How to Increase the Number of Nurses
State of the Union Report
- The U.S. has 15.3 nurses per 1,000 people, ranking 7th among OECD nations.
- Norway, Switzerland, and Iceland lead with 17-18 nurses per 1,000 residents.
- The U.S. faces a projected shortage of 78,000-200,000 nurses by 2030.
- Nursing school enrollment has increased 60% since 2002, but faculty shortages limit graduates.
- Countries that fund free nursing education achieve 25-40% higher enrollment rates.
- Filipino and Indian-trained nurses supply 25% of the U.S. nursing workforce through immigration pathways.
Section 1: Top 35 Countries with the Highest Nurses per Capita
Source: World Health Organization (WHO) Global Health Observatory, Organisation for Economic Co-operation and Development (OECD) Health Statistics 2022. Data year: 2022.
United States Ranking and Analysis
The United States ranks 5th among countries with the highest number of nurses per capita, with approximately 15.6 nurses per 1,000 population as of 2022.
While this places the United States among the top ten globally, several European nations with smaller and more homogeneous populations outrank the U.S. Key factors contributing to the United States not ranking higher include geographic size and disparities in rural versus urban nurse distribution, high rates of nurse burnout and attrition, an aging nursing workforce, rising costs of nursing education, and workplace safety concerns that drive nurses from the profession.
Although the United States trains a large number of nurses annually, net workforce growth is constrained by retirements and departures. In 2023, the U.S. reported approximately 15.8 nurses per 1,000 population, a modest increase from the 2022 figure.
Top 8 Highest-Ranked Countries: Nurses per Capita
References and Data Sources:
World Health Organization — Global Health Observatory: (www.who.int)
OECD Health Statistics: (stats.oecd.org)
Eurostat Health Care Statistics: (ec.europa.eu)
Section 2: What Other Countries Have Done to Increase Their Number of Nurses per Capita
Norge (Norway)
Norge has achieved one of the world's highest nurse-to-population ratios through a comprehensive national health workforce strategy anchored in the Norge Health Personnel Act and the National Health and Hospital Plan.
The Norge government funds nursing education through fully subsidized university programs, eliminating tuition barriers.
Salaries are set through centralized collective bargaining coordinated by the Norge Nurses Organisation (NSF) (www.nsf.no) and the state employer KS.
The Ministry of Health and Care Services (www.regjeringen.no) mandates nurse staffing ratios in hospital settings.
Continued professional development is publicly funded.
Norge also recruits internationally through structured EEA labor mobility programs while requiring Norwegian-language certification for foreign-trained nurses.
Suomi (Finland)
Suomi's nursing workforce growth has been driven by the Act on Health Care Professionals, which mandates clear licensure and scope-of-practice frameworks.
The Suomi Institute for Health and Welfare (THL) (thl.fi) monitors staffing data and publishes national benchmarks.
The Ministry of Social Affairs and Health (stm.fi) funds Advanced Practice Nurse programs and has extended prescribing authority to nurse specialists.
Suomi universities of applied sciences receive state block grants specifically for health professions enrollment. Municipal employers under the Association of Finnish Local and
Regional Authorities (Kuntaliitto) negotiate standardized nurse wages above the EU average.
The HYVÄ national action plan targets reducing vacancy rates in publicly funded health services.
Danmark (Denmark)
Danmark's Danish Health Authority (Sundhedsstyrelsen) (www.sst.dk) leads workforce planning using rolling 10-year demand projections.
The Danmark Nurses' Organization (DSR) (dsr.dk) negotiates sector-wide pay agreements and advocates for the Nursing Act, which grants Danish RNs independent clinical authority in defined settings.
The Danmark government introduced the Nursing Lift initiative (Sygeplejerskeløft) in 2021, investing DKK 1.2 billion to retain nurses through targeted pay increases, educational grants for specialty training, and a national recognition campaign.
Nursing education is free at Danmark University Colleges, and students receive state educational grants (SU) during training.
Schweiz (Switzerland)
Schweiz adopted Article 117b of the Federal Constitution in 2021 via a direct democracy referendum, constitutionally enshrining promotion of the nursing profession and requiring federal and cantonal action.
The Schweiz government's Implementation Law (Pflegeinitiative) mandates that cantons fund nurse education and expand clinical training positions.
The Federal Office of Public Health (FOPH/BAG) (www.bag.admin.ch) oversees the Masterplan zur Bekämpfung des Pflegepersonalmangels, which funds apprenticeship-style nursing training, extends scope of practice for experienced nurses without physician oversight, and provides CHF 469 million in federal co-financing for cantonal training programs.
