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Health at a Glance 2011: OECD Indicators
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branch 3. Health Workforce
  branch 3.9. Remuneration of nurses

The remuneration level of nurses is one of the factors affecting job satisfaction and the attractiveness of the profession. It also has a direct impact on costs, as wages represent one of the main spending items in health systems.

Gathering comparable data on the remuneration of nurses is difficult because different countries collect data based on different sources, covering different categories of nurses. The data presented in this section generally focus on the remuneration of nurses working in hospitals, although the data coverage differs for some countries (see the box on "Definition and comparability" ).

The data are presented in two ways. First, it is compared with the average wage of all workers in each country, providing some indication of the relative financial attractiveness of nursing compared to other occupations. Second, the remuneration level in each country is converted into a common currency, the US dollar, and adjusted for purchasing power parity, to provide an indication of the relative economic well-being of nurses compared with their counterparts in other countries.

In most countries, the remuneration of hospital nurses was at least slightly above the average wage of all workers in 2009. In Mexico, the income of nurses was 2.4 times greater than the average wage. In New Zealand and Luxembourg, it was 50% and 40% higher, while in the United States it was 30% greater than the average wage. However, in other countries, the salary of hospital nurses is roughly equal to the average wage in the economy, while in the Slovak Republic and Hungary it is lower (Figure 3.9.1).

When converted to a common currency, the remuneration of nurses was about four to five times higher in Luxembourg than in Hungary, the Slovak Republic, Estonia and the Czech Republic (Figure 3.9.2). Nurses in the United States also had relatively high earnings compared with their counterparts in other countries. This partly explains the ability of the United States to attract many nurses from other countries (Aiken and Cheung, 2008). In Mexico, although the salary of nurses appears to be high compared to other workers in the country, their wage level is low compared to nurses in the United States and other countries.

The remuneration of nurses in real terms (taking into account inflation) has increased in all OECD countries over the past decade, with the exception of Hungary, where it remained unchanged between 2003 and 2009. The growth was particularly strong in the Slovak Republic and the Czech Republic, narrowing the gap to a certain extent with their counterparts in other European countries. In these two countries, as well as in New Zealand, the United States, Australia and Canada, the wages of nurses also grew significantly faster than that of other workers, making the profession financially more attractive (Figure 3.9.3).

Concerns about the competitiveness of nurses' pay, pay equity, and shortages or uneven geographic distribution of nurses motivated pay interventions in some countries in recent years. Between 2006 and 2009, the Czech Republic, Finland, New Zealand and the United Kingdom implemented some pay increases for certain categories of nurses. These pay increases led to increased numbers of applicants into nursing education, but the impact on nurses already in work is more difficult to assess, as their labour market participation is also affected by the complex interaction of other aspects such as working environment and working conditions, career possibilities and individuals' priorities (Buchan and Black, 2011). In Iceland, cutbacks in nurse remuneration in response to the economic crisis have led nurses to increase their regular working time, while their overtime work was reduced (Friðfinnsdóttir and Jónsson, 2010).

Definition and comparability

The remuneration of nurses refers to average gross annual income, including social security contributions and income taxes payable by the employee. It should normally include all extra formal payments, such as bonuses and payments for night shifts and overtime. In most countries, the data relate specifically to nurses working in hospitals, although in Canada, New Zealand and the United States the data also cover nurses working in other settings. In some federal states, such as Canada, the level and structure of nurse remuneration is determined at the sub-national level, which may contribute to variations across jurisdictions.

Data refer only to registered ( "professional" ) nurses in Australia, Canada, Denmark and the United States, resulting in an overestimation compared to other countries where lower-level nurses ( "associate professional" ) are also included.

The data relate to nurses working full-time, with the exception of Belgium where part-time nurses are also included (resulting in an under-estimation). The data for some countries do not include additional income such as overtime payments and bonuses (e.g. Italy, Portugal and Slovenia). Informal payments, which in some countries represent a significant part of total income, are not reported.

The remuneration of nurses is compared to the average wage of full-time employees in all sectors in the country, except in Iceland, Mexico and New Zealand where it is compared to the average wage in selected industrial sectors.

Information on data for Israel: http://dx.doi.org/10.1787/888932315602.

 
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Figures
3.9.1 Hospital nurses' remuneration, ratio to average wage, 2009 (or nearest year) Figure in Excel
Hospital nurses' remuneration, ratio to average wage,
2009 (or nearest year)
3.9.2 Hospital nurses' remuneration, USD PPP, 2009 (or nearest year) Figure in Excel
Hospital nurses' remuneration, USD PPP,
2009 (or nearest year)
3.9.3 Growth in the remuneration of hospital nurses, 2000-09 (or nearest year) Figure in Excel
Growth in the remuneration of hospital nurses, 2000-09
(or nearest year)