Allison Squires, Professor at NYU Rory Meyers College of Nursing, tells Healthcare World Editor Sarah Cartledge about her surprisingly straightforward solutions for workplace retention
Global healthcare policy often presents nursing as a workforce problem. Governments discuss national workforce supply and training, reducing a caring profession to spreadsheets and staffing ratios. For Professor Allison Squires, however, the reality is more complex and personal.
A nurse and global health services researcher, Allison studies nursing systems worldwide, focusing on Greece and Guyana while also working in Ghana. She founded the Global Consortium of Nursing & Midwifery Studies, an 87-country consortium that conducts health services research and builds research capacity.
Her work connects workforce policy with migration, economics and patient care. Although shortages exist, she believes the much wider problem lies in outdated systems and unrealistic expectations about modern nursing careers.
The retention problem
“The system has been under such strain for so long that people start looking for alternatives,” Allison explains. “Healthcare systems have to recognise that the way they support nurses has to change. We cannot keep using the same 20th century management approaches.”
Retention, she argues, is often less complicated than policymakers assume. Nurses are more likely to stay where they feel valued and can provide good care. Bullying or discrimination from patients and colleagues can easily make an already demanding job intolerable.
Pay is equally important, but headline salaries do not tell the whole story. Economic wellbeing means earning enough to meet everyday costs while building some security against illness or other financial shocks. Nurses protect the health of their communities, yet many struggle to achieve that security themselves.
In the NHS, national salary structures may be adequate in lower-cost regions but are harder to justify in London. Housing costs and long commutes add pressure, particularly for staff working extended shifts. Similar tensions exist in New York, where apparently high nursing salaries are eroded by housing and healthcare costs.
Modern nursing careers
Experienced nurses tend to move away from bedside care for better pay or more sustainable working lives. Some progress into management or specialist practice; others leave nursing altogether. “Multiple staffing plans assume maybe 10 per cent of the workforce moves upward and 90 per cent remain stationary for their whole careers, but this model does not reflect modern working life nor labour market dynamics,” she says.
Workforce planning must recognise that nurses will want to develop throughout their careers. Retention therefore depends on creating varied routes through the profession without treating departure from bedside roles as the only route to progression.
International movement
Many high-income health systems remain heavily dependent on internationally educated nurses. Countries including the Philippines have developed education pipelines linked to overseas employment, while remittances make an important contribution to national economies.
Migration creates opportunity for individuals but can deepen shortages in countries struggling to retain staff. “You cannot stop people migrating,” Allison says. “It is a human right to move for work, especially for women, because nursing is one of the few professions with genuine global mobility.”
Ethical recruitment must respect that freedom while avoiding active recruitment from countries with critical shortages. Economic insecurity remains a powerful driver: nurses who are paid late, or not at all, will understandably seek stability elsewhere. International lending conditions can also limit public spending, leaving health workers to absorb the consequences.
For Allison, countries need health systems stable enough for people to remain. “Countries have to be willing to invest in healthcare properly. If you do not have healthy people, you cannot have economic development,” she says.
Several Middle Eastern countries are investing in nursing education as they seek to reduce long-term reliance on imported labour. The region also has one of the world’s highest proportions of male nurses, although men still tend to progress into leadership faster than women.
The human profession
Allison remains confident that nursing is secure despite the rapid adoption of digital tools and AI. Technology can reduce pressure, but poorly designed systems merely add administrative work. “Technology is great, but do not make it add to the work, it has to help the work,” she says.
Home-based technology can also shift responsibility onto families. Safe home care requires suitable housing and enough professional support; it cannot assume relatives, often women, can abandon paid work to provide care.
The answers are straightforward. Lower-income countries need investment that gives nurses reliable work and economic security. Wealthier systems should tackle unnecessary documentation and design technology around frontline practice.
Nursing remains a resilient career because it supports people through illness and recovery, as well as at the end of life. With fair treatment and career opportunities, healthcare systems can give nurses compelling reasons to stay.
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