Handle with care: The fragile state of nursing in the Caribbean

Background: The health care landscape in the Caribbean is being shaped by forces on both the supply and demand side. Population aging and the shift to chronic diseases are leading to increased demand. A shortage of health workers, nurses in particular, poses a significant risk to the capacity of health systems to supply services. Adding to the challenges are efforts toward regional economic integration and a growing global deficit of health workers.

Methods: We collected administrative data from ministries of health, nursing schools, and hospitals from five countries representing 80% of the English-speaking Caribbean population. We analysed census and national exam, licensing and registration data from Canada, the United Kingdom, and the United States. We carried out a survey among Jamaican trained nurses. We projected supply and demand, estimated wage differentials, the costs of strengthening and scaling up nurse training, as well as the costs and benefits of training nurses.

Findings: The nurse education system has substantial capacity constraints. We found that for every 100 qualified applicants to nursing programmes, only 34 are accepted. Dropouts are significant, as only 20 of those accepted graduate. Losses from out-migration are significant and are driven largely by nurse shortages in Canada, the United Kingdom, and the United States. We estimate that half of nurse graduates migrate to these countries within 15 years. Taken together, of an initial pool of 100 qualified applicants, only five spend their full careers working in the Caribbean.

Interpretation: To mitigate the large losses and stabilize the nurse labour market in the long term, three policy strategies seem most critical: increase completion rates, expand nurse training capacity, and manage migration.