On a weekend in March 2026, the Eric Williams Medical Sciences Complex - one of Trinidad and Tobago's two major hospitals - had approximately 30 patients sitting in its Accident and Emergency department with no nursing staff present. Not understaffed. Not short-handed. Zero nurses on the floor. The Trinidad and Tobago National Nurses Association warned it could get worse, using the word "shutdown" without qualification. This was not a freak scheduling failure. It was the logical endpoint of a workforce crisis that has been building for over a decade, ignored at every stage where intervention might have mattered.
The NCRHA responded by blaming "unexpected absenteeism." The nurses responded by pointing out that absenteeism is what happens when you cut overtime pay, freeze salaries for thirteen years, and expect the same people to keep showing up.
The Vacancy Map
Health Minister Dr. Lackram Bodoe disclosed the scale of the nursing shortage at a University of the West Indies School of Nursing graduation ceremony in July 2025. The figure he gave was not the 1,600 that had been circulating in public discussion. It was 1,868 - spread unevenly across the four Regional Health Authorities. The South-West RHA carries the heaviest burden with 719 vacancies. The North-West RHA, which includes the Port of Spain General Hospital, has 625. The Eastern RHA has 381. The North Central RHA - the authority responsible for the EWMSC where patients sat without nursing care - officially reports 143 vacancies, the lowest figure of the four.
That last number deserves scrutiny. If the NCRHA has the fewest vacancies on paper, and yet its flagship hospital cannot staff an emergency department on a weekend, the vacancy figures are undercounting the real gap. A budgeted position and a warm body on a ward are different things. Nurses who are technically employed but refusing extra-duty shifts because the pay was cut do not show up in vacancy statistics. They show up in empty wards.
The NWRHA has hired 97 nurses and 59 enrolled nursing assistants, with 69 nurses assuming duties at another RHA. Set against 1,868 vacancies, this recruitment rate would take years to close the gap - assuming nobody else leaves.
The Pay Freeze and the Overtime Trigger
Nurses in Trinidad and Tobago's public health system remain on 2013 salary levels. Thirteen years without a pay adjustment. During the same period, staff within the Ministry of Health - the administrative arm - received a ten percent wage increase and moved to 2019 salary scales. The people who file the paperwork got raises. The people who keep patients alive did not.
The wage disparity has a political dimension. The Public Services Association - whose members received the 10 percent increase - is aligned with the governing UNC through the OWTU-UNC alliance. Non-aligned unions representing nurses and other health workers remain stuck at 4 percent. PSA president Leroy Baptiste was subsequently appointed Minister of Labour, a trajectory that reinforces the perception of union patronage driving wage outcomes rather than workforce need. More than 15,000 Regional Health Authority workers have not received confirmation on when salary increases will be paid, with some issues stretching back to January 2014.
Into this environment, NCRHA Chairman Dr. Tim Gopeesingh made a decision that functioned as an accelerant. He cut monthly overtime hours from 60 to 40 and reduced the pool pay rate from $75 per hour to $60. The NCRHA justified the reduction by citing a directive from the Chief Personnel Officer, saying the authority had been paying rates above what was authorised. Gopeesingh went further, claiming an audit had uncovered a racket in which some nurses were taking home between $60,000 and $80,000 over three-month periods through accumulated overtime. The CPO directive, he said, set $60 per hour as the standard pool rate, with $75 reserved for three specialised areas - intensive care, the heart lab, and psychiatric nursing.
The framing matters. Gopeesingh cast the overtime issue as fiscal discipline and abuse correction. The nurses saw it differently. When your base salary has not moved since 2013 and overtime is the only mechanism available to keep pace with the cost of living, a cut to overtime is a pay cut in all but name. The response was predictable and rational: fewer nurses volunteered for extra shifts. The NCRHA's cost-saving measure did not save costs. It hollowed out the weekend and night rosters, which is how you end up with 30 patients in A&E and nobody to treat them.
It is worth noting the financial context in which these overtime cuts were made. When Gopeesingh's board took over the NCRHA, it inherited debts of $322 million owed to 521 service providers. Audits uncovered procurement irregularities spanning more than a decade - including a $52 million annual security contract and a $45 million annual cleaning contract, both awarded without tenders and running since 2007. A $4 million garden project at the EWMSC's southern entrance included $2 million in overtime wages alone. The NCRHA was haemorrhaging money in every direction. But the instrument Gopeesingh chose to demonstrate fiscal control - cutting nursing pool pay - targeted the one workforce the system cannot function without.
What It Looks Like Inside the System
The reports emerging from within the public health system describe conditions that have crossed from understaffed to unsafe. Nurses have reported administering expired medication because current stock was not available. Staff move ward to ward searching for basic supplies like saline. Student nurses - not yet fully qualified - are being deployed to fill shifts vacated by departing professionals. These are not anecdotes from a single bad night. They describe a pattern of resource depletion that is now directly affecting patient safety.
The nursing sickout in March 2026 affected multiple NCRHA facilities - the EWMSC, Mount Hope Women's Hospital, and Caura Hospital all saw reduced staffing. The Trinidad Express advised the public to expect patient delays. Several wards were left with a single registered nurse covering duties that would normally require a full team. The TTNNA said the situation could be resolved if EWMSC management would sit down with nurses and communicate with basic professional respect. That this needed to be said at all tells you something about the state of labour relations at the authority.
