Nurses
Nurses play a central role in the provision of healthcare and are a core element of any patient-centred health system. Generally, they are the most numerous category of health workers in most OECD counties. While most nurses are employed in hospitals, many also work in long-term care facilities or in the community.
In 2021, there were 9.2 practicing nurses per 1 000 population on average across OECD member countries, up from 8.2 in 2011. The density of nurses in 2021 ranged from fewer than 3 per 1 000 population in Colombia, Türkiye and Mexico to over 18 per 1 000 in Finland, Switzerland and Norway (Figure 8.13). Among partner countries, South Africa, India and Indonesia have relatively few nurses – fewer than 2 per 1 000 population in 2021. The number is higher in China, where it has increased rapidly over the past decade, from 1.7 in 2011 to 2.9 in 2021.
The number of nurses per 1 000 population has grown in almost all OECD countries over the past decade, except in Latvia, the Slovak Republic and Sweden, where it fell slightly between 2011 and 2021. Switzerland, Norway, Australia and Korea are among those countries that have managed to increase the number of nurses substantially over the past decade. This increase has been driven to a large extent by an expansion of the number of students in nursing education programmes (see section on “Nursing graduates”). However, it is not enough to train more nurses: there is also a need to retain nurses in the profession once they have completed their studies. This requires an improvement in their working conditions. In Norway, the government adopted a five-year action plan in 2016 – the Competence Lift 2020 – to improve the competencies, pay and retention rates of nurses. This action plan was extended for another five years under the Competence Lift 2025. Although the number of nurses has increased, the dropout rate continues to be high, especially among nurses working in long-term care.
In Switzerland, the increase in the number of nurses has been driven to a large extent by a rise in the number of “associate professional nurses” (or “intermediate care workers”), who have lower qualifications than “professional nurses” (or “qualified nurses”). Between 2011 and 2021, the number of associate professional nurses increased almost three times faster than the number of professional nurses. As a result, the share of associate professional nurses among all nurses went up from 30% in 2011 to 36% in 2021. Despite the growth in these two categories, hospitals and other health and long-term care facilities continue to have difficulties recruiting nurses, and there are concerns about shortages in the coming years.
In some countries, recruitment of foreign-trained nurses has played an important role in increasing nurse numbers. Nearly half of all nurses in Ireland are foreign-trained, and over a quarter in New Zealand and Switzerland obtained their first nursing degree in another country (see section on “International migration of doctors and nurses”). In Switzerland, most foreign-trained nurses come from France and Germany, and to a lesser extent from Italy, and the numbers have increased substantially in recent years.
In several countries, many nurses have perceived a degradation in their working conditions, with more considering leaving their jobs during and after the COVID-19 pandemic (OECD, 2023[1]). Concerns about a “great resignation” of nurses and other health workers emerged in early 2021 in the United States, and a little later in 2021 and 2022 in the United Kingdom. In the United Kingdom, the number of nurses who left the NHS in England reached an all-time high in 2021/22, and more than half of leavers were aged under 40, and therefore still many years away from retirement (King's Fund, 2022[2]). However, at the same time, a record number of nurses joined the NHS in England in 2021/22, driven largely by international recruitment, so the overall number of nurses continued to increase at least slightly (OECD, 2023[1]).
Nurses outnumber physicians in most OECD countries. On average, there are 2.5 nurses for every doctor. The ratio of nurses per doctor ranges from about one nurse per doctor in Colombia, Mexico and Latvia to more than four in Finland, Japan, the United States and Switzerland (Figure 8.14).
The number of nurses includes those providing services directly to patients (“practising”) and in some cases also those working as managers, educators or researchers.
In countries where nurses can hold different levels of qualification or roles, the data include both professional nurses, who have a higher level of education and perform more complex or skilled tasks, and associate professional nurses, who have a lower level of education but are nonetheless recognised as nurses. Healthcare assistants (or nursing aides) who are not recognised as nurses are excluded (in some countries such as Spain and France, this represents a large category of workers). Midwives are excluded, except in some countries where they are included because they are considered specialist nurses or for other reasons (Australia, Ireland and Spain).
Greece reports only nurses working in hospitals, resulting in an underestimation.
References
[2] King’s Fund (2022), The NHS nursing workforce: Have the floodgates opened?, https://www.kingsfund.org.uk/blog/2022/10/nhs-nursing-workforce#vacancies-have-always-been-high.
[1] OECD (2023), Ready for the Next Crisis? Investing in Health System Resilience, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/1e53cf80-en.
1. Associate professional nurses with a lower level of qualifications make up more than 50% of nurses in Slovenia, Croatia and Romania; between 33% and 50% in Greece, Iceland, Korea, Mexico and Switzerland; and between 15% and 30% in Australia, Canada, Finland, Japan, the United Kingdom and the United States. 2. Data include nurses working in the health sector as managers, educators, researchers and similar (e.g. for France, the number of practising nurses is overestimated by about 12%). 3. Data include all nurses licensed to practise. 4. Data only refer to nurses employed in hospitals. 5. Latest available data 2017.
Source: OECD Health Statistics 2023.
1. For countries that have not provided data on practising nurses and/or practising doctors, numbers relate to the “professionally active” concept for both nurses and doctors (except Chile, where numbers include all nurses and doctors licensed to practise). 2. Ratio underestimated (professionally active nurses/all doctors licensed to practise). 3. Data refer to nurses and doctors employed in hospitals.
Source: OECD Health Statistics 2023.