Discussion keeps the world turning.
This is Roundtable.
China's nursing workforce is growing faster and getting better educated than ever before.
Yet, hospital wards remain short -staffed and many nurses report burnout, low morale, and a desire to leave the field.
As we mark the 114th international nurses' day, is it time to rethink not just how we train nurses, but how we treat them.
Coming to you live from Beijing, this is Roundtable.
I'm He Yang. For today's program, I'm joined by Yu -Hsuan and Yu -Shun in the studio, first on today's show.
With over 6 million registered nurses expected in China by the end of this year and a rising share of them holding college degrees or higher, it seems like we're finally bridging the gap between quantity and quality.
But dig deeper. And you'll find long shifts, low pay, and limited career advancement still push many nurses to the edge.
This International Nurses Day, China marks the occasion with the theme, caring for the nurse team, guarding people's health.
But how far have we truly come in making nursing a sustainable and respected profession?
So guys, why is it so crucial to care for nurses, not just patients, on International Nurses Day?
Take it away Yu Xun!
Oh yeah so first of all, International Nurses Day is celebrated globally on May 12th, marking Florence Nightingale's birthday.
So the 2025 theme, Our Nurses, Our Future, Caring For Nurses Strengthens Economies, emphasizes the importance of nurses' health and well -being and recognizing their essential role in health care systems and economic stability.
The President of International Council of Nurses, or ICN, actually highlighted the need to address the physical, mental, emotional, and ethical challenges nurses face and called for practical solutions to support them.
In that case, in China, the National Health Commission has echoed this message with the theme, as you said, He Yang, caring for the nurse team guarding people's health.
Yeah, and you mentioned one name earlier, Yu Xun.
You mentioned this Florence Nightingale and her birthday being marked as the date celebrating International Nurses' Day worldwide.
And I just did a little bit of check on who she is.
So apparently this lady was a pioneering British nurse that's born in 1820.
And she was a nurse, a social reformer and the statistician who is widely considered the founder of modern nursing, and her work laid the foundation of professional nursing practices and also formal nursing education as well.
So that is why the date that she was born was chosen to honor her legacy and so to recognize the essential role the nurses play in healthcare system around the world as the International Nurses Day.
Yes indeed and with China's nursing workforce projected to reach 6 million by 2025 is the country adequately equipping and supporting its nurses through expanding training and higher education in response to an aging population population, and increasingly specialized long -term healthcare needs.
Well, the good news is that lately, there has been reports saying that China has established a multi -level, higher nursing education system as we speak.
And by the end of 2025, the total number of nurses in this country is expected to exceed 6 million.
And so, let's take a brief look at the current status here.
Wu Xinjun, the chairperson of the Chinese Nursing Association, said that China's nursing workforce continues to expand in recent years.
As of the end of 2023, the total number of nurses had reached over 5 .6 million, meaning that there are four nurses per 1000 people.
Over the past decade, the number of nurses has increased at an annual growth rate of 8%, with approximately 300 ,000 to 400 ,000 new nurses added every year.
And the educational level of nurses in China has also been improving as well and that is according to the latest data that 81 % of nurses now hold at least a junior college degree.
And currently more than 55 ,000 higher vocational colleges and 156 undergraduate institutions offer nursing programs. And additionally, 77 institutions provide academic masters programs in nursing, 124 offer vocational masters programs, and 34 institutions grant doctoral degrees in the field.
That was astonishing.
Back in the days in the 19, say, 80s, 90s, when my mom was attending a vocational school for the major of nursing, Most nurses come from vocational school, because back then I believe nursing was viewed as a skill as per a major to be pursued as a doctoral degree.
Look at how it's been over the past, almost three decades, if not more.
Now we have 34 institutions granting doctoral degrees in this field, which is quite impressive.
Exactly. That's also reflecting the fact that we are having more professional personnels in this field, and China will continue to strengthen the training and development of its nursing workforce.
As we mentioned, by the end of 2025, the number of nurses is projected to exceed six million, and by the end of 2027, it is expected to reach approximately seven million.
The thing is that we are listing a lot of numbers that the number of nurse or these kind of majors are increasing, there is still you know a space for improvement the insufficient number of nurses is also a difficulty in this kind of area.
Yes the fact is we need a lot of nurses and you guys mentioned some big numbers and a string of them which is all pointing to yes there's been major improvement in the education of nurses, but on the other hand, one can't help but wonder, given the massive shortage of nurses, then if you're spending so much of the educational resources in improving quantity, excuse me, in improving quality, then that doesn't quickly close the gap of you first of all need trained people in these important posts.
