As Taiwan’s nursing shortage reaches critical levels, hospitals are turning to smarter workflows, cross-industry innovation, and cultural reform to protect care quality and retain an overstretched workforce.

Only a day after undergoing hip surgery, an 82-year-old patient at Kaohsiung Medical University Hospital (KMUH) is already walking again, guided by a nurse trained in a new protocol that is reshaping how Taiwan delivers surgical care. This rapid recovery isn’t the result of a miracle drug, but rather a model of post-operative coordination that is redefining roles and routines across the hospital.

In one of KMUH’s orthopedic wards, the patient receives tailored guidance through the Enhanced Recovery After Surgery (ERAS) protocol. A case manager oversees discharge planning, while a dietitian adjusts nutritional supplements to support healing. After a surgery that was once considered high-risk, the patient is discharged in just a few days — mobile, confident, and satisfied.

This is the new standard of care at KMUH, where ERAS is revolutionizing how multidisciplinary teams deliver treatment. It offers a model of collaboration that may hold part of the answer to Taiwan’s worsening nursing shortage.

“We began preparing for ERAS as early as April 2021 and officially launched it that October,” says Dr. Wang Jaw-yuan, superintendent of KMUH. “It now spans 22 surgical procedures across 14 departments, from orthopedics to neurosurgery.”

The results are striking. Post-surgery hospital stays have dropped, 30-day readmission rates have declined, and patient satisfaction is on the rise. Just as importantly, the approach makes more efficient use of Taiwan’s limited healthcare workforce — particularly its overburdened nursing staff.

According to Ministry of Health and Welfare (MOHW) data, Taiwan’s 8.1 nurses per 1,000 inhabitants places it in the mid-range among OECD nations, slightly above South Korea but lower than the United Kingdom. But making matters worse, hospitals are under pressure from Taiwan’s aging population, increasingly complex caseloads, and persistently high attrition among nurses.

Recent media reports from outlets such as United Daily News and Liberty Times have highlighted the severity of the shortage. Nurses have publicly voiced frustration over excessive workloads and understaffing during night shifts, especially in emergency and intensive care units. Several large hospitals in Taipei and Kaohsiung have struggled to maintain safe nurse-to-patient ratios, increasing the risk of medical errors, longer wait times, and reduced patient safety.

Industry sounds the alarm

As hospitals struggle to maintain staffing levels, the private sector is also feeling the pressure. In July 2025, AmCham Taiwan conducted a pulse survey of its Medical Devices, Public Health, and Pharmaceutical committees to gauge the impact of the nursing shortage on international healthcare-related companies. The results reflected a consistent sense of strain.

More than half of respondents reported severe understaffing in hospitals, describing the impact on operations as significant. Another 40% noted moderate shortages. Not a single respondent said the situation is stable or improving.

Common problems cited include ER crowding, delayed procedures, and high patient-to-nurse ratios. Several noted frequent staff overtime and visible signs of burnout. One respondent noted that  “ICU staffing remains critically low.” Another cited “clear signs of overwork and strain.”

Although around 12,000 students graduate from Taiwan’s nursing programs annually, only 6,000 to 7,000 go on to work in clinical care. Many leave the profession early due to poor working conditions, limited incentives, or better job opportunities outside hospitals.

In the face of these challenges, approaches like the ERAS model offer promising support. Originally designed to enhance surgical recovery, ERAS now optimizes every stage of the patient journey, from pre-operative assessment to post-discharge rehabilitation. It emphasizes early mobilization, personalized anesthesia, patient education, and tailored nutrition plans.

“Patients over 70 with high surgical risk receive a fully coordinated care plan involving orthopedic surgeons, anesthesiologists, nurses, pharmacists, dietitians, and physical therapists,” says Dr. Wang. “We’ve developed a cloud-based system to flag medication risks and help the care team collaborate in real time.”

Initially, the rollout faced resistance. Nurses were asked to take on more responsibilities in patient education, mobility support, and care coordination. But cross-departmental collaboration helped refine workflows and lighten long-term burdens.

“Nurses, nurse practitioners, and case managers have taken on three key roles in the ERAS model — education, mobilization, and care coordination,” Dr. Wang says. “The work is more meaningful, and the recovery outcomes are a powerful motivator.”

To support implementation, KMUH created a modular ERAS training program and appointed senior nurses as “ERAS champions” within each department. The hospital also hosts annual forums to share best practices across institutions.

The model has been especially impactful for joint replacement patients. Average hospital stays for hip and knee surgeries dropped from 5.2 to 3.7 days. Readmission rates fell to zero, and patient satisfaction scores reached 84.4 out of 100.

While ERAS is still a novel concept in the region, it has become standard in many Western healthcare systems. Initially applied to colorectal surgery, it now spans specialties including orthopedics, urology, and gynecology. Countries like the United Kingdom, Canada, and the Netherlands have reported 30-50% reductions in hospital stays and significantly fewer post-operative complications.

“As hospitals look for ways to do more with fewer nurses, ERAS helps streamline care, reduce complications, and ensure everyone on the team knows their role,” says Dr. Wang.

Still, implementation remains fragmented. Dr. Wang notes that the government’s initial ERAS pilot focused only on orthopedic surgery, despite its initial application in Europe being colorectal surgery. “If resources allow, it should expand to include colorectal and other complex surgeries where recovery can benefit significantly,” he says.

Dr. Wang emphasizes the importance of institutional cultural change alongside investment. “Updating technology is easy compared to updating culture,” he says. “But ERAS proves that with teamwork and shared values, transformation is possible.”

To this end, Dr. Wang regularly shares his hospital’s experience at conferences and encourages other hospitals to begin with small pilot programs, gradually expanding as teams build trust and fluency in the ERAS model.