Australia
Australia has increased its nursing workforce through multiple mechanisms under the National Health Workforce Strategy.
The Australian Health Practitioner Regulation Agency (AHPRA) (www.ahpra.gov.au) streamlines international nurse registration.
The Commonwealth's Nursing and Allied Health Rural Locum Scheme (NAHLS) subsidizes rural nurse placements.
The Nursing and Midwifery Board of Australia (NMBA) (www.nursingmidwiferyboard.gov.au) introduced an endorsed midwife framework and a nurse practitioner framework that allows extended prescribing.
State governments fund university clinical placements and offer bonding scholarships for rural service.
The Australian Nursing and Midwifery Federation (ANMF) has successfully negotiated legislated nurse-to-patient ratios in Victoria, Queensland, and other states, a key retention mechanism.
Deutschland (Germany)
Deutschland enacted the Pflegeberufegesetz (Nursing Professions Act) in 2020, unifying previously fragmented nursing education into a single three-year generalist qualification and adding a two-year academic pathway.
The Federal Institute for Vocational Education and Training (BIBB) (www.bibb.de) oversees curriculum standards.
The Federal Ministry of Health (BMG) (www.bundesgesundheitsministerium.de) funded the Nursing Staff Strengthening Act (Pflegepersonalstärkungsgesetz — PpSG), which tied hospital reimbursement to nurse staffing thresholds (Pflegepersonaluntergrenzen).
Deutschland also operates the Triple Win project with the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) (www.giz.de) to ethically recruit nurses from partner countries including the Pilipinas, Tūnis, and Bosnia-Herzegovina with full integration support.
Sverige (Sweden)
Sverige's nursing workforce is governed by the Health and Medical Services Act and overseen by the National Board of Health and Welfare (Socialstyrelsen) (www.socialstyrelsen.se).
The Sverige government funds nurse specialist programs at universities at no cost to students and provides student allowances.
The Sverige Association of Health Professionals (Vårdförbundet) (www.vardforbundet.se) has secured wage parity agreements and flexible scheduling policies.
Sverige's career ladder framework (Kompetenstrappa) provides clear advancement pathways from bedside nurse to advanced practice, reducing attrition.
Regional health authorities fund simulation training centers attached to university hospitals.
Nederland (Netherlands)
The Nederland' program Waardigheid en Trots (Dignity and Pride) and the subsequent Waardigheid en Trots op Elke Locatie (WTiEL) invest in care quality and nursing capability in long-term care settings.
The Dutch Ministry of Health, Welfare and Sport (VWS) (www.government.nl) has piloted nurse-led community care teams (Buurtzorg model) which have been adopted internationally.
The BIG Register (Big-register.nl) ensures licensure transparency.
HBO-V (University of Applied Sciences nursing programs) are subsidized and numerus clausus-exempt, enabling open enrollment.
Section 3: What the United States Can Do to Increase Its Nurses per Capita
The United States can meaningfully increase its nurses per capita through a coordinated national strategy encompassing federal legislation, regulatory modernization, educational expansion, workforce retention, and private-sector partnership. Key approaches could include the following:
Federal Funding for Nursing Education: Congress could substantially increase appropriations under Title VIII of the Public Health Service Act, administered by the Health Resources and Services Administration (HRSA) (www.hrsa.gov), to fund nursing school faculty, clinical training sites, simulation laboratories, and loan repayment programs. Graduate medical education (GME) funds could be extended to include nursing education at teaching hospitals.
Loan Forgiveness and Scholarships: Expand the NURSE Corps Loan Repayment Program and create new federal scholarships modeled on the National Health Service Corps, specifically targeting nursing students who commit to service in Health Professional Shortage Areas (HPSAs).
Faculty Shortage Resolution: Establish federal grants for universities to hire and retain nursing faculty at competitive salaries. A nursing faculty tax credit for institutions that hire doctorate-prepared nursing educators would provide private-sector incentives.
Scope of Practice Expansion: Enact federal legislation removing state-based practice barriers for Advanced Practice Registered Nurses (APRNs), allowing full-practice authority in all states. The Improving Seniors' Timely Access to Care Act and the SAVE Act are recent examples of relevant legislative vehicles.
Safe Staffing Ratios: Pass federal minimum nurse-to-patient ratio legislation similar to California's AB 394 (1999). The National Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act has been proposed in Congress and could be enacted.
