In a week in which nurses are nominally honored, the truth is harder to celebrate. Nurses in Taiwan continue to struggle against a tide of attrition, professional disempowerment and systemic neglect.
Taiwan’s nursing programs are among the highest-ranked globally — but that does not mean our bedside care is world-class. Academic rankings reflect publication output, not patient outcomes. The real determinant of care quality lies in the system nurses must operate within. A well-trained nurse cannot perform miracles in an environment plagued by understaffing and poor governance.
We have heard it again and again: “Taiwanese nurses are professionally trained and capable of handling emergencies.” But when a patient is found in a deep coma (E1V1M1), the first response is not resuscitation — it is to carry the patient back to bed. Is it because a death that happens on a hospital bed would not raise questions? This is not international-standard emergency care, it is an institutional reflex of self-preservation, rooted in fear of accountability for where the patient was found.
Media headlines have been dominated by stories of staffing shortages, pay raises and the struggle to retain nurses by improving working conditions. This has led the public to believe that nurses are leaving simply because they are exhausted or underpaid. A deeper cause, one more insidious and demoralizing, is the slow erosion of professional competence and the helplessness that nurses feel in the face of life-threatening emergencies they are no longer equipped to handle.
It is not heavy workloads that is driving nurses away: It is professional impotence. Time and again, they know what they are supposed to do — but are unable to do it. A nurse might know that during shock, they must assess circulation, insert an intravenous line and administer vasopressors. But when the crisis hits, they hesitate, unsure of the steps, terrified of making a mistake — because they have never actually done it in practice.
Or when a cardiac monitor shows a potentially fatal arrhythmia, they “think they know” what it is, but they are afraid to confirm, afraid to speak up — terrified that a wrong call will bring blame. So they wait for another beep, another signal, another confirmation. And when no doctor is present and a patient’s condition worsens, they can only wait — missing the critical window for intervention. This helplessness accumulates, quietly, until it shatters confidence completely.
The problem is not only on the wards — it starts in education. Senior nurses are overwhelmed covering staffing gaps and have no time to train juniors. Teaching hospitals prioritize physician education, leaving new nurses to fend for themselves. This broken pipeline ensures that clinical competence never fully forms, trapping nurses in stagnant or spiraling career paths.
Not every nurse gives up. Some strive to grow, to reclaim their clinical power, but the system throws up barriers at every turn. Nurses eager to improve their emergency response skills are suffocated by understaffing and inflexible shifts. Those who do dare to rise to the challenge often learn through error, carry the trauma of preventable deaths and still face blame. Those who stop trying grow numb. They do the bare minimum, avoid mistakes and avoid responsibility. So patients who could have been saved die — not from negligence, but from a system that normalized failure.
How do we stop this collapse of nursing professionalism? First, stop treating nurses as subordinate labor. We must re-establish them as key actors in clinical decisionmaking. Hospitals must rebuild career pathways that allow nurses to advance into high-level clinical roles — not remain static for decades. Staffing must be recalibrated to give nurses protected time for simulations, drills and advanced training. Only then can they reclaim their agency — to act, not wait; to decide, not defer; to save, not mourn.
The true root of nursing attrition lies not merely in hours or wages, but in the unbearable weight of professional guilt and helplessness. When we stop forcing nurses to be witnesses to avoidable deaths — and instead empower them to intervene — we will finally begin the long-overdue return to a healthcare system grounded in professionalism, not survival.
It is not just about making them stay — it is about giving them a reason to move forward. Because only where professional autonomy exists can passion and purpose endure. Surely, nursing is not just the skill of care — it is the courage to save lives.
Chu Jou-juo is a professor in the Department of Labor Relations at National Chung-cheng University.
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