Written by Professor Giorgi Pkhakadze exclusively for www.sheniekimi.ge
Introduction: Understanding Georgia’s Nursing Crisis
In March 2025, a groundbreaking policy paper titled “Strengthening Health Workforce in Georgia: Identifying Gaps and Integrating Evidence-Based Strategic Planning” was published in the International Journal of Health Planning and Management by Giorgi Aladashvili, Mariam Kirvalidze, Aleksandre Tskitishvili, Nikoloz Chelidze, Nikoloz Tvildiani, Giorgi Pkhakadze, Thomas J. Bossert, Karsten Lunze, and Ilia Nadareishvili (DOI: 10.1002/hpm.3922).
This comprehensive study, produced by leading experts from institutions such as David Tvildiani Medical University, Harvard T.H. Chan School of Public Health, and Boston University, represents the most in-depth analysis to date of Georgia’s healthcare workforce challenges. It serves as a strategic call to action for policymakers, offering a roadmap to build a more sustainable, data-driven, and equitable health workforce system in Georgia.
The study specifically highlights the acute shortage of nurses and the imbalance in physician-nurse ratios as one of the central weaknesses in the Georgian health system. By synthesizing data, analyzing systemic barriers, and offering international comparisons, the research emphasizes that without immediate reform in nursing education, workforce distribution, and compensation, Georgia’s ability to deliver safe and effective healthcare will remain compromised.
Georgia’s healthcare system continues to produce a high number of physicians. Yet, a fundamental weakness persists: the serious shortage of qualified nurses. While doctors often receive the spotlight in public health debates, the nursing profession has been undervalued, underfunded, and systematically overlooked in Georgia. This article explores the dangerous imbalance between doctors and nurses, systemic issues in education and workforce planning, and the real-life consequences for patients.
Imbalance in the Health Workforce: A Silent Emergency
Georgia’s nurse-to-doctor ratio is one of the lowest in Europe. According to the State Audit Office of Georgia, the national ratio is just 0.9:1. In primary care facilities, this number drops even further to 0.3:1. For comparison, in countries like Norway or Germany, there are 3 to 4 nurses per doctor.
This shortage of nurses places overwhelming pressure on physicians and leads to unsafe patient care conditions. When nurses are spread too thin, they cannot provide adequate bedside monitoring, medication management, or patient support. The lack of qualified nursing staff is a major risk factor for poor health outcomes.
Detailed data is available via the World Health Organization’s Global Health Workforce Statistics Database.
Systemic Undervaluation: Low Pay, Low Recognition
Nursing in Georgia is undervalued both economically and socially. The median monthly salary for nurses is approximately 774 GEL (about $280), while doctors earn nearly double that, around 1500 GEL (about $550). These figures are published in the 2023 report by the State Audit Service.
Nursing is often perceived as low-status “support work” rather than a skilled clinical profession. This is compounded by gender bias, as the vast majority of nurses in Georgia are women. The result is a disempowered workforce with limited career mobility and poor access to continuing medical education.
Related analysis can be found in our article on gender inequality in Georgian healthcare.
Migration Crisis: Georgia is Losing Its Nurses
Many of Georgia’s most experienced and promising nurses are leaving the country. Reports from Radio Free Europe and Business Media Georgia confirm that countries like Germany and Italy are actively recruiting Georgian nurses.
These nurses cite better salaries, safer working conditions, and professional respect as key motivators. This exodus leads to dangerous understaffing in local clinics and hospitals, particularly in rural and underserved regions.
For more insights, visit our detailed feature on nurse migration and its impact on healthcare quality.
The Collapse of Nursing Education
Georgia’s current nursing education system is not producing enough qualified graduates. Only 19 students enrolled in bachelor-level nursing programs in 2022, while the vast majority completed vocational programs with outdated curricula and inadequate clinical training. This information is confirmed in the National Center for Disease Control and Public Health 2022 report.
The Nursing Development Strategy 2020–2030 aims to modernize education and certification systems, but implementation has been slow and inconsistent. Few institutions offer simulation labs or structured clinical mentorship programs. As a result, Georgia is not meeting the demands of modern patient-centered care.
Additional commentary and resources are available at www.sheniganatleba.ge.
Consequences for Patients and Public Health
The consequences of Georgia’s nursing crisis are not abstract—they affect patients every day. When nurses are absent, overworked, or undertrained, patients face:
- Higher risk of infections and medical errors
- Longer hospital stays and slower recovery
- Poorer monitoring of chronic conditions
Our article on hospital safety and nursing care standards outlines what patients should expect but often don’t receive.
According to WHO data, Georgia has just 595 nurses per 100,000 people. Countries like Germany and Norway have more than double that. Even countries with lower GDPs like Armenia and Moldova outperform Georgia in nurse availability.
