“The SoWN 2025 report culminates in clear calls to action. Governments and policy-makers are urged to invest sustainably in nursing education, employment and leadership as outlined by the WHO Global Strategic Directions.”
The World Health Organisation’s State of the World’s Nursing 2025 report (WHO, ICN et al.) provides a comprehensive, up-to-date analysis of the global nursing workforce.
It emphasises five key domains: education, employment/jobs, leadership, service delivery, and emerging issues such as workforce well-being, migration, technology and climate change.
These themes are interlinked with the strategic priorities of nursing/midwifery and the SDGs (Sustainable Development Goals).
The report introduces new indicators (e.g. education capacity, advanced practice nursing, wages) and outlines policy priorities for 2026–2030.
It calls on governments, educators, employers and nurses to use this evidence to strengthen the profession and advance UHC.
Global Workforce: Size, Distribution And Demographics
The global nurse workforce reached ~29.8 million in 2023 (up from 27.9 million in 2018).
However, access to nurses is highly uneven. About 78–80% of all nurses work in countries that together represent just ~49% of the world’s population.
High-income countries (HICs) house nearly half of the world’s nurses, despite having only ~17% of people.
In contrast, many low- and lower-middle income nations have very low nurse densities.
For example, the African region has roughly 1.7 million nurses (nearly doubling from 0.9 million in 2018) but only about 14.1 nurses per 100,000 people (far below the SDG target of 44.5 per 10,000).
These inequities in distribution and density threaten progress on UHC and health equity.
Global shortages are improving but remain grave. The report finds the nursing shortfall shrinking from ~6.2 million in 2020 to ~5.8 million in 2023, with a projected decline to 4.1 million by 2030.
Yet regional gaps persist: most of the remaining shortage is concentrated in low-resource settings. Two-thirds of the African Region’s projected 6.1 million health worker shortfall (by 2030) will be nursing positions.
Demographically, the nursing workforce is predominantly female (about 85%) and generally young. About 33% of nurses globally are under 35 years old (vs ~19% expected to retire within 10 years).
However, age profiles vary: in ~20 countries (mostly high-income), retirements will soon outpace new nurses.
Migration is significant: roughly 1 in 7 nurses worldwide is foreign-born – 23% in high-income countries, but much lower in poorer nations.
This high degree of migration underscores the need for ethical recruitment and bilateral agreements.
Key statistics: ~29.8M nurses globally (2023); 78% of nurses in countries with 49% of population; 85% female; 33% <35 years old; ~5.8M nursing shortage (2023).
Education And Training
Nursing education capacity has grown, but improvements are uneven. Many countries have increased the number of nurse graduates, especially in low-income settings, and new data are reported for the first time.
However, faster population growth means density often lags; rising graduate output has not automatically translated into higher nurse-to-population ratios.
The report notes a “mixed picture”: while enrollment and training programs have expanded in many places, challenges remain in ensuring quality and alignment of curricula with health needs.
New indicators in the report highlight education capacity (e.g. number of training institutions, faculty, simulation facilities) and emphasise strengthening domestic education systems.
A key call is to train the right number of nurses for each setting, with curricula updated for evolving roles (such as advanced practice and digital health skills).
The lack of jobs to absorb graduates is a major concern – without new positions, even rising graduate numbers can leave densities stagnant and fuel migration.
The report explicitly urges countries to create employment opportunities and improve working conditions so that new graduates are retained in the health system.
Employment And Service Delivery
Workforce employment and deployment are central policy issues. The global analysis shows a higher absolute stock of nurses but persistent gaps in where they work.
Rural areas and underserved regions tend to have the lowest nurse densities.
Most countries (92%) have a nursing regulatory body, and over 75% require initial competency assessment; about 72% mandate continuing professional development.
However, scope-of-practice restrictions and inconsistent education standards limit mobility and full use of nurses’ skills (especially for nurse practitioners).
The report highlights advanced practice nursing (APN) as a growing force: 62% of countries now have APN roles, up from 53% in 2020. APNs and nurse-led services can improve access and quality, but only if regulatory barriers are addressed.
In terms of employment, the report notes large unemployed or underemployed pools of nurses in some countries.
It stresses that investing in nursing jobs is both a health and economic strategy: decent nurse jobs stimulate economic growth and women’s workforce participation, and are essential for UHC.
Countries are urged to expand and equitably distribute nursing positions (especially in primary care and underserved areas) and to ensure fair wages and safe working conditions.
For example, the report cites the global median starting wage for nurses (about US$774 per month in 82 countries in 2023) and notes that pay in high-income countries is roughly twice that in upper-middle-income, and three times that in low-income countries.
Improving compensation and career pathways is key to retaining staff.
Leadership And Governance
Leadership is another core focus. The report finds encouraging progress: 82% of countries now have a designated chief nurse or senior government nursing official to oversee the workforce. This is a marked improvement in governance since 2020.
However, leadership development opportunities remain uneven.
While 66% of countries report having structured leadership programs for nurses, only about 25% of low-income countries do so.
