Shortage of nurses in Hong Kong: the challenges ahead

PurposeThe aging of a population poses significant challenges to healthcare, housing, social security and elderly care services. Active aging is promoted by the Hong Kong government but is compromised by a shortage of nurses, doctors and professional aides. This study aims to review the history of nursing education in Hong Kong, evaluate Hong Kong's nursing manpower policy with a macro–micro analysis based on sociological imagination and provide sound recommendations.Design/methodology/approachThis article analyzes the nursing shortage in Hong Kong. A comprehensive literature review was conducted, concerning the Hong Kong healthcare workforce and covering relevant government reports, consultation papers and articles from academic journals from 1943 to the present.FindingsThe nursing shortage in Hong Kong can be understood from both absolute and relative terms. The total number of practicing nurses and fresh graduates registering through the four aforementioned pathways increased from 17,034 in 1996 to 61,295 in 2020 (growth rate of 74.4%), but it is predicted that there will be a shortage of 455, 1,383 and 1,669 nurses in 2020, 2025 and 2030, respectively. Moreover, Hong Kong had 8.2 nurses per 1,000 people in 2020. Although this rate exceeds those of China, South Korea and Singapore, it lags behind those of the USA and Australia as well as the international recommendation of nine nurses per 1,000 people. The nurse shortage has been further aggravated by an interaction between macro factors, including aging population, a lack of coherent and long-term nursing manpower policy (an analysis is based on a health policy triangle), numerous obstacles imposed on nurses from abroad and micro factors emanating from an interplay of push–pull factors among nurses.Practical implicationsThe proportion of the Hong Kong population aged 65 years or older was 18% in 2019. The availability of healthcare workers is essential for attaining optimal health outcomes for older adults. The high turnover rate of nurses in public hospitals negatively affects the provision of timely high-quality medical services in the dual-track medical system. Therefore, workforce projections should be made every three years. Such policy should rely primarily on local nurses trained both by University Grant Committee-funded institutions and by self-financed tertiary institutions. Foreign nurses should be a supplementary resource. The budget allocated to the public healthcare sector should be increased to improve remuneration, provide abundant training opportunities and improve working environment to retain nurses in public hospitals.Originality/valueGiven that deep-seated problems surrounding the quantity and quality of nurses, the avenues for pursuing nursing degree education and the turnover rate of nurses in public hospitals remain unsolved, it is imperative to investigate how to alleviate the healthcare workforce shortage in Hong Kong.