By James X. Stobinski
This month I would like to return to a familiar topic – nursing workforce issues. This article stems from the release of a report from the World Health Organization – State of the World’s Nursing 2025: Investing in Education, Jobs, leadership and Service Delivery.(1) This report speaks to the whole international nursing workforce and its distribution. This report is informative regarding the interconnected nature of the global workforce.
Last year, 317,710 registered nurse candidates took the NCLEX test. The Pass Rate for first time, U.S. educated graduates was 91.16% and the overall Pass Rate for all candidates was 73.26%. A key statistic within the NCSBN data is that 31% of all NCLEX test takers (98,986 candidates) in 2024 were internationally educated.(2) The statistics make clear that a significant portion of the American nursing workforce comes from other countries.(2) Nurses educated in Canada, the Philippines and India make up the largest countries contributing to the American nursing workforce.(3)
The WHO also tells us that globally, “Approximately one in seven practising nurses in 2023 was born in another country.” (p. x) High Income Countries (HIC) such as the United States are more reliant upon nurses educated in other countries. We benefit from high-quality, pre-licensure education programs in countries such as the Philippines. The World Health Organization (WHO) speaks to the net effect of nurses migrating to other countries in this section of text:
The increasing reliance on foreign-born nurses in HICs represents a transfer of educational
investment from low- to high-income countries. This compromises health system
development in source countries while inadvertently compensating for insufficient workforce
planning and inadequate investments in education capacity in destination countries. (p. x)
The investments of other countries in their nursing education systems serves to fill our shortfalls but also masks our deficits in education capacity.
It was reported in The 2024 National Nursing Workforce Survey, that, “…about 40% of nurses report they plan to leave nursing or retire over the next 5 years.” (p. s3).(3) While the American nursing workforce has stabilized to some degree post pandemic there are still spotty shortages by region and in certain specialties. This 2024 report also informs us that many experienced nurses did return to the workforce after COVID. It is also reported that, “…structural issues, such as short staffing and the accompanying high workloads, that predated the pandemic remain a source of concern for the long-term stability of the nursing workforce.” While higher wages and retention efforts cited in this report are a welcome development additional resources are needed to further improve the overall nursing work conditions.
Previous dire predictions about severe shortages in the American nursing workforce have not been realized we do have a tenuous balance at present. History tells us that there is often a gap between nurses answering a survey and expressing a desire to leave nursing and actually leaving the profession. There is also the sad reality of Reluctant Staying. Here nurses desire to leave nursing or their current employer but cannot do so secondary to family, financial or other obligations. These nurses are present but perhaps not fully engaged.
American healthcare has a fragile margin relative to the increasing demand for nurses. High-income countries like ours continue to benefit from the nursing education systems of other countries. The United States has high quality pre-licensure nursing education programs, but these do not meet all our workforce needs. Internationally educated nurses are a key resource supporting American healthcare. The WHO Report clearly describes the flow of nursing talent and reinforces the interconnectedness of the global nursing workforce.
– James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is a faculty member at Central Michigan University and NIFA Director of Hospital and ASC Surgical Education Relationships.
References
World Health Organization. (2025). State of the world’s nursing 2025: Investing in education, jobs, leadership and service delivery. https://iris.who.int/bitstream/handle/10665/381329/9789240110236-eng.pdf?sequence=1
NCSBN. (2024). The pathway to practice. https://www.ncsbn.org/public-files/NCLEX_Stats_2024_Q4_Passrates.pdf
Smiley, R.A., Kaminski-Ozturk, N. R., Burwell, M., Oliveira, P, Shobo, C. M., Allgeyer, Y., Zhong, R.L., O’Hara, E., Volk, C., Martin, B.A. (2025). The 2024 National Nursing Workforce Survey. Journal of Nursing Regulation, (16)1, S1 – S88.
