capita than other countries of comparable national income. the number of nurses in morocco was 29.025 in 2011, two thirds being registered nurses and one third auxiliary nurses, a ratio of 8 nurses per 10,000 population. as a result, morocco has been classified among 57 countries suffering from a shortage of medically trained human resources. a recent study by the european institute of health sciences (institut européen des sciences de la santé) in casablanca based on scientific modeling of future needs indicates that the situation will worsen and that to bridge the nursing gap, morocco needs to produce between 40,000 and 80,000 new nurse graduates until the year 2025. philippines the philippines is the largest exporter of nurses in the world supplying 25% of all overseas nurses. an organisation for economic co-operation and development study reported that one of every six foreign-born nurses in the oecd countries is from the philippines. of all employed filipino rns, roughly 85% are working overseas. this is partially in response to the inability of filipino nurses to enter their domestic workforce due to a lack of jobs and instead become heavily dependent upon international job markets for nurses. the united states has an especially prominent representation of filipino nurses. of the 100,000 foreign nurses working in the u.s. as of 2000, 32.6% were from the philippines. reasons for international migration the international migration of filipino nurses takes place in response to "push and pull" factors. the push factors are rooted in the economic conditions in the philippines in which there is an overabundance of rns and a lack of open employment positions. the unemployment rate in the philippines exceeds 10%. additionally, health care budgets set up filipino nurses for low wages and poor benefit packages. there are fewer jobs available, thereby increasing the workload and pressure on rns. filipinos often pursue international employment to avoid the economic instability and poor labor conditions in their native country. the government also highly encourages the exportation of rns internationally. filipino nurses are pulled to work abroad for the economic benefits of international positions. while a nurse in the philippines will earn between $180 and $200 u.s. dollars per month, a nurse in the u.s. receives a salary of $4,000 per month. nurses abroad are greatly respected in the philippines as they are able to support an entire family at home through remittances. in 1993, filipinos abroad sent $800 million to their families in the philippines thereby supporting the economy. additionally, remittances from filipinos made up 5.2% of the filipino gdp (gross national product) between 1990 and 2000. further pull factors stem from the additional economic benefits of signing bonuses in the u.s. to attract more foreign nurses, u.s. hospitals increased signing bonuses from $1,000 to $7,000. positions abroad in the health sector are also enticing for their immigration benefits. throughout the past 50 years of nurse migration, the u.s. has made efforts to ease the visa application process to further encourage international nurses to relieve the nursing shortage. scholars note that the better living and working conditions, higher income, and opportunities for career advancement draw nurses from the philippines to work in the u.s. as the relation between the u.s. and the philippines stretches back 50 years, filipino nursing institutions often reflect the same education standards and methods as the u.s. curriculum. furthermore, a knowledge of english in the philippines makes it easier for filipino nurses (rather than nurses from other developing nations) to work in the u.s. since 1916, 2,000 nurses have arrived each year in the u.s. in 1999, the u.s. approved 50,000 migrant visas for these nurses. today, on average, there are about 30,000 filipino nurses traveling to the u.s. each year. effects of migration the transnational migration of filipino rns has profound effects on the economy and workforce dynamics in both sending and receiving nations. the departure of nurses from the domestic workforce represents a loss of skilled personnel and the economic investment in education. in addition, the "scarce and relatively expensive-to-train resources" invested are lost when a worker chooses to work abroad. when rns migrate internationally, the country they emigrate from loses a valuable resource and any financial or educational support that was invested in the individual. according to many filipinos working in hospitals, the most educated and skilled nurses are the first to go abroad. there is disagreement among scholars on the extent to which the filipino health sector is burdened by its nursing shortage. while the numerical data are inconsistent about whether the nurse supply is in excess or a shortage, it is clear that there is a short supply of the most skilled nurses who go abroad. as a result, operating rooms are often staffed by novice nurses, and nurses with more experience work extremely long hours. as skilled nurses decline in the urban areas, nurses from rural areas migrate to hospitals in the cities for better pay. as a result, rural communities experience a drain of health resources. stories and studies alike demonstrate that a treatable emergency in the provinces may be fatal because there are no medical professionals to help treat them. in fact, "the number of filipinos dying without medical attention has been steadily increasing for the last decade." the lack of attention from medical professionals has increased despite advances in technology and medicine and the increasing number of trained nurses in the philippines. doctors, too, have changed professions and joined the international mobility trend. filipino doctors have begun leaving their professions to train as nurses under the title md-rn with the hope of immigrating to the u.s. or other developed nations more easily. since 2000, 3,500 filipino doctors have migrated abroad as nurses. the u.s. incentives for nurse migration encourage doctors to train as nurses in the hopes of increasing their economic prospects. as a result, the philippines have a lower average of doctors and nurses with 0.58 and 1.69 respectively for a population of 1,000. the average statistics globally in contrast are 1.23 and 2.56. between 2002 and 2007, 1,000 filipino hospitals closed due to a shortage of health workers. a study conducted by the former philippine secretary