Global nursing crisis deepens as violence and poor pay trigger exodus

Scale of the exodus

Since the height of the pandemic in 2021, the International Council of Nurses (ICN) reports that 48.4% of national nursing associations have observed a “significant increase” in nurses leaving the profession altogether. The same survey shows that 72.1% of associations said nursing salaries have seen little or no increase since that year, while 36.4% indicated that wages have fallen in real terms after inflation.

In the United States, National Nurses United (NNU) counts 1.15 million registered nurses with active licences who are not currently working as nurses. NNU frames the problem as a “retention crisis, not a Nurse shortage,” arguing that unsafe and unsustainable working conditions are pushing both new and experienced nurses out of hospital wards.

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Violence and workplace safety

Violence against nurses emerges as a dominant driver. ICN President Pamela Cipriano told reporters, “A shocking 86.2% of nurses’ associations reported experiences of violence from patients or the public, yet a third of countries had no policies in place to protect nurses from workplace violence.”

ICN’s findings link the surge in attacks to frustration over over‑burdened, under‑resourced health systems, citing India’s public‑sector challenges as an example. The organization calls for the World Health Assembly (19‑27 May) to extend the global nursing and midwifery strategy, warning that health‑workforce budgets remain vulnerable to cuts.

Compensation, workload and burnout

Stagnant pay and rising workloads compound the safety issue. ICN data show that 61.7% of nursing associations reported increased day‑to‑day duties since 2021. The same survey found that 38% of associations rated their country’s capacity to meet current health needs as “poor” or “very poor.”

Joyce University’s 2025 survey of 1,000 U.S. Nurses found that 74% describe themselves as emotionally exhausted, citing missed meals, sleepless nights and a sense that help is unavailable even when technically present. Respondents linked exhaustion to “charting overload, constant interruptions and systems that demand more without giving enough back.”

Insights from employee reviews

When former employees were asked to rate their employers, scores ranged from 2.6 to 4.9 on a five‑point scale. The variation reflects stark differences between staffing agencies and traditional health‑care employers. Agency nurses consistently reported higher satisfaction, citing faster onboarding, better credentialing, and more responsive communication. The review notes that 75% of agency‑nurse comments about process efficiency were positive, compared with 23% for health‑care systems.

Beyond process speed, agency nurses highlighted “psychological safety” and “honest communication” as key benefits. One agency’s tagline—“We tell it like it is so you won’t be surprised how it goes”—was quoted in the study as an example of transparent messaging that resonates with staff.

Former staff nurses also offered concrete suggestions for improvement. Recommendations included the use of scheduling apps, modest bonuses ($20‑$50) for last‑minute shift pickups, and the creation of nurse‑led committees to set schedules. The study stresses that “flexibility in scheduling” and “uninterrupted work breaks” are critical, especially for hospital and primary‑care nurses, while home‑health nurses prioritize predictable timetables.

Economic stakes

ICN CEO Howard Catton framed the crisis as an economic threat, citing a “potential opportunity value of $100‑$300 billion” from reduced sick leave, absenteeism and attrition if nurses’ health and well‑being were improved. He referenced World Economic Forum and McKinsey estimates that investing in worker health can generate $2‑$4 of return for every dollar spent.

Policy responses and what’s next

In the United States, NNU is pushing the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S. 1709, H.R. 3415), a federal bill introduced in 2025 that would mandate minimum nurse‑to‑patient ratios, mirroring California’s longstanding legislation. NNU President Jamie Brown warned that “the never‑ending cycle of training a new nurse, only for them to leave after six months because of the intolerable conditions” threatens patient safety.

Internationally, the ICN plans to lobby World Health Assembly member states during the May meeting to extend the global nursing strategy and to safeguard health‑workforce budgets from austerity cuts. The organization also calls for stronger workplace‑violence protections, noting that one‑third of surveyed countries lack formal policies.