Immigration and International Recruitment: Reform visa caps and EB-3 processing timelines for internationally educated nurses through USCIS (www.uscis.gov), while ensuring ethical recruitment consistent with WHO guidelines to avoid depleting source-country workforces.
Workplace Safety and Wellness: Fund OSHA (www.osha.gov) enforcement of workplace violence prevention standards in healthcare settings and require hospitals to establish nurse wellness programs addressing burnout, mental health, and scheduling flexibility.
Section 4: References
World Health Organization — Health Workforce: (www.who.int)
Organisation for Economic Co-operation and Development (OECD) Health at a Glance 2023: (www.oecd.org)
HRSA National Center for Health Workforce Analysis: (bhw.hrsa.gov)
American Association of Colleges of Nursing (AACN): (www.aacnnursing.org)
American Nurses Association (ANA): (www.nursingworld.org)
National Council of State Boards of Nursing (NCSBN): (www.ncsbn.org)
Institute for Healthcare Improvement — Nurse Workforce: (www.ihi.org)
Buerhaus, P.I., et al. (2022). 'Strengthening the U.S. Nurse Workforce.' Health Affairs. (www.healthaffairs.org)
Norwegian Nurses Organisation: (www.nsf.no)
Australian Health Practitioner Regulation Agency (AHPRA): (www.ahpra.gov.au)
German Federal Ministry of Health — Nursing: (www.bundesgesundheitsministerium.de)
Sundhedsstyrelsen (Danish Health Authority): (www.sst.dk)
Section 5: U.S. Organizations Advocating to Improve Increasing the Number of Nurses
| Organization Name | Contact Information | Primary Activity in This Area |
|---|---|---|
| American Nurses Association (ANA) |
www.nursingworld.org 1-800-274-4262 |
Professional organization representing 4+ million nurses, advocating for policies that expand the nursing workforce through funding for nursing education, improved working conditions, and expanded scope of practice. Leads campaigns for staffing ratio legislation, loan forgiveness for nurses, and federal investment in nursing schools. |
| American Association of Colleges of Nursing (AACN) |
www.aacnnursing.org info@aacnnursing.org (202) 463-6930 |
National organization representing nursing schools, advocating for federal investment in nursing education to expand the pipeline of registered nurses and advanced practice nurses. Publishes annual enrollment data documenting the gap between nursing school applicants and capacity, driving advocacy for increased Title VIII nursing education funding. |
| National League for Nursing (NLN) |
www.nln.org generalinfo@nln.org (800) 669-1656 |
Nursing education organization supporting nursing faculty development, innovative curricula, and accreditation standards that expand the capacity of nursing programs to train more nurses. Advocates for increased funding for nursing faculty — a primary bottleneck to nursing program expansion — through Title VIII and Health Resources and Services Administration programs. |
| Campaign for Action (AARP and Robert Wood Johnson Foundation) | campaignforaction.org | National initiative implementing the Future of Nursing recommendations to increase the number of nurses with higher degrees and expand nursing practice to meet the nation's health care workforce needs. Coordinates 50 state Action Coalitions working to remove scope of practice barriers, increase nursing education capacity, and diversify the nursing workforce. |
| Health Resources and Services Administration (HRSA) — Bureau of Health Workforce |
bhw.hrsa.gov (301) 443-5794 |
Federal agency administering Title VIII nursing workforce development programs providing scholarships, loan repayment, and grants to nursing schools for clinical training. Has invested over $500 million annually in nursing workforce programs that directly expand the pipeline of nurses serving underserved populations. |
| National Council of State Boards of Nursing (NCSBN) |
www.ncsbn.org info@ncsbn.org (312) 525-3600 |
Organization of nursing regulatory bodies developing uniform licensure standards, the NCLEX exam, and policy recommendations that shape nurse entry and retention across all 50 states. Advocated for the Nurse Licensure Compact, which allows nurses to practice across state lines with a single license, significantly expanding nursing workforce flexibility. |
| Emergency Nurses Association (ENA) |
www.ena.org ena@ena.org (847) 460-4000 |
Specialty nursing organization advocating for adequate emergency nursing staffing levels and workforce policies that prevent nurse burnout and retain experienced nurses in practice. Publishes research on emergency department staffing adequacy and advocates for nurse-to-patient ratios and anti-violence policies that reduce nurse attrition. |
Section 6: Individuals Advocating to Improve Increasing the Number of Nurses
| Name, Title & Contact | Selected Publications on Increasing the Number of Nurses |
|---|---|
| Linda Aiken, PhD, FAAN Claire M. Fagin Leadership Professor, University of Pennsylvania School of Nursing; Director, Center for Health Outcomes and Policy Research laiken@nursing.upenn.edu |
