Whether nurses are paid adequately has been a contested topic for many years. The COVID‑19 pandemic and, more recently, the cost-of-living crisis, have brought further attention to the income of nurses, with concerns about whether remuneration is sufficient to attract and retain nurses in the profession.
On average across OECD countries, the remuneration of hospital nurses in 2023 was 20% above the average wage of all employees. However, in Switzerland, the United Kingdom, Finland and Italy, nurses made less than the average worker, whereas in Mexico, Poland, Chile and Czechia, their income was at least 50% higher than the economy-wide average (Figure 8.15, left panel).
Figure 8.15 (right panel) compares the remuneration of hospital nurses based on a common currency (US dollars), adjusted for differences in purchasing power to provide an indication of the relative economic well-being of nurses across countries. In 2023, the income of nurses in Luxembourg was over three times higher than the income of those working in Mexico, Portugal, Bulgaria and Greece. In general, nurses in Central and Eastern and Southern European countries receive salaries below the OECD average, which may partly explain why many choose to migrate to other EU countries. Nursing income in the United States is higher than in most other OECD countries, which is one of the reasons why the United States is able to attract several thousand nurses from abroad every year (see section on “International migration of nurses”).
In most OECD countries, the remuneration of nurses increased in real terms in the years leading up to the pandemic. This was particularly the case in Central and Eastern European countries and the Baltic countries. In Poland, Latvia and Lithuania, nurses obtained pay rises averaging 9‑11% per year in real terms in the years before the pandemic, thereby narrowing the gap with other EU countries (Figure 8.16). In Hungary, the Slovak Republic and Czechia, the annual increases stood at 6%. In contrast, the remuneration of nurses decreased in real terms by around 1% per year or more between 2013 and 2019 in Greece, Ireland and Portugal, a legacy of adjustment measures to reign in public spending in the wake of the financial and debt crisis.
Between 2019 and 2023, nurses saw their income increase in real terms in only around half of OECD countries. Nurses in Lithuania and Latvia continued to benefit from substantial pay increases per year (above or close to double digit). Annual salary growth was also robust in Poland, Hungary, the Slovak Republic, France and Estonia at above 4%. On the other hand, in New Zealand, Chile, Italy, the Netherlands and the United Kingdom, the salary of nurses fell in real terms by more than 1% annually.
Two conflicting trends can explain part of the variation in the pay trajectory of nurses over the 2019‑2023 period. On the one hand, in many countries, a large proportion of nurses and other health workers received one‑off COVID‑19 “bonuses” in 2020 and 2021 in recognition of the frontline role they played during the pandemic. However, these bonuses frequently took the form of lump-sum payments and were not included in the regular wages (with Slovenia being one of the exceptions). On the other hand, moderate nominal wage increases were in many cases eroded by high inflation rates in the cost-of-living and energy crises, leading to negative real growth rates. Nurses were not the only occupation group affected by this phenomenon. In many countries, average real wages fell between 2021 and 2023 due to inflation (OECD, 2024[1]).
