The future of nursing: attrition, innovation, and the path ahead

Currently, the nursing profession is facing a global crisis, exacerbated by the deep disillusionment experienced by nurses following the COVID-19 era. Nurses had anticipated significant advancements in terms of better working conditions, increased staffing levels, enhanced professional recognition, and improved compensation. However, these expectations have largely gone unmet, leading to profound concerns within the profession. Coinciding with these concerns, International Nurses Day 2024, observed on May 12, has adopted the theme "Our nurses. Our future. The economic power of care."1 This occasion offers a pivotal opportunity to reflect on the status of nurses, their expectations, and the economic power of nursing care in addressing global health challenges. In response, the International Council of Nurses (ICN) has introduced the Charter for Change, which includes 10 policy actions underscoring that strategic investments in nursing can yield significant economic and social benefits.1 Now, more than ever, it is crucial to acknowledge the significant economic contribution that nursing makes to the field of health care and to society at large.1 These recommendations are in line with the globally recognized issue of nursing attrition. Studies indicate that turnover rates among nurses may exceed 40%, and are particularly evident in those with less than three years' postgraduate experience.2,3 For instance, a 2013 cross-sectional study conducted across 10 European countries found that 9% of the nurses intended to leave the profession, ranging from 5% to 17% across different countries.4 A scoping review in this issue of JBI Evidence Synthesis identifies the individual and environmental factors that influence registered nurses' and midwives' decisions to stay or leave their professions.3 The review reveals that factors such as professional self-image, identity, pride in the profession, support from nurse managers, and the transition from academia to practice are crucial for retaining newly qualified professionals.3 Another recently published review highlights the primary factors influencing newly graduated registered nurses' intention to leave: demographic variables (eg, age, educational level, years of experience, professional title, employment status, health status, shift work, hospital location and size); support from supervisors and peers; workplace challenges; cognitive and affective responses to work; work environment factors (eg, collegial nurse–physician relationships, staffing level, person–work environment fit); gender stereotypes; autonomous motivation; role models; and resilience.5 Although the nursing profession is exceptionally demanding and often does not receive commensurate salary recognition, the education provided to these professionals is thorough. Nurses benefit from meticulously structured curricula offered by educational institutions, which distinguish them as highly skilled professionals with unique human capabilities and a strong ethical compass.6 The skill set of nurses, which encompasses emotional, relational, ethical, and communication proficiencies, is transferrable to various other professions, facilitating a wide array of career opportunities and enabling easy transitions across contexts and even professions. Nonetheless, the challenge of retaining these professionals within the nursing sector remains. It is hoped that—alongside political empowerment and the implementation of strategic visions, as advocated by the ICN1—other mechanisms, such as digitization and robotics, powered by artificial intelligence (AI), will mitigate some factors contributing to attrition, thus making the profession more attractive. There is a belief that AI can help create positive, safe, effective, and efficient practice environments, as well as reduce costs, optimize resources, foster a sense of belonging, enhance professional recognition, and improve remuneration.3,7 The global demand for the digitization of health care is prompting debates about the future. Digital health aims to enhance comprehensive, integrated care and achieve universal care coverage,8,9 yet the complex expectations surrounding AI and its unpredictable impacts have fueled discussions involving various professionals, from physicians to chaplains. The potential roles of robotics in health care have been explored, encompassing physical, socio-emotional, and spiritual-existential aspects of care.10 However, these discussions also emphasize the irreplaceable role of human caregivers in providing holistic and humanistic care.10 The essence of nursing, deeply rooted in caregiving, promises a bright future enhanced by AI and robotics, enabling safer, more efficient, and personalized care.7 Yet, the fundamental elements of nursing, such as emotional support, human comfort, and effective communication, remain crucial and irreplaceable, ensuring that nurses continue to hold a central, invaluable role in health care (at least in the near future). Looking ahead, nurses will continue to be an integral and irreplaceable component of any health care model, despite possible shifts in the professional landscape. Research has been conducted to address the question, "Can AI replace nurses?" The consensus is that robots are not seen as substitutes for nurses11; instead, AI-driven health technologies are recognised for their potential to enhance nursing practice. This is exactly what the profession and discipline of nursing needs to enable our nurses to envision a future and foster socially sustainable and healthy economies.