Remuneration of nurses

The COVID-19 pandemic has brought further attention to the pay rate of nurses and the need to ensure sufficient remuneration to attract and retain nurses in the profession.

On average across OECD countries, the remuneration of hospital nurses in 2019 (before the pandemic) was slightly above the average wage of all workers. However, in some countries like Switzerland, Lithuania, France, Latvia and Finland, nurses earned less than the average wage of all workers, whereas in other countries like Chile, Mexico, Luxembourg and Belgium, they earned much more (Figure 8.14).

Figure 8.15 compares the remuneration of hospital nurses based on a common currency (US dollars) and adjusted for differences in purchasing power to provide an indication of the relative economic well-being of nurses across countries and the financial incentives to consider moving to another OECD country to achieve better-paid jobs. In 2019, nurses in Luxembourg had remuneration levels at least four times higher than those working in Lithuania, the Slovak Republic and Latvia. In general, nurses working in central and eastern European countries had the lowest levels of remuneration, explaining at least in part why many choose to migrate to other EU countries (Socha-Dietrich and Dumont, 2021[16]).

The remuneration of nurses in the United States is higher than in most other OECD countries, explaining why the United States is able to attract several thousand nurses from other countries every year.

In many countries, the remuneration of nurses has increased in real terms since 2010, albeit at different rates (Figure 8.16). In Israel and Australia, nurses obtained substantial pay raises between 2010 and 2018.

In France and the United States, the remuneration of nurses was about the same in real terms in 2018/2019 as in 2010. In Spain, the remuneration of nurses fell after the 2008-09 economic crisis due to cuts in the public sector, but it has recovered since 2013, so that on average the remuneration level was about 5% higher in real terms in 2019 than in 2010.

In the United Kingdom, the remuneration of nurses increased in nominal terms, but it fell by over 5% in real terms between 2010 and 2018 due mainly to the public sector pay cap between 2010/11 and 2017/18. Since 2018, the average income of nurses in real terms has started to increase due to the Agenda for Change pay deal for 2018-2021 (Buchan, Shembavnekar and Bazeer, 2021[17]).

Many countries provided some form of COVID-19 “bonus” to nurses in recognition of the frontline role they played during the pandemic and the additional stress and workload. The level and coverage of such bonus payments varied across countries. In Germany, some bonuses were provided in 2020 for nurses working in nursing homes and those working in hospitals with a minimum number of COVID-19 patients (approximately one-third of all hospitals qualified). An additional bonus was provided for nurses in hospitals in April 2021. The national bonuses were between EUR 500 and EUR 1 500, depending on hours worked. Some Länder also provided additional bonuses of approximately EUR 500.

In France, payment for the overtime work of nurses and other workers in hospitals and nursing homes was increased during the first wave of the pandemic in spring 2020. In addition, most hospital workers, including nurses, received a COVID-19 bonus after the first wave, ranging from EUR 1 000 to EUR 1 500, depending on the intensity of the pandemic in each region. To improve recruitment and retention, all health workers in hospitals and nursing homes received a permanent pay raise of EUR 183 per month in 2020, followed by another raise of between EUR 45 and EUR 450 per month at the end of 2021/early 2022, depending on professional categories and years of experience (OECD/European Observatory on Health Systems and Policies, 2021[9]).

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