A Strategy Without a System: National Health Strategy 2022–2030
Georgia’s National Health Strategy 2022–2030 acknowledges the urgent need to improve nursing, but lacks a clear roadmap or enforcement mechanisms. The plan includes goals like increasing nurse education enrollment by 30% and introducing certification requirements. Yet there is no coordinated data collection, quality assurance, or performance monitoring.
Additionally, Continuing Medical Education (CME) remains optional for nurses. According to a 2021 BMJ study, CME access in Georgia is inconsistent, poorly regulated, and concentrated in urban centers.
Solutions: What Georgia Must Do
- Raise Salaries: Ensure nurses earn a living wage and are compensated fairly for overtime and night shifts.
- Expand Bachelor and Master’s Programs: Reduce dependency on vocational education and increase enrollment in accredited academic institutions.
- Mandate Licensure and CME: Implement mandatory certification and periodic re-certification with accessible, quality-assured CME programs.
- Professionalize Nursing: Define clear career paths for nurses with opportunities to specialize, lead, and influence healthcare policy.
- Launch Public Education Campaigns: Promote nursing as a critical, respected, and essential profession in society.
For a detailed breakdown of education and reform policies, explore our guide to choosing a healthcare career in Georgia.
Expert Commentary from Professor Giorgi Pkhakadze
“A strong healthcare system doesn’t function without skilled, respected, and empowered nurses. Georgia must stop treating nursing as an afterthought. We need to act now—with better pay, better education, and better recognition—to build a resilient and equitable system.”
References
- Aladashvili G, Kirvalidze M, Tskitishvili A, Chelidze N, Tvildiani N, Pkhakadze G, Bossert TJ, Lunze K, Nadareishvili I. Strengthening health workforce in Georgia: Identifying gaps and integrating evidence-based strategic planning. Int J Health Plann Mgmt. 2025;1–19. https://doi.org/10.1002/hpm.3922
- World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030 [Internet]. Geneva: WHO; 2016. Available from: https://apps.who.int/iris/handle/10665/250368
- Ruadze E, Cherkezishvili E, Roma E, et al. Multistakeholder perspectives on the strengthening and embedding of mandatory continuing medical education in Georgia: a qualitative study. BMJ Open. 2021;11(12):e052686. https://doi.org/10.1136/bmjopen-2021-052686
- State Audit Service. Audit of Professional Development of Medical Personnel [Internet]. Tbilisi: State Audit Office of Georgia; 2023. Available from: https://sao.ge
- National Center for Disease Control and Public Health. Health Care Georgia 2022 Highlights [Internet]. 2022. Available from: https://ncdc.ge/#/pages/file/26d04482-9587-48bb-b746-c9b4dcf01734
- World Health Organization. Aladashvili et al. (2025) further demonstrated that the shortage of nurses is not only a quantitative issue but also stems from systemic neglect in planning and policy. Their study emphasizes the necessity of centralizing workforce governance and aligning Georgia’s training infrastructure with WHO recommendations. Global Health Workforce Statistics Database [Internet]. Available from: https://www.who.int/data/gho/data/themes/topics/health-workforce
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia. National Health Strategy 2022–2030 [Internet]. Tbilisi: Government of Georgia; 2022. Available from: https://matsne.gov.ge/en/document/view/5453716?publication=0 The findings of Aladashvili et al. (2025) provide critical context to this strategy, noting that its implementation remains slow, underfunded, and uncoordinated, particularly in areas related to nursing reform.
- Squires A, Ojemeni MT, Olson E, Uchanieshvili M. Nursing’s public image in the Republic of Georgia: a qualitative, exploratory study. Nurs Inq. 2019;26(4):e12295. https://onlinelibrary.wiley.com/doi/10.1111/nin.12295
- Government of Georgia. Nursing Development Strategy [Internet]. 2019. Available from: https://www.moh.gov.ge/uploads/files/2019/Failebi/06.08.2019.pdf
- Business Media Georgia. Nurses are leaving the country: they have better emotional lives abroad – Association of Nurses [Internet]. 2024. Available from: https://bm.ge/news/eqtnebi-qveynidan-gadian-utskhoetshi-uketesi-emotsiuri-tskhovreba-aqvt-saeqtno-asotsiatsia
- Radio Free Europe / Radio Liberty. How did German clinics hire up to 40 Georgian nurses and why nurses are disappearing in Georgia? [Internet]. 2024. Available from: https://www.radiotavisupleba.ge/a/ქართველი-ექთნები-გერმანიაში-საქმდებიან/32831047.html
- WHO Regional Office for Europe. Results of Initial Health Labour Market Analysis in Ukraine [Internet]. World Health Organization; 2024. Available from: https://iris.who.int/bitstream/handle/10665/379429/WHO-EURO-2024-10458-50230-75692-eng.pdf?sequence=1&isAllowed=y
- Tsaturyan S, Scarpetti G. Health Systems in Action Armenia [Internet]. Copenhagen: WHO Regional Office for Europe; 2022. Available from: https://iris.who.int/bitstream/handle/10665/362322/9789289059107-eng.pdf?sequence=1
