Editorial: Nursing workforce: global challenges and solutions

This special issue of JCN focuses on the critical challenge of the nursing workforce: getting the numbers right, getting the skills right and getting the teamwork right, to ensure quality care. The challenge bridges all continents and the issue includes papers from four: The Americas, Europe, Asia and Australasia. There is a notable specific contribution from Japan. The nursing workforce in Japan is one of the largest world wide, and the policy challenges and solutions being examined in that country have a resonance elsewhere, just as solutions being tried and tested in other countries may have a significance to Japan. It is clear, as demonstrated in this issue, that there is huge variation in the nurse: population ratios throughout the world, but it is also the case that there is increasing evidence of nurse supply/demand imbalances in many countries. Against this backdrop of growing concern about shortages of nurses and other health personnel, the journal edition focuses on a range of the policy challenges that must be met. These include the so called ‘three R’s’– recruitment, retention and return – of which the latter is often overlooked. The pools of underemployed or non-working nurses in many countries must be tapped if shortages are to be combated in a cost effective manner. Whilst it is the case that nursing skill mix and staff mix vary between organisations, systems and countries, and that there is no single ‘optimal’ mix of nurses and other staff that all can aspire to, there is a real need to be clear about decisions on skill mix and workload. There is a link between adequate nurse staffing levels and positive care outcomes. Basing skill mix decisions on the evidence of the reality of care demand and care outcomes is a necessary step, as is ensuring that the workload for individual nurses and for teams is maintained within reasonable levels. The papers published in this issue highlight the need for effective policy intervention, which requires good evidence, stakeholder involvement and strong leadership.