On March 6, hundreds of workers from the TTNNA, TTUTA, and the Contract and General Workers Trade Union staged a lunchtime protest at the San Fernando General Hospital. A second action was held at the Sangre Grande Hospital on March 27. A larger march is planned for April 10 through Port of Spain, from the Ministry of Health on Queen's Park East to the Central Bank and the Ministry of Finance. The gap between the Health Minister's November 2025 pledge to address nursing shortages and the March 2026 protests was four months. The gap between the last salary adjustment and now is thirteen years.
The 540-Bed Question
The Port of Spain General Hospital Central Block - a $1.3 billion, 540-bed, twelve-storey facility managed by UDeCOTT - was promised for completion by March 31, 2026. That deadline has been missed. The new target is June 30. A broken pipeline in January allowed water into the building's electrical bus duct system, causing a three-day power outage. The replacement component will not arrive until April. Two international medical gas certifiers declined to travel to Trinidad and Tobago during the State of Emergency. Health Minister Bodoe publicly disagreed with UDeCOTT's claim of 90 percent completion, saying the facility appeared far less complete upon inspection.
The construction delays are a story in themselves. But the workforce question is more consequential. Who will staff 540 new beds when the system already has 1,868 unfilled nursing positions? The budget allocated money to build the Central Block. Whether comparable investment was made in recruiting and retaining the people required to operate inside it has no public answer. Opening a hospital into a nursing desert does not add capacity. It adds empty beds.
The Pipeline Problem
The vacancy crisis is compounded by a training bottleneck. Trinidad and Tobago's nursing students have the highest regional exam failure rate in the Caribbean, with more than half failing their registration exams. This reflects underfunded programmes, insufficient clinical placements in overstretched hospitals, and a profession struggling to attract candidates when the end result is a 2013 salary.
The migration pattern compounds the training problem. Nurses train in Trinidad and Tobago, then leave for Canada, the United States, or the United Kingdom, where pay can be three to five times higher. Vacancy rates for budgeted nursing positions have historically reached 53 percent in Trinidad and Tobago and 59 percent in Jamaica. Every month the salary freeze continues, the emigration math becomes more compelling for any nurse with transferable credentials.
The System-Level View
The nursing crisis does not exist in isolation. In schools, TTUTA president Ashe has highlighted the absence of school nurses and guidance counsellors - connecting the healthcare shortage to the crisis in school violence and adolescent mental health. Between January 2024 and February 2026, 22 children under 18 died by suicide or attempted it. These are not separate problems. They are the same shortage expressing itself in different buildings.
The ask from nurses is straightforward: pay that reflects the current cost of living, overtime rates that make extra shifts worth accepting, and conditions that do not require administering expired medication. The government's ask is also straightforward: show up, staff the wards, keep patients alive while a 540-bed facility is completed. These two asks are in direct conflict as long as the salary freeze holds.
The 1,868 vacancies are not going to fill themselves. Every month the pay issue remains unresolved, the number grows through resignation, emigration, and retirement. At some point the shortage becomes irreversible within any reasonable recruitment timeframe. Whether that threshold has already been crossed is a question the Ministry of Health has not publicly answered - and may not want to.
Sources
- Trinidad Guardian: "Govt to fill 1,868 nursing vacancies across RHAs" (July 2025)
- Trinidad Guardian: "Government targets 1,800 nursing vacancies and high failure rate" (July 2025)
- Trinidad Guardian: "Nurses stage weekend sickout amid staffing, pay disputes" (March 2026)
- Trinidad Guardian: "NCRHA owing $322M; Gopeesingh orders probe into spending"
- Trinidad Guardian: "NCRHA to fix pay issue affecting nurses" (March 2026)
- Trinidad Guardian: "Beckles: Public health system on the brink amid nursing crisis" (March 2026)
- Trinidad Guardian: "Workers protest over stalled pay increases" (March 2026)
- Trinidad Guardian: "Health Minister pledges to address nurse shortages amid protests" (November 2025)
- Trinidad Express: "Expect patient delays at NCRHA facilities" (March 2026)
- Trinidad Express: "Gopeesingh: Nurses taking home up to $80,000 from overtime" (March 2026)
- Trinidad Express: "Central Block gets new reopening date" (February 2026)
- Trinidad Express: "Chairman Gopeesingh: Squandermania at NCRHA"
- CNC3: "Nurses stage weekend sickout amid staffing, pay disputes" (March 2026)
- CNC3: "TTNNA warns patient care at risk amid standoff with NCRHA" (March 2026)
- TV6: "TTNNA warns of 'shut down'" (March 2026)
- TV6: "POSGH Central Block delayed to June 30th" (February 2026)
- TTT News: "Health Ministry tackles over 1,800 nursing vacancies" (July 2025)
- Newsday: "NCRHA denies 'chronic nurse shortage' at Mt Hope hospital" (November 2025)
- Tobago Updates: "TT nursing students have regional's highest exam failure rate" (2025)
- Civicus Monitor: "Protests erupt over labour rights and public services amid state of emergency" (March 2026)
- OECD: "Health at a Glance 2025 - International Migration of Nurses" (November 2025)
- ECLAC: "Emigration of nurses from the Caribbean: causes and consequences" (research paper)
- Human Resources for Health: "Caribbean nurse migration - a scoping review" (BMC, 2020)