of health, jaime galvez-tan, concluded that close to 80% of government doctors have become nurses or are studying nursing. of the 9,000 doctors-turned-nurses, 5,000 are working overseas. the extraordinary influence of this international migration has had devastating effects on the health of filipinos. the number of deaths that were not prevented with medical attention have increased as hospitals are shut down and rural areas are deprived of any medical treatment. due to the high interest in international mobility, there is little permanency in the nursing positions in the philippines. most rns choose to sign short-term contracts that will allow for more flexibility to work overseas. filipino nurses feel less committed to the hospitals as they are temporary staff members. this lack of attachment and minimal responsibility worsens the health of filipino patients. the education system has also been hurt by the increase of nurses in the philippines. as filipinos are attracted to working as nurses, the number of nursing students has steadily increased. as a result, the number of nursing programs has grown quickly in a commercialized manner. in the 1970s, there were only 40 nursing schools in the philippines; by 2005 the number had grown to 441 nursing colleges. while the education opportunities for nursing students has grown tremendously, the quality of education has declined. this can be seen by the low rate (50%) of students who pass the nursing exam since the 1990s. furthermore, the technical committee on nursing education of the commission on higher education (ched) determined that 23% of filipino nursing schools failed to meet the requirements set by the government. in summary, the emigration of filipino nurses has encouraged doctors to switch to nursing, created a shortage of skilled specialized and experienced nurses, affected the education system, and distorted health care delivery and attention to medical issues in rural areas. while remittances, return migration, and the transfer of knowledge support the philippines, they fail to fully compensate the loss of health workers, which disrupts the filipino health and education sectors. dr. jaime-galvez tan, the former philippine secretary of health, warns that if the u.s. passes legislation allowing for freer immigration of nurses the health service of the philippines could collapse. united kingdom in october 2015 the uk government announced that nurses will be added to the government's shortage occupation list on an interim basis. in december 2015, 207 out of 232 english hospitals (90%) reported nursing shortages. in january 2016 the rcn stated that more than 10,000 nursing posts went unfilled in 2015. this represented a 3% increase year on year from 11% in 2013, 14% in 2014 and 17% in 2015 of all london nursing positions and 10% as an average nationwide. according to a bbc article the department of health said it did not recognise the figures. poland as of 2020 in poland, has had very complex issues with their nursing staff. as more nurses have received higher levels of education, they are demanding more pay and better qualifications. poland's poor access to medical care services, their poor financial situation of most hospitals and medical facilities, the unfinished healthcare reform and increasing costs of modern medical procedures and limited accessibility are the leading causes of staffing shortages in poland. united states according to the american national council of state boards of nursing, the number of u.s. trained nurses has been increasing over the past decade: in 2000, 71,475 u.s.-trained nurses became newly licensed. in 2005, 99,187 u.s.-trained nurses became newly licensed. in 2009, 134,708 u.s.-trained nurses became newly licensed. therefore, a 9.8% annual increase of newly licensed u.s. nurses has been observed each year over nine years. it is clear that nursing enrollment in the u.s. has significantly increased over the past decade relative to the 1.19% annual u.s. population growth. while the number of u.s. trained licensed nurses has increased each year, the projected nursing demand growth rate from 2008 to 2018, as reported by the u.s. bureau of labor statistics, is anticipated to be 22%, or 2.12% annually. therefore, the 9.8% annual growth of new rn's exceeds the current new position growth rate by a net of 7.7% per year with the assumption of consistent growth figures over the next decade. the united states population is projected to grow at least 18% over two decades in the 21st century, while the population of those 65 and older is expected to increase three times that rate. the increase in the number of elderly is projected to lead to an increased demand for nurses in senior care facilities as well as the need to fill the positions of nurses as they reach retirement age. projections suggest that by 2020 to 2025 one third of the current rn and lpn workforce will be eligible to retire. the current shortfall of nurses is projected at 800,000 by the year 2020. professional health and related occupations were expected to rapidly increase between 2000 and 2012. the demand for health care practitioners and technical occupations will continue to increase. it is projected that there will be 1.7 million job openings between 2000 and 2012. the demand for registered nurses is even higher. registered nurses are predicted to have 1,101,000 openings due to growth during this 10-year period. in a 2001 american hospital association survey, 715 hospitals reported that 126,000 nursing positions were unfilled. other research findings report a projection of opposite trend. although the demand for nurses continues to increase, the rate of employment has slowed down since 1994 because hospitals were incorporating more less-skilled nursing personnel to substitute for nurses. with the decrease in employment, the earnings for nurses decreased. wage among nurses leveled off in correlation with inflation between 1990 and 1994. the recent economic crisis of 2009 has further decreased the demand for rns. comparing the data released by the bureau of health professions, the projections of shortage within two years have increased. year supply demand shortage percent 2000 1,889,243 1,999,950 -110,707 -6% 2005 2,012,444 2,161,831 -149,387 -7% 2010 2,069,369 2,344,584 -275,215 -12% 2015 2,055,491 2,562,554 -507,063 -20% 2020 2,001,998 2,810,414 -808,416 -28.8% us: supply versus demand projections for fte registered nurses source: data from the bureau of