing leadership skills, stakeholder engagement and policy development.
These skills are essential for building resilient, responsive and equitable health systems to address present and future health challenges. Eighty-five percent of previous participants have progressed to leadership roles as Chief Nurses or senior leaders in their countries.
The Pacific Leadership Program forms part of the Partnerships for a Healthy Region; Strengthening Health Workforce in the Pacific Program, which builds upon these existing networks to create a sustainable and resilient health workforce.
This program is strengthening regional workforce regulation, and developing an education framework including consistent competencies for practice and standards for accreditation across the region.
As a Leadership Fellow from the Cook Islands said: “For us to meet all the different countries and the professionals who have come here to share their expertise… This program has widened my mind to political awareness and getting stakeholders buy-in.
“I always say I am a clinical nurse and am not good at management. But now in this program leader and manager have been shown to me. I have been collecting data but we never go back to the data and ask questions of this data. We are not asking the right questions. This program has shown me we need to use this data.”
This week’s release of the State of the World’s Nursing report offers a timely opportunity to reflect on progress and persistent challenges in nursing and midwifery.
Globally, we are seeing a shocking lack of effective policy and practice to ensure fair working conditions, tackle issues of workforce shortages, unequal pay, and support of nurse’s health, wellbeing and career progression.
We also must do more to ensure signatory countries adhere to the WHO Global Code of Practice on the International Recruitment of Health Personnel. Part of this is to reduce destination countries’ reliance on foreign-born nurses and midwives – particularly from underserved regions such as the Pacific.
Now more than ever, strong public support for health development efforts is vital to amplifying the voices of vulnerable communities and the health workers who serve them.
Strengthening the nursing workforce is not a cost: it is a vital investment with substantial returns of improved population health and economic stability and growth, in all economies.
Caring for nurses today ensures resilient health systems tomorrow.
Author details
Professor Michele Rumsey AM RN PhD FACN has been Director of WHO Collaborating Centre for Nursing, Midwifery and Health Development at the University of Technology Sydney (WHO CCNM UTS) since its inception in 2004. Michele has over 25 years of experience directing international health co-design research, advice and policy, with health professional expertise in regulation and governance, human resources for health, health system strengthening, capacity development, stakeholder and network coordination globally and regionally.
Michael Larui RN is the former National Director of Nursing in Solomon Islands. Michael has served in the nursing profession for the past 38 years working at various clinics and provincial hospitals, including holding various administrative posts within the nursing cadre, including Chairing of the Solomon Islands Nursing Council Board. Michael is currently working as the Regional Coordinator under the PHR SHWP Program with WHO CCNM UTS.
Kerri Gianesi has spent the past five years working and studying in the global health field, holding a Master of Global Health from the University of Sydney. For the past three years, she has been with the WHO CCNM UTS, where she coordinates key initiatives including the Pacific Leadership Program, the SPCNMOA Secretariat, and other major projects supporting health workforce development across the region.
Chris Rossiter has been working at the WHO CCNM UTS for the past four years, and is currently working on the Strengthening Health Workforce in the Pacific program and studies of health professional migration. She is a social scientist who has collaborated in health research projects including midwifery, maternal and child health, prostate cancer nursing, aged care, and health services management.
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