The current situation in Georgia’s healthcare system differs radically from European standards. The number of doctors and nurses in the country is almost equal. Today, the nursing profession is increasingly unattractive, primarily due to low pay, overworked schedules, and vague perspectives for career growth. As a result, the country faces a massive outflow of qualified personnel and a growing deficit.
We spoke with Akaki Zoidze, a physician and expert in healthcare policy and systems, about these systemic challenges and potential solutions. According to him, the shortage of nurses and the low prestige of the profession are the results of problems accumulated over decades, requiring systemic changes.
Zoidze believes the solution lies in a complex approach: increasing salaries, expanding responsibilities and competencies, and creating a continuous education model that ensures professional independence and real career advancement for nurses.
In Georgia, we have a paradoxical situation where the number of doctors and nurses is nearly equal, which sharply contradicts international (e.g., European) practice. Why has our healthcare system failed to increase the attractiveness of the nursing profession, and what political or economic levers are needed to ensure nurses outnumber doctors?
This issue is simultaneously very simple and very difficult. The changes needed to organize nursing affairs are complex and require a long time. However, we must implement this reform sooner or later; we have been talking about this problem for 30 years. In reality, some steps were taken, but I would call them “half-measures” and unfinished reforms. This ultimately created the situation we have today: instead of having three nurses per doctor, we actually have three doctors for every two nurses. This is an absolutely abnormal picture rarely encountered elsewhere in the world.
Unlike European models, Georgia still struggles with low pay for nurses and overworked schedules. Based on your observations, what structural reforms are necessary for nursing to become a valued and prestigious profession in our country?
The prestige of a profession is directly dependent on compensation, motivation, and the responsibilities assigned to the nurse. We have significant problems in all three directions. While nurses play a leading role in Western healthcare systems—in maintaining health, treatment, rehabilitation, prevention, and palliative care—in our system, the nurse’s role is most often reduced to the level of a medical orderly.
Of course, we have experienced personnel: intensive care, surgical, and operating block nurses who possess unique skills and theoretical knowledge, but this is a very narrow circle. Training such specialists takes a long time, and they must have the corresponding motivation and salary. When the nurse’s role is so diminished, the pay is minimal. This differs sharply from the income of certain medical specialists whose compensation is on par with their Western colleagues.
The gap between the pay of our nurses and those in Western countries is enormous. This is why the outflow of qualified staff is catastrophic. In terms of labor migration, Germany is the most popular destination, where many Georgian nurses go through legal channels; under the current system, the probability of them returning is very low. We must also consider that this process is happening within Europe itself—nurses from Eastern Europe move West for better conditions. In our case, this migration has reached a critical limit due to low pay, low motivation, and minimal responsibility.
In Europe, nurses have a clear career path (clinical nurse, manager, researcher, practitioner). Why is this profession stagnant at the entry-level position in Georgia, and why do we lack a continuous education model to help nurses grow?
A unified model of continuous education should exist for both doctors and nurses. Today, in many countries, membership in a professional development system is mandatory for practice. In such a rapidly evolving field, where technological and scientific progress happens daily, it is essential to “keep a finger on the pulse of development.”
Offering a clear career path is crucial for maintaining motivation. A nurse needs to know where their path to growth lies, which is virtually non-existent under current conditions. The only “solution” currently is working at multiple locations to accumulate a solid income, which leads to further burnout, frustration, and the desire to leave the country.
What needs to change in our educational system so that Georgian nurses possess the same clinical competencies and autonomy as their European colleagues?
Serious steps must be taken to break this vicious cycle. First and foremost, the role of nurses must be sharply increased within the framework of primary healthcare reform, as well as in state-funded rehabilitation programs.
The first attempt at financial stimulation should be ensuring their salary does not fall below a certain benchmark. The state should encourage salary increases through its programs. On the other hand, we must assist private networks that try to raise the prestige of the profession and provide more education to employees.
Supporting Bachelor’s programs is essential—today, it isn’t worth it for a student to spend 4 years on a degree because it gives them no advantage over a 1-2 year technical college certificate. Ultimately, both the quality and the purpose of education must increase. We cannot popularize the profession if we do not offer young people a specific career path and vision. We need a complex mix of salary increases, support for higher education, strengthening the role of professional associations, and funding for retraining programs.
Furthermore, we need the fundamental changes we’ve discussed for 30 years. We need more specialization so that their roles are not limited. The legislative and regulatory framework must change to expand nursing responsibilities. More responsibility means more pay and prestige. If we do not grant nurses the right to perform medical interventions and take responsibility for patient treatment, we cannot move forward. In the US, for example, the nurse is a primary actor in medical procedures. Here, due to a surplus of doctors, their roles are often filled by physician assistants or a “junior doctor” link we “invented,” which is absolutely redundant and fails to fulfill the tasks of either side perfectly.
A registry of nurses and mandatory registration is planned for 2027, yet a significant portion of nurses lacks proper education or an accredited diploma. The Ministry has introduced a “nurse assistant” position. What do you think will happen once this registry is active, considering nearly half of the nurses likely won’t be able to register?
In this context, the 2027 registry is merely a tool, not a reform. It is understandable that certain regulations are needed, but the main point of regulation should be a shift in competencies and responsibilities. The registry gives us a certain picture, but it is not the ultimate goal. A registry alone will change nothing if we do not solve fundamental issues like compensation, the educational model, and the redistribution of competencies.
How possible is it to achieve tangible results in improving the current situation by implementing European practices in the Georgian reality?
There is no magic solution that will solve the problem with one stroke. Great effort is required. When we mention “European experience,” we specifically mean steps like having clearly defined requirements for nurses, expanded responsibilities, and adequate compensation. It is vital to take real steps—we must end these “half-measures” and move toward decisive actions. I have great hope that all of this will finally come to fruition.
