According to Columbia University’s Earth Institute¹, over the next 20 years, climate change is expected to significantly affect the United States across multiple dimensions:

• Changing weather patterns are impacting farming, making food more expensive.
• Pollinator loss is impacting what can be grown, and diseases will reduce food variety.
• Health risks are worsening with longer pollen seasons, and poor air quality is increasing asthma and allergies.
• Water quality is affected when storm run-off carries pollutants into water supplies, and algal blooms and saltwater intrusion are also threatening drinking water.
• Heart-related illness and vector-borne diseases are on the rise (e.g., West Nile, dengue), and mental health impacts from disasters are also rising.
• Outdoor work in heatwaves leads to heat exhaustion and stroke. More days will require air conditioning and extreme weather will strain the electrical grid.
• Flooding will continue to worsen due to sea level rise and more intense storms, and increased risk of costal flooding is leading to rising home insurance costs in the United States, particularly in high-risk areas².

The impacts of these changes are evident around the world, with even more intensity at the poles, in arid regions and on small low-lying islands particularly prone to sea level rise. Such patterns are impacting many sectors of the economy and associated certification programs. Real estate, building codes, insurance, finance, actuaries and health care are some of the obvious areas that are going to see changes in the job roles being certified. We can learn something by focusing on health care, specifically nursing.

Climate change has caused people to be displaced in many regions of the world^3,4,5,6. It has also become an increasingly significant cause of involuntary nurse migration^7,8.

Implications for Global Mobility and Testing

According to the WHO State of the World’s Nursing 2025 Report, there is a great disparity in the number of nurses per 100,000 people around the world.

Many of the regions with the lowest density of nursing resources are in the most vulnerable areas. Globally, it is predicted that by 2030 there will be a shortage of 11 million nurses. Adding to this problem is the difficulty of nursing credentials to be recognized in different countries, such that a qualified nurse who moves to a different part of the world must recertify to do the same job somewhere else. The cost, complexity and time required to recertify is a drag on mobility, and in a crisis situation this is particularly unfortunate.

When nurses arrive in destination countries, their skills and abilities can fill crucial workforce needs⁹. However, nurses who migrate to another country often work below their educational level or scope of practice^{10,11,12,13,14}. Few policies and policy recommendations help support or facilitate repatriation and post-conflict reintegration of displaced nurses, leaving them without pathways to work or to return home, even as their skills are desperately needed around the world.

Thought leaders have called for additional policies and initiatives to provide meaningful support for displaced and repatriated health care workers in post-conflict zones such as Lebanon, South Sudan, and Afghanistan¹⁵. It is a tremendous lost opportunity that these skilled workers are unable to put their skills to work. Research has shown that refugee nurses provide especially appropriate and empathetic care for refugee populations¹⁶.

Involuntarily displaced nurses face significant challenges, including long waiting times and limited information regarding work permits in their destination countries¹⁷. Policies that provide opportunities for professional development, incorporate financial incentives, establish flexibility and identify staff with strong community links can help nurses and other skilled health care workers put their training to good use in places disrupted by conflict and climate change¹⁸.

As an increasing number of local regulatory concerns become regional and global, and as global pressures result in significant populations of skilled professionals moving around the world, certification will become more critical than ever. Individuals will require portable credentials to rapidly enter the workforce in new sectors as they move to new contexts of work. Sudden critical needs will require rapid expansion of the local workforce, and credentialed specialists who can hit the ground running will be required to address these needs.

If tens of thousands of skilled nurses are suddenly needed in a location, certifications will be the basis on which tens of thousands of skilled nurses will be identified, transferred and enabled to address public health emergencies.

In 2024-2025, TruMerit carried out a comprehensive design and development process to meet the challenges of an evolving profession and global nursing shortages. This process was grounded in broad global participation and collaboration from nursing experts, including 73 nursing leaders and subject matter experts from 50 countries, and from across all world regions and income levels, to lend their expertise to creating an exam that would enable nurses and their employers to benchmark their skills against a global standard.

The resulting Nurse Qualifying Exam (NQE) is designed to validate the applied knowledge and practice competence of first-level, general nurses worldwide. Carrying this credential signifies that nursing knowledge and experience have been assessed against a global industry standard with an established competency framework for nursing. The CGN credential is intended to provide nurses with greater mobility within the profession and across geopolitical boundaries throughout their career.

Credentials can provide opportunities for displaced professionals and, in turn, enable employers and policymakers to rapidly address critical needs for skilled workers. As credential professionals, we have a responsibility and an opportunity to be mindful of this and help find a path forward.

What Can Other Certification Programs Do to Prepare?

Initiate a risk evaluation if you haven’t already, and identify how climate change might impact your industry, certification and your candidates. This should include:

1. Scope Definition – The geographical scope and time horizon that you are trying to protect or understand.

2. Hazard Identification – The issue at hand, like extreme heat, lack of water, or another environmental crisis.

3. Vulnerability Assessment – Evaluate how exposed and sensitive assets or populations are to these hazards.

Be transparent with your members and other affiliated organizations; make sure you collaborate on research and potential solutions to the specific issues faced.