And some would argue that filling those posts is the first urgent thing to do.
And then the second urgent thing to do, secondary, is you know training them to such a high level especially when you mention doctoral level of nurses.
I wonder how many hospitals would want to employ someone who's spent how many years in a medical institution just to become, quote unquote, just to become a nurse.
This is probably somebody who's qualified to train nurses, I would think.
So I think it's an interesting sort of calculation maybe one could do at the same time, or at least for industry insiders to do in coming up with, I suppose, better arrangement or of some sort, to really match the resources with the adequate amount of training to the adequate amount of people that we need to fill these posts and hospital wards.
I wonder if you guys have any thoughts about this.
I think you pointed out something that's really sharp in this industry, Huyang, because well, based on how I observe my mom's working routine, when I noticed that they have, of course, new nurses coming in to fill in that gap we just talked about every year.
But the thing is, as the older batch of say, the more experienced batch of nurses are gradually retiring, the newer ones they're not necessarily quite adequate to quickly and swiftly fit into the job, like doing all the basic skills and nursing practices.
They need to learn, and that learning period will take a few years perhaps.
So, in the meantime, it's extra burden, it puts extra burdens on those nurses who are experienced, who is perhaps looking forward to retiring in the next few years, but still are faced with potential even longer working years, given that they also need to train some new newcomers, trainees in this perspective.
And, yeah, who will say take all that years, like you mentioned, to get a doctoral degree just to participate in a job opportunity that perhaps just requires me to attend a three -year Vocational school that used to be the thought say when I was very young when when My mom was talking to other say peers and didn't thought that I would I was listening She was been she they've been talking about this this whole time saying that yeah This job has always been like this is trained for vocational skills By vocational schools and nowadays they're elevating the say the the doorstep of entering this job
with say educational backgrounds, how many years you've been in real practices, so these are all practical barriers and issues and challenges faced by nurses in China nowadays.
Indeed we will see bigger changes to come in the future, but nowadays I think we're gradually making shifts, only not that big of a step taken yet, I'll say.
But from another perspective, I was thinking at least it is setting up a lot of opportunities for a lot of people to understand this kind of area and getting into this area as we are talking about such a big of shortage in this area right and also the stats are saying this kind of thing we mentioned before the nursing resources in China as of the end of 2023 is about like four nurses per 1 ,000 people right however it's it's been increasing right but from a global perspective this number is actually still not very high Statista is showing that in 2021 Finland had the highest number of practicing
nurses per capita for every 1000 population there were nearly 19 practicing nurses and the figures were 12 .1 in Japan and 12 in the United States.
Hold on, so China is four and the other countries you mention is 19, 12 .1, which is pretty much 12, and then 12 out of 1 ,000 people in a population of a country.
But also if you look at China, a decade ago, we only had 1 .35 million registered nurses, which is essentially even less, well, a lot less than what we have now.
So it's like almost like one out of a thousand people here in China or something like that, or slightly over that.
So already, major progress if you compare the numbers in 20 years.
But that is still far from enough.
And then every year we hear like, oh, there's like a few million shortage of nurses.
Or something like, with one doctor, then you're supposed to have two nursing staffs to help that person.
So that is far from being fulfilled in our country's situation.
So the shortage, I don't think is news to people, but how big the shortage is still kind of strikes you in an unexpected way.
So we've talked about some of the issues that these nurses or nurses -to -be feel.
And, Yushan, you mentioned something about the increasing or improved or more difficult educational qualifications that they are facing.
And that could become a barrier - see, it's either a barrier or it's just improved standards because our living standards have improved in this country, our medical standards have improved as well and you need better qualified people to hold these positions.
So there's the bright side and there's also the very difficult or more practical side that those who are in the game are facing every day.
So guys, talk about this, you know, the more challenging educational requirements that they're facing and also the reality of being a nurse in this very like high demand, high pressure and difficult work that they do.
That's basically the imbalance between the job enrollment and also the educational resources that's required for the job that you just mentioned Heouyang.
So well this is not only according to me well this is according to the paper .cn who who introduced the study on the demand and training of nursing professionals, which was done by sorting out the recruitment information of 32 hospitals in Zhejiang province in East China in 2021.
This study found out that undergraduate graduates were able to apply for the highest ratio of hospitals.
And that accounted for about over 96%, almost 97%.
