Exploring nurse staffing and policy implications in times of crisis: the case of North Lebanon.

BACKGROUND: Since late 2019, Lebanon's healthcare system has been severely affected by three crises, the economic collapse worsened by the pandemic and the Beirut Port explosion. This led to a drastic shortage of competent nurses due to an upsurge in nurse migration. This study explores nurse migration rates, causes, and replacement in north Lebanese hospitals located in an underserved area affected by public health outbreaks especially the COVID-19 pandemic and the economic crisis. METHODS: This study employs a convergent mixed methods design to investigate nurses' migration and replacement rates in North Lebanon between 2020 and 2023. The migration and replacement rates were based on secondary data analysis of hospital administrative records from the sampled twelve hospitals. The qualitative component explored the reasons behind nurse migration and departure through interviews with designated hospital personnel. To ensure thorough and transparent reporting, the findings from both quantitative and qualitative parts are presented following the Good Reporting of a Mixed Methods Study (GRAMMS) checklist. RESULTS: Nurses from adult "medical-surgical" units and "critical care" departments migrated at a greater rate due to financial reasons, job insecurity, and job opportunities made available to them. University-prepared nurses out of the total number of nurses in private hospitals have decreased from "47.2%" in 2020 to "41.9%" in 2023. The same category that is already underrepresented in the public sector also declined, from 26.2% to 23.2% in the same period, reflecting a further loss of qualified nurses in this underserved area. To compensate for their losses, public hospitals predominantly hired technically prepared nurses, whereas private hospitals prioritized university-prepared nurses. Despite recruitment and replacement efforts, North Lebanon's hospitals experienced a 10.24% loss in their nursing workforce, mainly university-prepared nurses, further challenging the healthcare system ability to provide high-quality care. CONCLUSION: The protracted economic crisis and the COVID-19 pandemic have a serious effect on the hospitals' abilities to replace the departing nursing staff. A noteworthy finding of this study is the increasing reliance on hiring technically-prepared nurses to fill the gap left by the nurse migration. These factors have serious implications on the quality of care delivered to patients in the study hospitals.