We can do this by increasing global ties and building portability of certifications so that certified individuals can move around the world more freely to help and to get work.

References

1. Cho, R. (2019). “10 Climate Change Impacts That Will Affect Us All.” Columbia University, Climate, Earth, and Society. Retrieved from: https://news.climate.columbia.edu/2019/12/27/climate-change-impacts-everyone/
2. Carbonaro, G. (2025). “These California Insurers Cut Policies Before Devastating Wildfires,” Newsweek, https://www.newsweek.com/these-california-insurers-cut-policies-before-devastating-wildfires-2012158
3. Cubelo, F. (2022). “Internationally Educated Nurses’ Role in Climate Change: Sustainability and Mitigation Practices,” Public Health Nursing, 2023(40): 585-589.
4. Tanay, M. A., Quiambao-Udan, J., Soriano, O., Aquino, G., and Valera, P. M. (2023). “Filipino Nurses’ Experiences and Perceptions of the Impact of Climate Change on Health care Delivery and Cancer Care in the Philippines: A Qualitative Exploratory Survey,” ecancer, 17(1622): 1-11.
5. Samba, V. F., Mezgebu, E., Habtes, H., Oti, N. O., Mangongolo, B. M., Bafumba, R., Burns, K., Olarte Sierra, M. F., Challinor, J., de Villiers, M. (2023) “Climate Change and Oncology Nursing: the African Perspective,” ecancer, 17 (1621): 1-20.
6. Nichols, P. K., Breakey, S., McKinnon, S., Eddy, E. Z., Fanuele, J., and Starodub, R. (2021). “A Climate: A Tool for Assessment of Climate-Change-Related Health Consequences in the Emergency Department,” Journal of Emergency Nursing. 2021(47): 532-542.
7. World Health Organization. (2025). State of the World’s Nursing 2025: Investing in Education, Jobs, Leadership and Service Delivery, World Health Organization: Geneva. Licence: CC BY-NC-SA 3.0 IGO.
8. Bou-Karroum, L., El-Harakeh, A., Kassamany, I., Ismail, H., El Arnaout, N., Charide, R., Madi, F., Jamali, S., Martineau, T., El-Jardali, F., & Akl, E. A. (2020). “Health Care Workers in Conflict and Post-Conflict Settings: Systematic Mapping of the Evidence,” PLoS One, 15(5): 1-35.
9. Chang Chiu, A. C., Monk, J., Docal, M., & Reynolds, N. R. (2024). Nursing Nurses: Fostering Safety and Belonging for Successful Workplace Assimilation of Displaced Nurses From War and Conflict. Nurse Leader, 22(2), 146-152.
10. Correa-Betancour, M., Marcus, K., Balasubramanian, M., and Short, S. D. (2024). “Barriers and Facilitators to the Professional Integration of Internationally Qualified Nurses in Australia- A Mixed Methods Systematic Review,” Australian Journal of Advanced Nursing, 41(1): 39-53.
11. Cubelo, F. (2024). Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis. Policy, Politics, & Nursing Practice, 15271544241245975.
12. Gotehus, A. (2021). Agency in deskilling: Filipino nurses’ experiences in the Norwegian health care sector. Geoforum, 126, 340-349.
13. Lillekroken, D., & Nortvedt, L. (2024). Hope, passion and perseverance: experiences of internationally educated nurses pursuing nursing authorisation in Norway–a qualitative study. BMC nursing, 23(1), 637.
14. Stokes, F. and Iskander, R. (2021). “Human Rights and Bioethical Considerations of Global Nurse Migration,” Bioethical Inquiry, 2021(18): 429-439.
15. Rayes D, Meiqari L, Yamout R, Abbara A, Nuwayhid I, Jabbour S et al. Policies on return and reintegration of displaced healthcare workers towards rebuilding conflict-affected health systems: a review for The Lancet-AUB Commission on Syria. Confl Health. 2021;15:36 (https://doi.org/10.1186/s13031-021-00367-4).
16. Duclos, D., Fouad, F. M., & Blanchet, K. (2021). When refugees care for refugees in Lebanon: providing contextually appropriate care from the ground up. Medicine Anthropology Theory, 8(3), 1-22.
17. Gotlib, J., Cieslak, I., Wawrzuta, D., Jaworski, M., Theofanidis, D., Wojcik, G., Malkowski, P., and Panczyk, M. (2023). “Challenges in Job Seeking and the Integration of Ukrainian War Refugee Health care Workers into the Polish Health care System: Facebook Content Analysis,” International Journal of Public Health,” 68: 1-10.
18. Lin, T. K., Werner, K., Kak, M., & Herbst, C. H. (2023). Health-care worker retention in post-conflict settings: a systematic literature review. Health Policy and Planning, 38(1), 109-121.

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