Global nursing workforce grows but inequities jeopardize health progress

Editor's Note

The global nursing workforce has expanded to 29.8 million, up from 27.9 million in 2018, but stark disparities in nurse distribution threaten progress toward universal health coverage and global health security, according to a May 12 World Health Organization (WHO) news release announcing the State of the World’s Nursing 2025 report. Produced by WHO, the International Council of Nurses (ICN), and partners, the report consolidates data from 194 countries and finds the worldwide shortage of nurses has narrowed slightly, from 6.2 million in 2020 to 5.8 million in 2023, with projections for further decline. Still, nearly 80% of nurses are concentrated in countries representing less than half the global population.

As detailed in the report, low- and middle-income countries face hurdles in graduating, employing, and retaining nurses, while high-income nations contend with large cohorts approaching retirement and continued reliance on foreign-trained staff. Globally, one in seven nurses is foreign-born, with the proportion reaching nearly one-quarter in high-income countries. WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, urged countries to address these imbalances rapidly, calling the findings both encouraging and concerning.

The update highlights progress in several areas, including a growing number of countries recognizing advanced practice nursing roles, now reported by 62% of nations compared with 53% in 2020. These positions have been shown to broaden access to quality care. Leadership has also strengthened, with 82% of countries reporting a senior government nursing official, though structured leadership development is far less common in low-income countries.

Challenges remain pressing. Gender equity is central, with women making up 85% of the nursing workforce, yet pay and leadership gaps persist. Nurse well-being is another concern: only 42% of countries report provisions for mental health support, despite pandemic-related strain. Demographics also reveal risks. While one-third of nurses are under 35, nearly one-fifth are expected to retire in the next decade, and in some high-income countries, retirements will exceed new entrants.

According to the report, policy priorities for 2026–2030 include creating and equitably distributing nursing jobs, improving working conditions and pay equity, strengthening education systems, expanding advanced practice roles, and enhancing mental health support. Other goals include preparing nurses for climate-responsive care, harnessing digital tools, and advancing leadership development across all regions. ICN President Pam Cipriano said delivering on universal health coverage depends on fully valuing nurses and supporting their role as catalysts for systemwide improvement.