The global state of nursing is complex and CNOs must understand it to make the most informed decisions.
In the U.S., industry leaders and experts often discuss the nursing shortage and its impact on the healthcare industry. Shortages can leave the entire workforce feeling burned out, resentful, and angry, and the impact on patient care is even greater.
As CNOs work to recruit and retain nurses, both locally and internationally, it's important to understand that the nursing industry in the U.S. is only one piece of the puzzle. Globally, the situation is incredibly complex and the challenges go beyond just workforce shortages.
The World Health Organization’s (WHO) State of the world’s nursing 2025 report states that progress in closing workforce gaps has slowed, despite the number of healthcare workers increasing steadily over the last 10 years.
Here are some key findings that CNOs should be aware of.
Nurse employment
According to the report, there are 29.8 million nurses globally, but the distribution and density of those nurses around the world is extremely unequitable and hides a shortage of 5.8 million nurses. Additionally, 78% of nurses are found in countries representing only 49% of the world population, and high-income countries, which are about 17% of the population, contain 46% of nurses globally.
The density of nurses across countries is largely based on income, with high-income countries having 10 times the density of nurses than low-income countries. African and Eastern Mediterranean regions have significantly less nurses than European regions, as defined by WHO.
These facts show a troubling trend throughout the world and indicate a lack of access to healthcare services provided by nurses for large populations. However, the report also showed that the nursing industry has become more professional, with 80% identifying as "professional nurses," and around 70% of them work in public sector facilities.
WHO emphasizes that differentiated roles, scopes of practice, and corresponding compensation are necessary to prevent nurse migration to only countries with better professional opportunities. The report also predicts that the number of nurses will increase to 36 million by 2030, and while the overall shortage will lessen, there will still be inequity in the global density of nurses.
CNOs should be cautious when internationally recruiting nurses by making sure they are not pulling talent from countries that have severe shortages. Nurse leaders should follow WHO guidance, Bilateral Agreements on Health Worker Migration and Mobility, which serve as a tool for improving the development, negotiation, implementation, monitoring, and evaluation of international healthcare worker agreements in alignment with the WHO Global Code of Practice on the International Recruitment of Health Personnel.
Leadership and environment
In terms of leadership, the report provides a mixed outlook. According to WHO, 82% of the participating countries reported having a government CNO (GCNO) or a similar position, but their roles in workforce, policy, and planning are undefined.
WHO emphasizes in the report that the gap in governance impacts education, working conditions, patient care quality, and more. GCNOs must have clarified authority and the proper resources so that they can have a hand in important healthcare decisions for each country.
Additionally, 92% of responding countries reported having a regulatory body for nursing, along with competencies (72%), continued professional development (72%), and advanced practice nurse (APN) positions (62%). However, many of the competency standards and APN regulations are different per country, which can complicate nurse qualifications and potentially impact patient safety, according to WHO.
Lastly, most countries reported having laws surrounding minimum wage (94%), social protection measures (92%), and health worker safety (78%), but only 55% reported regulations for working hours and conditions, and 42% reported provisions for mental health and wellbeing. More mental health support and emphasis on healthy work environments are needed for nurses globally if the industry wants to remain sustainable.
To read the entire report, click here.
G Hatfield is the CNO editor for HealthLeaders.
KEY TAKEAWAYS
According to the WHO report, there are 29.8 million nurses globally, but the distribution and density of those nurses around the world is extremely unequitable and hides a shortage of 5.8 million nurses.
Many of the competency standards and APN regulations are different per country, which can complicate nurse qualifications and potentially impact patient safety, according to WHO.
More mental health support and emphasis on healthy work environments is needed for nurses globally if the industry wants to remain sustainable.