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Nurses are critical to deliver on the promise of 'leaving no one behind' and the global effort to achieve the Sustainable Development Goals (SDGs). They make a central contribution to national and global targets related to a range of health priorities, including universal health coverage, mental health and noncommunicable diseases, emergency preparedness and response, patient safety, and the delivery of integrated, people-centred care. No global health agenda can be realized without concerted and sustained efforts to maximize the contributions of the nursing workforce and their roles within interprofessional health teams. To do so requires policy interventions that enable them to have maximum impact and effectiveness by optimizing nurses' scope and leadership, alongside accelerated investment in their education, skills and jobs. This report, developed by the World Health Organization (WHO) in partnership with the International Council of Nurses and the global Nursing Now campaign, and with the support of governments and wider partners, provides a compelling case on the value of the nursing workforce globally. The report reveals much to celebrate about the nursing workforce. Opportunities for advanced nursing education and enhanced professional roles, including at the policy level, can drive improvements in population health. At the same time, we continue to see vast inequities in the distribution of nurses around the world which we must address.

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This systematic review and meta‑analysis identified early evidence quantifying the disruption to the education of health workers by the [Coronavirus Disease 2019] COVID‑19 pandemic, ensuing policy responses and their outcomes. Methods: following a pre‑registered protocol and PRISMA/AMSTAR‑2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random‑effects meta‑analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end‑year. We assessed risk of bias (Newcastle–Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

Results: of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1 per cent (95 per cent confidence interval 67.9-74.2) and learner redeployment at 29.2 per cent (25.3-33.2). About one in three learners screened positive for anxiety (32.3 per cent, 28.5-36.2), depression (32.0 per cent, 27.9-36.2), burnout (38.8 per cent, 33.4–44.3) or insomnia (30.9 per cent, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID‑19‑specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two‑thirds of learners (75.9 per cent, 74.2–77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8 per cent, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0 per cent (51.2–60.7), face-to-face 48.8 per cent (45.4–52.1), and online-only 32.0 per cent (29.3–34.8). They supported continuation of the virtual format as part of a blended system (68.1 per cent, 64.6–71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

Conclusion: The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

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