Progress is being made in tackling the worldwide nurse shortage, but some countries are in a much worse position than others, the second-ever global assessment of nursing reveals today.
Published on International Nurses Day, the State of the World’s Nursing (SoWN) 2025 report raises concern about “persistent and worsening inequities” in nurse supply, education, wages and working conditions.
“On International Nurses Day, I urge countries and partners to use this report as a signpost”
Tedros Adhanom Ghebreyesus
Released by the World Health Organization (WHO), the International Council of Nurses (ICN) and other partners, the report includes information from 194 WHO member states and is a follow up to the first SoWN report, which was released in 2020.
Positively, the latest report shows that the global nursing workforce shortage has reduced from 6.2 million in 2020 to 5.8 million in 2023, with a projection to decline to 4.1 million by 2030.
There are now 29.8 million nurses around the world – an increase from 27.9 million in the last SoWN report.
However, the WHO said that the overall progress masked deep regional disparities.
It warned that 78% of the world’s nurses were concentrated in countries representing just 49% of the global population.
High-income countries, which represent only 17% of the population, host 46% of the world’s nursing population.
The average “density” of nurses globally is 37.1 nurses per 10,000 – however, when looking regionally, the density is five times higher in the WHO Europe region than the African and East Mediterranean regions.
In the UK, the density is 90.8 nurses per 10,000 people.
The report also found that higher income countries tended to have an older nursing workforce than lower income countries.
Globally, 33% of nurses are aged under 35 years, compared with 19% who are aged 55 years or above.
However, in the UK, 27% are aged 35 and under, and 24% are 55 or above.
“Stark regional differences may signal a scenario where regions most in need of experienced nurses will have predominantly novice workforces, while regions with better resources face large numbers of nurses retiring,” warned the report.
Meanwhile, richer countries continue to rely more heavily on international recruitment than lower income ones.
The latest SoWN report found that 23% of nurses in high-income countries are foreign born, compared with 8% in upper middle-income countries, 1% in lower middle-income countries and 3% in low-income countries.
This situation represented a “transfer of educational investment from low- to high-income countries”, stated the report.
“This compromises health system development in source countries while inadvertently compensating for insufficient workforce planning and inadequate investments in education capacity in destination countries,” it added.
In terms of education, the report said that the shortage of faculty staff was one of the “bottlenecks” to increasing student nurse numbers.
There was also a focus in the report on advanced practice.
It found that around two-thirds (62%) of countries had advanced practice nursing roles – an increase from 53% in the last report.
Low-income countries were most likely to report the presence of advanced nurse roles, which the report said may reflect a strategy to maximise the use of nurses in the context of limited doctor availability.
On the subject of working conditions, the report warned that “too few” countries had provisions for supporting the mental wellbeing of their nursing workforces.
While most countries reported laws on minimum wages (94%) and health worker safety (78%), only 55% had regulations on working hours and conditions and 42% had provisions for mental wellbeing.
Data on pay was provided by 82 countries and placed the global median entry-level wage of nurses as of 2023 at 774 US dollars per month.
However, as with other areas, there was significant variation between regions, with median wages being three times better in high-income countries compared with low-income countries.
When adjusting for purchasing power, nurse wages were highest in the European and Eastern Mediterranean regions, and lowest in the African and South-East Asia regions.
Meanwhile, an analysis of figures from 31 countries identified a nurse gender pay gap of 7% in favour of men, despite the profession being 85% female.
An improvement was seen in top-level nursing leadership, with 82% of countries reporting having a government chief nursing officer or equivalent position in place, compared with 71% in the last report.
However, the WHO warned that some chief nursing officers lacked “clear authority and resources”, making their ability to positively impact nursing in their countries limited.
The SoWN 2025 report made a series of recommendations, including:
The development of evidence-based nursing recruitment and retention policies in countries suited to the local context;
Increasing adherence to the WHO Global Code of Practice on the International Recruitment of Health Personnel, which prevents unethical international recruitment;
Improving working conditions for nurses including mental health support, better salaries, equal pay for equal work, safe staffing and protections for those taking industrial action;
Strengthening government-level nurse leadership;
Further development of the advanced practice nurse role;
Addressing gender-related bias in nursing;
Making sure nurses can fully harness the potential of digital tools and technologies;
Empowering nurses to contribute to the climate agenda through education, advocacy, practice and leadership;
Providing tailored support for nursing education, employment and working conditions in “fragile, conflict-affected and vulnerable settings”.
WHO director-general Dr Tedros Adhanom Ghebreyesus said: “This report contains encouraging news, for which we congratulate the countries that are making progress.
Tedros Adhanom Ghebreyesus
“However, we cannot ignore the inequalities that mark the global nursing landscape.
“On International Nurses Day, I urge countries and partners to use this report as a signpost, showing us where we’ve come from, where we are now, and where we need to go – as rapidly as possible.”
Pam Cipriano, president of the ICN, said the report “exposes the inequalities” that were holding back the nursing profession and acting as a barrier to achieving universal health coverage (UHC) – where all citizens globally can access the healthcare they need.
“Delivering on UHC is dependent on truly recognising the value of nurses and on harnessing the power and influence of nurses to act as catalysts of positive change in our health systems,” she added.