“The key is to start with one surgery, work through the challenges, and then expand,” he says. “You’ll face resistance in the beginning, but it becomes smoother with time.”

Automation in action

While KMUH emphasizes team-based care, another hospital is exploring a high-tech solution to nursing shortages. At Taichung Veterans General Hospital (TCVGH), Deputy Director of Nursing Liu Shu-fang is leading a team piloting Nurabot — a mobile service robot co-developed with Foxconn (also known as Hon Hai Precision Industry Co.), Nvidia, and Kawasaki Robotics, a division of Japan’s Kawasaki Heavy Industries.

“Nurses often spend a significant amount of time walking between stations and patient rooms to transport specimens and medications,” Alice Lin, Foxconn’s director of UX/UI Design, told TOPICS earlier this year. “These tasks are essential, but they’re time-consuming and physically demanding.”

Nurabot is built to handle these logistical duties. With AI navigation and onboard sensors, it moves autonomously through corridors, avoids obstacles, and even operates elevators, freeing nurses to focus on patient care.

To prepare for real-world use, Foxconn created Taiwan’s first high-fidelity digital twin of a hospital using Nvidia’s Isaac Sim — its reference application built on the Nvidia Omniverse platform. The virtual environment allowed engineers to simulate daily operations and fine-tune integration before deployment.

Now in testing, Nurabot can transport medication and lab samples, deliver patient education messages, and guide visitors. It also offers basic voice interaction with patients.

“We’re tracking metrics like walking distance reduction, delivery accuracy, and staff satisfaction,” says Liu. “So far, feedback has been very positive. Nurses report less physical strain and better time management.” She adds that patients have responded positively to the robot’s approachable exterior.

TCVGH’s integration model includes contributions from nursing informatics, engineering, and IT staff. The robot is initially deployed in general wards, with the service then expanded based on frontline feedback and simulation data.

Beyond helping Taichung nurses, the project demonstrates how cross-industry collaboration can accelerate healthcare innovation. Kawasaki Robotics contributed autonomous motion algorithms based on its experience in manufacturing automation, while Foxconn integrated its proprietary navigation stack and sensor fusion technologies. Nvidia’s three computer frameworks — Isaac for Healthcare, Holoscan, and Jetson AGX Orin — has enabled Nurabot to perform real-time AI processing, multimodal perception, and autonomous navigation in complex hospital environments. TCVGH, meanwhile, served as both testing ground and co-developer, providing real-time clinical feedback.

“We continue to refine the robot and its integration into our workflows,” Liu says. “The goal is to reduce unnecessary walking and let nurses focus on complex care tasks that require their expertise. We also hold regular drills and gather user feedback to refine the system.”

Like KMUH, TCVGH sees technology not as a replacement but as an enabler. “Technology should augment care — not complicate it,” Liu says.

Gaping policy gaps

Comments by AmCham healthcare company executives indicate broad support for innovative solutions that can help turn around a steadily worsening situation. Survey respondents emphasized the need for both technological and systemic changes to stabilize Taiwan’s nursing workforce. Suggestions included improving compensation and incentives for clinical nurses, expanding nurse practitioner roles and training, encouraging broader adoption of ERAS and AI-driven smart wards, and facilitating international collaboration and knowledge exchange.

One respondent noted that in ICU settings, inadequate staffing without additional hazard pay leads to increased workloads for those remaining. Another emphasized the need for policy incentives to retain nurses beyond their early career years.

Looking ahead, 62% of AmCham’s survey participants said they expect the nursing shortage to worsen, citing burnout and demographic headwinds. None said they believe the situation will improve without significant intervention.

To address the shortage, Taiwan’s government has launched several initiatives. In 2023, the MOHW rolled out a 12-point incentive program worth around NT$1.8 billion (US$60.3 million), designed to address chronic understaffing. The program includes salary boosts for night and graveyard shifts, new nurse-to-patient ratio standards with financial bonuses for compliance, enhanced training, and subsidies to recruit and retain nurses, particularly in rural areas.

The government has also increased funding to expand nursing school enrollment, streamlined licensing and hiring systems, and launched pilot programs to integrate foreign nursing aides and caregivers into hospitals and long-term care settings.

Yet frontline nurses and expert analysts argue these efforts haven’t significantly reduced attrition or improved working conditions. Many hospitals have responded by reducing bed numbers or shifting staff schedules to meet ratio mandates rather than hiring more nurses. Wage supplements are often unequally distributed or absorbed into hospital budgets instead of reaching nurses, and longstanding issues like excessive overtime, burnout, and poor management culture remain largely unaddressed.

Without systemic reforms — including overhauling payment structures, investing in long-term cultural change within hospitals, and establishing transparent deployment of incentives — the band‑aid policies risk treating symptoms instead of the root causes.

Beyond revamping staffing models, Taiwan’s drive toward becoming a smart healthcare leader has opened new possibilities for alleviating the nursing burden. Hospitals are increasingly integrating AI-powered tools and digital infrastructure into routine workflows, streamlining care and reducing the cognitive and administrative load on existing staff.

Meanwhile, the broader shift toward minimally invasive procedures is also contributing to reduced hospital stays and quicker recovery times. These techniques help lower complication rates and ease the burden on nursing staff by shortening inpatient care duration.

Still, many younger nurses are choosing not to enter or remain in clinical practice. Educators in Taiwan’s nursing programs report that students are increasingly drawn to research, public health, or pharmaceutical careers instead of hospital-based care. This shift reflects both a desire for better work-life balance and concern about burnout. For those who do join the clinical workforce, their early years are often marked by high attrition. “One of the biggest challenges is helping new nurses feel supported during their first year,” notes a senior instructor at a nursing school in Taipei. “Without structured mentorship and onboarding, many nurses leave before they’ve had a chance to build confidence in clinical care.”