Nursing understaffing at the center of the World Health Organization’s “Nursing Action” project

Nursing understaffing has emerged as one of the most critical challenges facing health systems globally and across the European Region. Nurses constitute the largest professional group within healthcare organizations and provide the vast majority of direct patient care. Adequate nurse staffing is essential not only for patient safety and quality of care, but also for the physical and mental well-being of nurses, the effective functioning of healthcare organizations, and the long-term sustainability of health systems. In recent years, and particularly following the COVID-19 pandemic, nursing shortages have intensified, revealing structural vulnerabilities that demand coordinated international action. The causes of nursing understaffing are multifactorial and interconnected. Key drivers include workforce ageing and retirements, poor working conditions, high levels of occupational stress and burnout, low salaries, limited career development opportunities, and insufficient educational capacity. Migration of nurses to higher-income countries has further exacerbated shortages, while the pandemic has contributed to increased attrition through illness, mortality, and resignations. At the same time, demand for healthcare services continues to rise due to population ageing, the growing prevalence of chronic diseases, increased mental health needs, and heightened patient expectations. These converging pressures have resulted in unprecedented strain on nursing workforces across Europe and beyond. The consequences of nursing understaffing are profound and far-reaching. For healthcare systems, insufficient staffing leads to overburdened personnel, higher absenteeism and turnover, reduced capacity to respond to public health crises, and escalating economic costs associated with overtime, temporary staffing, and recruitment. For patients, understaffing is associated with increased risks of adverse events, including infections, medication errors, falls, prolonged hospital stays, and higher mortality rates, alongside longer waiting times and reduced continuity and quality of care. For nurses themselves, chronic understaffing contributes to burnout, psychological distress, reduced job satisfaction, and a growing intention to leave the profession, creating a self-reinforcing cycle of workforce depletion. In response to these challenges, the World Health Organization, in collaboration with the European Union and key professional and social partners, launched the Nursing Action initiative in January 2025. This EU-funded programme aims to support Member States in developing evidence-informed strategies to improve nurse recruitment, retention, and working conditions. Nursing Action focuses on strengthening workforce data and policy dialogue, promoting mentorship and leadership development, improving safety and well-being, and supporting the implementation of safe staffing practices. Central to the initiative is the recognition of nurses not merely as care providers, but as essential leaders in health policy, system planning, and service delivery. Overall, Nursing Action represents a coordinated and strategic response to one of the most pressing workforce crises in contemporary healthcare. By investing in nursing education, employment, protection, and leadership, the initiative seeks to enhance workforce resilience and ensure equitable, high-quality care for populations across Europe. Sustained political commitment and cross-sector collaboration are essential to translate this initiative into lasting systemic change.