Building leadership skills and gender-balanced nursing leadership teams is emphasised as vital.
Nurses (85% of whom are women) need support to advance into management and policy roles.
The report echoes the WHO Global Strategic Directions calling for leadership development and empowerment of nurses, noting that leveraging nurses’ influence is “dependent on truly recognising their value”.
Emerging Issues: Well-being, Migration, Technology And Climate
Several cross-cutting issues are highlighted.
Workforce well-being and mental health remain urgent concerns: only 42% of countries have formal provisions for nurses’ mental health or well-being, despite the high stress and trauma of recent years.
Addressing this (through support programs, safe staffing and psychosocial care) is essential to retain skilled professionals.
Migration continues to reshape nursing. Wealthy countries rely heavily on foreign-born nurses (23% of nurses in HICs are migrants), while many nurses from low-income countries seek work abroad (42% of nurses in Africa report they intend to emigrate).
The report stresses adherence to the WHO Global Code of Practice to ensure ethical recruitment and to develop bilateral agreements that benefit source countries.
Technology And climate are emerging on the agenda. The report calls for harnessing digital health and preparing nurses for climate-responsive care.
While these topics were not extensively analysed in past editions, SoWN 2025 introduces them as policy priorities.
For example, equipping nurses with e-health skills and involving them in climate resilience planning are noted as forward-looking needs.
Progress Since the 2020 Report
“The report and its champions (e.g. ICN leadership) stress that achieving UHC depends on recognising nurses’ value and amplifying their influence.”
Compared to the 2020 edition, the 2025 report shows both gains and ongoing gaps.
Data quality and coverage have improved – 194 countries reported data this round (33% more than in 2020), and detailed country profiles are now available publicly.
More countries have APN roles (62% vs 53% in 2020), and chief nursing officers are more common.
The global nursing shortage has declined (from 6.2M to 5.8M). These are encouraging trends.
However, systemic inequities persist.
The uneven distribution of nurses worsened in some regions, and many countries still have severe shortages.
For example, while low-income countries are increasing graduate numbers faster than high-income countries, these gains often don’t translate into higher nurse densities due to rapid population growth and lack of jobs.
In 20 mostly high-income countries, retirements will soon outpace new entrants, signalling potential future gaps.
In summary, the 2025 report finds modest overall progress but “deep regional disparities” and continuing equity challenges.
Nursing In Africa
The report devotes special attention to regional contexts. In the African Region, nurses make up about 70% of the health workforce, reflecting their critical role.
Despite improvements, the region still has very low nurse-to-population ratios.
The workforce grew from ~900,000 in 2018 to ~1.7 million in 2023, yet this represents roughly 14.1 nurses per 100,000 people (one of the lowest densities globally).
The WHO Regional Director warns that nearly half of African nurses intend to leave the continent for better pay and safety, which could further drain fragile health systems.
Africa faces a massive projected shortfall: nurses alone account for about 66% of the region’s estimated shortage of 6.1 million health workers by 2030.
Common issues include insufficient training capacity, migration, and underinvestment in jobs and infrastructure.
The report (and WHO African Regional Office) calls for urgent policy action: increasing domestic training and employment of nurses, improving wages and working conditions, and strengthening retention strategies.
Investing in nursing in Africa is seen as both a public health necessity and a way to bolster economic development and gender equality (since most nurses are women).
Recommendations And Calls To Action
The SoWN 2025 report culminates in clear calls to action. Governments and policy-makers are urged to invest sustainably in nursing education, employment and leadership as outlined by the WHO Global Strategic Directions. This includes expanding nursing schools, aligning qualifications with health needs, and integrating nurses fully into primary health care.
Specifically, the report recommends that countries create and distribute nursing jobs equitably, especially in underserved areas, and raise salaries toward parity.
Strengthening regulation (including advanced practice roles) and adopting bilateral agreements for migration are also highlighted.
Educators and academic institutions should scale up training capacity and modernise curricula. They are encouraged to collect better data on graduates (as done in the report) and to collaborate with health systems to ensure graduates meet practical needs.
The report’s emphasis on education capacity underscores the need for more faculty, resources, and innovative training methods.
Health service employers and regulators are called on to improve working conditions for nurses. This means providing safe staffing ratios, mental health support, continuing professional development and clear career pathways.
Only 42% of countries currently support nurse well-being programs; this must increase. Employers should also champion nurses’ expanded roles (e.g. through APN) and include nurses in leadership and decision-making.
Nurses and their associations are encouraged to leverage this evidence to advocate for change. The report and its champions (e.g. ICN leadership) stress that achieving UHC depends on recognising nurses’ value and amplifying their influence.
Nurses are urged to engage in leadership development and policy dialogue, ensuring their perspectives shape health reforms.
Overall, the report provides policy options and evidence-based recommendations for each stakeholder group, aligning them with global goals. As WHO DG Tedros states, the findings should be a “signpost… showing us where we need to go – as rapidly as possible”.
Read the full report here.
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