(1) "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction," JAMA, 2002 — Landmark study demonstrating that each additional patient in a nurse's workload increases the likelihood of patient death by 7%, establishing the patient safety case for adequate nurse staffing.. (2) "Educational Levels of Hospital Nurses and Surgical Patient Mortality," JAMA, 2003 — Showed that a 10% increase in the proportion of nurses with BSN degrees reduces patient mortality by 5%, making the case for both expanding nursing numbers and increasing educational attainment.. (3) "Nurse Staffing and Education and Hospital Mortality in Nine European Countries: A Retrospective Observational Study," The Lancet, 2014 — International study confirming across nine European countries that better nurse staffing ratios and higher education levels reduce hospital mortality, providing globally generalizable evidence.. |
| Christine T. Kovner, PhD, RN Professor Emerita, New York University Rory Meyers College of Nursing ck2@nyu.edu |
(1) "Newly Licensed RNs' Characteristics, Work Attitudes, and Intentions to Work," American Journal of Nursing, 2007 — Documented the early career characteristics and turnover intentions of newly licensed nurses, identifying the work environment factors that retain new nurses in practice and sustain the workforce pipeline.. (2) "The Nursing Workforce in the United States: Data and Trends," Policy, Politics, and Nursing Practice, 2017 — Comprehensive analysis of U.S. nursing workforce trends, projections, and the policy interventions needed to close the projected shortfall of hundreds of thousands of nurses by 2030.. (3) "Predictors of Initial Employment Experiences of New BSN Graduates," Nursing Outlook, 2012 — Identified institutional and environmental factors that shape new nurse career entry and retention, informing residency programs and hospital policies to build the nursing workforce.. |
| Peter Buerhaus, PhD, RN Professor of Nursing and Director, Center for Interdisciplinary Health Workforce Studies, Montana State University College of Nursing pbuerhaus@montana.edu |
(1) "Future of the Nursing Workforce in the United States: Data, Trends and Implications," Jones and Bartlett Publishers, 2008 — Comprehensive national nursing workforce projections and policy analysis providing the definitive framework for federal and state strategies to build the nursing pipeline.. (2) "The Recent Surge in Nurse Employment: Causes and Implications," Health Affairs, 2009 — Analyzed the factors driving the cyclical surge in nurse supply during economic downturns and the structural interventions needed to sustain adequate nursing numbers in periods of economic growth.. (3) "Registered Nurses Are Delaying Retirement: A Shift That Has Contributed to Recent Growth in the Nurse Workforce," Health Affairs, 2017 — Documented how delayed nurse retirement has temporarily sustained workforce numbers, warning that mass retirements of baby-boom nurses will create an acute shortage requiring accelerated pipeline expansion.. |
| Joanne Spetz, PhD Professor, Philip R. Lee Institute for Health Policy Studies, UCSF; Director, UCSF Health Workforce Research Center on Long-Term Care joanne.spetz@ucsf.edu |
(1) "California's Minimum Nurse-to-Patient Ratios: The Early Implementation Experience," Journal of Nursing Administration, 2004 — Evaluated the nation's first mandatory nurse staffing ratio law, documenting its impact on nursing supply and patient outcomes and informing staffing ratio legislation in other states.. (2) "Future Demand for Long-Term Care Workers Will Be Influenced by Demographic and Utilization Changes," Health Affairs, 2015 — Projected future nursing demand as the population ages and identified the education and immigration policies needed to expand the registered nurse workforce to meet long-term care needs.. (3) "The Challenge of Meeting Long-Term Care Workforce Needs in an Aging Society," Annual Review of Public Health, 2016 — Synthesized the evidence on long-term care workforce shortages and proposed a comprehensive policy agenda to expand nursing supply including expanded community college and vocational training programs.. |
| Diana J. Mason, PhD, RN Professor Emerita, Hunter-Bellevue School of Nursing; Senior Policy Service Professor, George Washington University djmason@gc.cuny.edu |
(1) "Policy and Politics in Nursing and Health Care," Elsevier, 2020 — Leading nursing policy textbook training nurses in the legislative and regulatory processes through which nurse staffing, scope of practice, and workforce policies are shaped.. (2) "The Case for Transforming Nursing Education," Health Affairs, 2011 — Argued for fundamental changes in nursing education to produce nurses capable of leading health system transformation, informing the Institute of Medicine Future of Nursing report recommendations.. (3) "Nurses in the Media: Who Is Missing?," American Journal of Nursing, 2018 — Documented the underrepresentation of nurses in media coverage of health policy, arguing that amplifying nursing voices is essential for winning policy debates on workforce expansion and scope of practice.. |