And that's followed by three -year higher Vocational College graduates who could apply for about 78 % of these hospitals, while Vocational School graduates could only apply to around 3 % of these hospitals, meaning that the higher educational background you hold as a nurse as well as a nursing student in that major, the more likely you're going to be hired by one of those hospitals.
However, in 2017, only 10 % of that total nursing major enrollment in China went to undergraduate universities.
Like I said, back in the days people will never choose to spend four years of bachelor degree studying just to chase for a job opportunity that a vocational school diploma could offer you.
So back in 2017, that's the case, only 10 % of the total nursing major enrollment in China went to undergraduate universities while more than half of the enrollment was made by vocational schools.
So I would say This is timely shifting.
Like you guys mentioned, the hospitals or the medical facilities themselves, they're trying to elevate their service quality and personnel quality by hiring people with higher professional skills and overall comprehensive quality that's provided through university degrees, or bachelor degrees if not higher.
So that's kind of the trend in every industry nowadays, same for teachers.
Teachers in public schools used to only qualify to have one bachelor degree, but now it's being raised to masters, if not doctoral degrees.
So I see that happening in more than just the nursing or medical industry, but in a lot of other facets of our society as well.
So it's just a necessary process of elevating quality of their hired employees, I guess?
So the number you're telling us means that the higher educational background that you have, more opportunities you can have in the future, or when you're getting to your career, right?
So I think, as you, Heian -sai, you corrected yourself before, Saying that we're focusing more on quantity right now and you correct it as when I meant quality Yes, so but I think it is actually also Focusing on quantity because when people are having a higher Educational background they are having more opportunity and they are getting into as we said most Hospitals and they can apply for most of the hospitals Here in China So, it is also a shift that we can see that people are pursuing a higher educational background and also China is offering this kind of system for these people in this area.
So it means that for those who are going through vocational training to become a nurse, then, in a way, their fate does not look very bright because they know that there are a whole bunch of undergraduate degree holders, and then they're coming after the same job.
So I mean, if you look at this positively, then there is competition, and then this means that more people would possibly want to go through higher education to get a nursing degree and then become a nurse.
But what would this mean for for those vocational school students?
That's one thing, and Also, we all know if you live in China that nursing isn't the best paying job out there, although some people say that it's quite okay compared across the board. Also, you need to look at the setting, whether you're talking about a county level hospital, a small city level hospital, what kind of hospital, in a big city as well I think the treatment could vary a bit.
But I mean, this is not really all adding up for me as somebody who's an outsider.
This sounds like there's some kind of mismatch in this whole thing.
That is, on the one hand, you're saying that apparently pay is really low and then you're also attracting undergraduate students into the profession to compete with vocational school students.
And I understand this is a very complicated matter, but let's talk about it.
In the long term, the higher educational background you hold when entering the job, it seems easier for you to plan a career path that's more, say, easier to get promotions, for example, or easier to secure other bonuses in a way.
But let's look at this.
Once these young students become nurses, here's other issues they are facing.
For example, there are busy work schedules, especially night shifts that most nurses would definitely go through in some part of their career life.
And one 2019 study published in the Chinese Journal of Hospital Management found out that over 60 % of medical staff worked four or more night shifts per month.
And over 33 % of those nurses worked eight or more nights shifts in the month, which is also a significant ratio higher than that of doctors.
And not only the night shifts, I would say the nurses' working schedule has, well, little to do with national holiday and festival arrangements.
For example, I don't really remember seeing my mom very often in primary school years because when I get back to school, she's either working or getting ready for her next shift, and also for, say, gathering times, family gathering times, like festivals and holidays, they don't really plan their working schedule based on that, like the rest of us, but rather on who is needed, who is on leave, and how to manage the rest of the crew in that certain office or departments so a lot of times we don't see her on say spring festival.
That's part of the job which is really difficult and ideally then you can have in many people working for this hospital as nurses and then you can have different shifts instead of having maybe two shifts you have three shifts so people can rotate so that nobody's having to work the night shift too many in a row, that kind of thing, but you kind of need more people, qualified people to make that happen and whether the hospital is willing to employ that many people to fill these jobs.
And I think to look at the treatment of nurses, it's inevitable.
We look at how much they're being paid.
And what we hear is the salary is low.
Mm -hmm a survey conducted in 2017 on more than 11 ,000 nurses from 10 hospitals in 10 provinces show that even in Tertiary hospitals which means it is quite a high -level hospitals year in China nearly comprehensive ones with bigger say a more specialized care and service as in Medical hubs regionally speaking.
