In crisis, nurses step up in health system resilience

Nurses deliver almost 80% of hands-on direct care globally, making them important in strengthening health system resilience. Despite their contributions during health crises, they remain underrepresented in leadership roles that shape essential resilience strategies.

A new study from the University of Michigan highlights the importance of health system resilience, defined as the ability of health systems to effectively respond to system shocks or disasters while maintaining essential services and preserving population health.

“What surprised me most was how few papers discussed both the nursing workforce and their contributions in terms of health system resilience,” said lead author Katherine Kruger, a doctoral student at the U-M School of Nursing.

The research emphasizes both the challenges and opportunities for more effectively integrating nurses into these crucial processes. The findings support the World Health Organization’s call to enhance health system resilience by empowering nurses, a vital part of the global health care workforce.

Nurses face barriers such as inadequate staffing, training and restrictive policies. These obstacles contribute to their limited involvement in strategic planning and leadership, compounded by traditional hierarchies and gender-based power dynamics in medicine.

“This is the first piece of research, that says, we are talking the talk, but we’re really not taking the action needed to get nurses involved on a global scale to be involved in developing resilient health systems,” Kruger said.

A strong nursing presence contributes to a superior health system performance and improved population health outcome, including reduced mortality rates. Expanding the involvement of nurses in system-level roles can further improve resilience and equity in health care delivery, building on their existing impact within these positions.

“My hope is that we continue with top-down, large or global organizations increasing nursing voices, but it is also beneficial for bottom-up engagement to remind nurses that when disaster strikes, nurses are the ones who are responding and adapting,” Kruger said.

Co-authors include: Sue Anne Bell, U-M associate professor and senior author of the study; Jody Lori, U-M professor of nursing; and Petra Brysiewicz, professor of nursing at the University of KwaZulu-Natal.

Study: The role of the nursing workforce in health system resilience during disasters: A scoping review of empirical studies (DOI: 10.1016/j.ijnsa.2025.100361)