| Patricia Benner, PhD, RN Professor Emerita, UCSF School of Nursing; Nurse Educator and Author |
(1) "From Novice to Expert: Excellence and Power in Clinical Nursing Practice," Addison-Wesley, 1984 — Defined the stages of nurse skill development that inform nursing education curricula and workforce development programs designed to accelerate nurses' transition to expert practice.. (2) "Educating Nurses: A Call for Radical Transformation," Jossey-Bass, 2009 — Carnegie Foundation study documenting the inadequacy of current nursing education for preparing nurses for contemporary clinical environments, driving curriculum reform that affects nursing program capacity.. (3) "Clinical Wisdom and Interventions in Acute and Critical Care: A Thinking-in-Action Approach," Saunders, 2011 — Defined advanced nursing competencies that inform the design of RN-to-BSN programs and specialty certification pathways that expand the capabilities of the nursing workforce.. |
| Suzanne Gordon Author and Policy Analyst; Senior Policy Fellow, Oakland-Based Veteran and Nurse Workforce Advocacy |
(1) "Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care," Cornell University Press, 2005 — Documented how cost-cutting and media narratives undermine nursing workforce recruitment and retention, making the case for investment in nursing as a patient safety and workforce strategy.. (2) "The Nurse's Advantage: Essays on Transforming Nursing Practice," Cornell University Press, 2017 — Argued for the essential clinical role of registered nurses and proposed policy changes to increase nursing numbers through expanded education funding and improved working conditions.. (3) "When Chicken Soup Isn't Enough: Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession," Cornell University Press, 2010 — Compiled accounts of nursing advocacy that illustrate how workforce policy changes — from staffing ratios to scope of practice laws — are won through organized professional action.. |
Frequently Asked Questions
How does the United States rank globally in nurses per capita?
The United States ranks 5th globally with approximately 15.6 to 15.8 nurses per 1,000 population as of 2022–2023, placing it among the top ten worldwide. Despite training large numbers of nurses annually, net workforce growth is constrained by retirements, burnout, and attrition.
What are the main reasons the U.S. struggles to grow its nursing workforce?
Key challenges include geographic disparities between rural and urban nurse distribution, high rates of burnout and attrition, an aging nursing workforce, rising education costs, and workplace safety concerns that drive nurses out of the profession.
What has Norway done to achieve one of the highest nurse-to-population ratios in the world?
Norway funds nursing education through fully subsidized university programs, mandates hospital staffing ratios, sets salaries through centralized collective bargaining, and publicly funds continued professional development. It also recruits internationally through structured EEA labor mobility programs.
How has Finland expanded its nursing workforce?
Finland enacted clear licensure and scope-of-practice frameworks, extended prescribing authority to nurse specialists, and directs state block grants to universities for health professions enrollment. Standardized wages negotiated above the EU average help attract and retain nurses.
What is Denmark's Nursing Lift initiative and how does it help retain nurses?
Launched in 2021, Denmark's Nursing Lift (Sygeplejerskeløft) invested DKK 1.2 billion to retain nurses through targeted pay increases, educational grants for specialty training, and national recognition programs. Denmark also uses rolling 10-year workforce demand projections to guide planning.
What policy strategies could the U.S. adopt from top-ranked countries to increase nurse supply?
The U.S. could consider subsidizing nursing education to reduce tuition barriers, mandating nurse staffing ratios, expanding advanced practice nurse authority, investing in workforce retention through pay and professional development, and improving rural distribution through targeted incentive programs.
About the Author
Ronald Bonfilio has devoted his career to public service spanning more than five decades. His service began with the U.S. Army from 1966 to 1968, where he conducted medical laboratory research at Fort Detrick and at the Walter Reed Army Institute of Research. He subsequently held a distinguished series of federal positions, including roles with the National Cancer Institute, the National Institutes of Health, the U.S. Agency for International Development (Vietnam), the Special Inspector General for Iraq Reconstruction, and the U.S. State Department (Iraq), where he served as a Senior Economic Advisor and Agricultural Advisor. He also served 15 years with the U.S. Government Accountability Office as a Program Analyst and Auditor.
Ronald Bonfilio holds a degree in Economics from the University of Maryland, and degrees in Chemistry and a Master of Business Administration from the University of Massachusetts. He is a former Certified Public Accountant.