Yeah So in this situation, nearly 20 % of nurses earned less than 4 ,000 yuan.
That's about $552 USD per month and more than half of them earn less than $6 ,000.
That's around $820 USD per month.
And only less than 4%, that's about like 3 .68 % of them can make 10 ,000 yuan.
that's around one thousand three hundred eighty US dollars a month and that is actually reflecting a fact that, yes, being a nurse looks quite, it's a quite a stable job, but it's not a lucrative job.
Yes and then people would not think that oh it is a high income job that you a lot of people are attracted to like apply for these kind of jobs or occupations.
Well, that's one argument you could make for many of the medical staff.
We've talked about many times on the show for doctors, especially children's doctors, that's a pediatricians and for nurses.
You know, ideally, folks could be paid better.
So, you know, that that's really essentially how you attract talent.
And the numbers you cited, I think also needs to be taken consideration with the sort of the caveat of what city, county or, you know, because in certain areas, 4000 Yuan per month isn't that bad, you know.
In Beijing it sounds like oh, that's a low paying job to a certain extent.
But if you go to some of the more remote regions and then that's considered a pretty decent jobs.
So I think it's all kind of irrelevant and we need to be more careful in making these comparisons before jumping into conclusions.
But one thing that has changed in our medical system in the last decade or so that is for medical doctors and more for nurses.
It's no longer the stable job for life.
A lot of the times, especially for younger nurses, they're employed on a contract base so they don't immediately sort of enter the quota system which is the lifelong stable job category.
And this has apparently really shifted people's sort of perception towards what the nurse job entails.
Could you explain a little bit to us like how you know this employment status for people these days might be making people feel a little bit differently about going into the nursing profession.
Well, you mentioned QLDA just now, so that's back in the day kind of a must for entering the nursing job position.
Like back in my mom's generation if you get such a QLDA job, then that means like you mentioned it's a lifelong job opportunity that you are not going to be easily fired in any way, unless you made very big an obvious mistake, of course.
But for them, they want to pursue a stable life.
That's why they become nurses, or other jobs like teachers, or jobs that allocate quota to you.
But nowadays, we are hired by companies, but it's okay.
We can still plan our career path, and we can still get promotion as long as we can get through, sit through all the challenges that's faced at us that's how a lot of the younger nurses viewed this whole planning or this whole system nowadays.
This has a lot to do with the perceived future for one's career because if you're not holding the so -called stable job and then on one also questions about promotional opportunities in the future with some of the surveys that have come out regarding how nurses feel about profession, quite a large percentage of them say that they feel this is a job that doesn't really have much of a future.
They feel like they're just constantly stuck in this one one position and that's about it.
So I think it's also, it's important to consider, you know, what's the next leg of my career and if you don't really see much of a future in that sense then especially for let's say if you spend four years in your undergraduate degree then well yeah but but you guys mentioned that perhaps these folks get the promotion earlier than some of the others who might have entered the profession with a vocational education but definitely that the future is something that every working person would be considering and it's not all promising for the nurses by the sound of it.
And before we move on to the next topic discussion today I just like you guys quickly talk about which reforms what you think make the biggest difference for nurses on the front lines and how optimistic do you see them turning into reality.
I think the one that we mentioned earlier, China has established a multilevel, higher nursing education system, is just a starting point, right?
In the future, the system could be used to standardize and regulate nurses' career advancement and also salary levels, maybe, ensuring that their rights and benefits are fully recognized and protected.
And also, as we can see, China published the guidelines to strengthen the construction of the nursing team and optimize nursing services in July 2024.
And it said we should optimize staffing and personnel management and reasonably adjust the nursing service prices, strengthen nurses' salary and benefits.
So there is still a space for improvement and we are on the track.
Yeah, and also there's been a recent notice issued by the National Health Commission pointing out that health administrative departments and medical institutions in various regions should take practical and caring measures to truly care for the nursing team.
Hear the sound of that.
So how are they going to do that?
This notice specifies that effective measures are to be taken to effectively reduce the burden on frontline clinical nurses.
And by doing that, they were trying to introduce more of the high tech replacement of just basic trivial jobs, such as using say 5G, the AI technologies and new information technologies for say the consulting in the hallway of the hospital and doing other basic tasks that doesn't necessarily require a nurse to be there and answer all the time.
So here are some of the progresses and also policies that we hear that our country is stepping forward to.
