Remuneration of nurses
The COVID-19 pandemic has brought further attention to the pay rate of nurses and the need to ensure sufficient remuneration to attract and retain nurses in the profession.
On average across OECD countries, the remuneration of hospital nurses in 2019 (before the pandemic) was slightly above the average wage of all workers. However, in some countries like Switzerland, Lithuania, France, Latvia and Finland, nurses earned less than the average wage of all workers, whereas in other countries like Chile, Mexico, Luxembourg and Belgium, they earned much more (Figure 8.14).
Figure 8.15 compares the remuneration of hospital nurses based on a common currency (US dollars) and adjusted for differences in purchasing power to provide an indication of the relative economic well-being of nurses across countries and the financial incentives to consider moving to another OECD country to achieve better-paid jobs. In 2019, nurses in Luxembourg had remuneration levels at least four times higher than those working in Lithuania, the Slovak Republic and Latvia. In general, nurses working in central and eastern European countries had the lowest levels of remuneration, explaining at least in part why many choose to migrate to other EU countries (Socha-Dietrich and Dumont, 2021[16]).
The remuneration of nurses in the United States is higher than in most other OECD countries, explaining why the United States is able to attract several thousand nurses from other countries every year.
In many countries, the remuneration of nurses has increased in real terms since 2010, albeit at different rates (Figure 8.16). In Israel and Australia, nurses obtained substantial pay raises between 2010 and 2018.
In France and the United States, the remuneration of nurses was about the same in real terms in 2018/2019 as in 2010. In Spain, the remuneration of nurses fell after the 2008-09 economic crisis due to cuts in the public sector, but it has recovered since 2013, so that on average the remuneration level was about 5% higher in real terms in 2019 than in 2010.
In the United Kingdom, the remuneration of nurses increased in nominal terms, but it fell by over 5% in real terms between 2010 and 2018 due mainly to the public sector pay cap between 2010/11 and 2017/18. Since 2018, the average income of nurses in real terms has started to increase due to the Agenda for Change pay deal for 2018-2021 (Buchan, Shembavnekar and Bazeer, 2021[17]).
Many countries provided some form of COVID-19 “bonus” to nurses in recognition of the frontline role they played during the pandemic and the additional stress and workload. The level and coverage of such bonus payments varied across countries. In Germany, some bonuses were provided in 2020 for nurses working in nursing homes and those working in hospitals with a minimum number of COVID-19 patients (approximately one-third of all hospitals qualified). An additional bonus was provided for nurses in hospitals in April 2021. The national bonuses were between EUR 500 and EUR 1 500, depending on hours worked. Some Länder also provided additional bonuses of approximately EUR 500.
In France, payment for the overtime work of nurses and other workers in hospitals and nursing homes was increased during the first wave of the pandemic in spring 2020. In addition, most hospital workers, including nurses, received a COVID-19 bonus after the first wave, ranging from EUR 1 000 to EUR 1 500, depending on the intensity of the pandemic in each region. To improve recruitment and retention, all health workers in hospitals and nursing homes received a permanent pay raise of EUR 183 per month in 2020, followed by another raise of between EUR 45 and EUR 450 per month at the end of 2021/early 2022, depending on professional categories and years of experience (OECD/European Observatory on Health Systems and Policies, 2021[9]).
The remuneration of nurses refers to average gross annual income, including social security contributions and income taxes payable by the employee. In most countries, the data relate specifically to nurses working in hospitals, although in Canada the data also cover nurses working in other settings. In some federal states, such as Australia, Canada and the United States, as well as in the United Kingdom, the level and structure of nurse remuneration is determined at the subnational level, which may contribute to variations across jurisdictions.
Data refer only to registered (“professional”) nurses in Canada, Chile, Ireland and the United States, resulting in an overestimation compared to other countries where lower-level (“associate professional”) nurses are also included. Data for New Zealand include all nurses employed by publicly funded district health boards, at all levels; they also include health assistants, who have a different and significantly lower salary structure than registered nurses.
The data relate to nurses working full time. The data for some countries (such as Italy and Slovenia) do not include additional income such as overtime payments. Informal payments, which represent a significant part of total income in some countries, are not reported.
The income of nurses is compared to the average wage of full-time employees in all sectors in the country. It is also compared across countries based on a common currency (US dollars) and adjusted for PPP. The figures in this edition of Health at a Glance are not comparable to those in previous editions because a different PPP indicator was used to adjust for differences in cost of living across countries.
1. Data refer to registered (“professional”) nurses only in the United States, Canada, Ireland and Chile (resulting in an overestimation). 2. Data for New Zealand and Switzerland include “associate professional” nurses, who have lower qualifications and revenues.
Source: OECD Health Statistics 2021.
Note: Numbers here cannot be compared with those in previous editions of Health at a Glance because a different PPP indicator has been used to adjust for differences in cost of living across countries.
1. Data refer to registered (“professional”) nurses only in the United States, Canada, Ireland and Chile (resulting in an overestimation). 2. Data for New Zealand and Switzerland include “associate professional” nurses, who have lower qualifications and revenues.
Source: OECD Health Statistics 2021.
