Global Nursing Workforce Reaches 29.8M: WHO Flags Deep Inequities, Urges Action

A new landmark report, State of the World’s Nursing 2025, launched by the World Health Organization (WHO), the International Council of Nurses (ICN), and global partners, presents a comprehensive assessment of the nursing workforce. Released on International Nurses Day, the report underscores that while the global number of nurses increased from 27.9 million in 2018 to 29.8 million in 2023, significant inequities in their distribution persist. These disparities, unless addressed, threaten to derail progress toward Universal Health Coverage (UHC), global health security, and broader health-related Sustainable Development Goals (SDGs).

Shrinking Global Shortage, But Regional Gaps Widen

Encouragingly, the global nursing shortage has declined from 6.2 million in 2020 to 5.8 million in 2023, and it is projected to shrink to 4.1 million by 2030. Despite this progress, 78% of the world’s nurses are concentrated in countries that house just 49% of the global population. The remaining countries—mostly in low- and middle-income regions—struggle to train, employ, and retain nurses, exacerbating the imbalance and creating critical gaps in essential health services.

Low- and middle-income countries (LMICs) face ongoing hurdles in producing and sustaining a robust nursing workforce. These nations must significantly increase domestic investments to ensure that new nursing graduates are hired and retained. In contrast, high-income countries need to prepare for large-scale retirements among nurses and reduce over-reliance on foreign-trained nurses through well-managed bilateral agreements.

Foreign-Born Nurses and Demographic Dynamics

The report finds that 1 in 7 nurses globally is foreign-born, with this figure rising to 23% in high-income countries. In contrast, just 3% of nurses in low-income countries are foreign-born, reflecting vastly different health workforce migration patterns.

While 33% of the nursing workforce is under the age of 35, offering hope for generational continuity, the fact that 19% are due to retire within the next 10 years raises concerns, particularly in 20 high-income countries where retirements are projected to outpace new workforce entrants. This could diminish the availability of experienced mentors for early-career nurses and exacerbate regional shortages.

Education and Workforce Deployment Challenges

Low-income countries are rapidly increasing nursing graduates, often outpacing high-income countries in graduation rates. However, these gains are frequently diluted by rapid population growth and insufficient job creation, resulting in stagnant nurse-to-population ratios. The report urges governments to create jobs and improve working conditions to retain graduates within national health systems.

Furthermore, 42% of countries have systems in place for nurses' mental health support—a figure considered inadequate given the persistent stress and trauma faced by healthcare workers, particularly post-COVID-19. Mental health provisions are emphasized as crucial for retaining skilled professionals and ensuring quality care.

Leadership, Advanced Roles, and Gender Equity

Significant progress has been made in enhancing nursing leadership: 82% of countries now report having a senior government nursing official, and 66% have leadership development initiatives. However, only 25% of low-income countries offer structured leadership training, reflecting uneven support for career advancement.

The presence of advanced practice nursing roles has grown to 62% of countries from 53% in 2020, showing an increasing global reliance on nurses in expanded roles to enhance access to quality care. These roles are pivotal in managing complex health needs, especially in primary care and underserved regions.

The report also notes that 85% of the global nursing workforce are women, making gender equity a critical consideration. Nursing remains a highly feminized profession, and addressing pay equity, leadership opportunities, and protection in fragile contexts is crucial to creating inclusive and fair health systems.

Policy Priorities: A Roadmap for 2026–2030

The SoWN 2025 report outlines a strategic set of policy priorities to be adopted between 2026 and 2030. These include:

• Expanding and equitably distributing nursing jobs, especially in underserved and rural areas.

• Investing in domestic nursing education systems and aligning qualifications with evolving healthcare roles.

• Enhancing working conditions, ensuring pay equity, and prioritizing mental health and well-being.

• Developing and regulating advanced practice nursing roles to improve service delivery.

• Advancing gender equity and providing protections for nurses in conflict-affected zones.

• Leveraging digital health technologies and preparing nurses to respond to climate-related health threats.

• Strengthening leadership development, particularly in LMICs, to ensure sustainability.

These priorities align with WHO’s Global Strategic Directions for Nursing and Midwifery 2021–2025 and support the goals of the 78th World Health Assembly’s resolution on accelerating action for the global health workforce by 2030.

A Call to Action

WHO Director-General Dr. Tedros Adhanom Ghebreyesus called on countries and stakeholders to treat the report as a strategic roadmap. “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,” he stated.

ICN President Pam Cipriano echoed this sentiment, adding, “The report clearly exposes the inequalities that are holding back the nursing profession and acting as a barrier to achieving UHC. Delivering on UHC depends on truly recognizing the value of nurses.”

As the world grapples with aging populations, pandemics, climate threats, and the need for resilient health systems, a robust, equitable nursing workforce will be foundational to meeting future health challenges.