Shin Kyung-rim

South Korea's Nursing Crisis Deepens as 40% of Licensed Staff Quit

The author is the president of the Korean Nurses Association.

The shortage of medical personnel can no longer be explained as a simple issue of supply. At its core lies a structural pattern of abnormal work force outflow. As of 2024, more than 200,000 licensed nurses in Korea are not working in clinical settings, accounting for about 40 percent of all license holders. The issue is not a lack of trained personnel, but a system in which nurses cannot endure conditions and ultimately leave. More troubling is that even those who return to the field struggle to stay, with 52.7 percent leaving again after reemployment. This points to a structural failure in retaining experienced professionals.

Some argue that wages are the primary cause, but the data suggest otherwise. Tertiary hospitals, Korea's highest-level general hospitals, which offer some of the highest compensation in the industry, report the highest rate of repeated resignations at 55.7 percent. Nurses are leaving not because of pay, but because of excessive workloads and staffing systems that fail to support them. The persistence of high attrition even in better-paying institutions highlights that the problem is rooted in working conditions rather than financial incentives alone.

The number of patients per nurse illustrates the strain. In tertiary hospitals, each nurse is responsible for nine to 10 patients, while in general hospitals, the number often exceeds 30. By contrast, countries such as the United States and Australia legally cap this ratio at four to seven patients per nurse. This gap is not merely statistical; it marks a threshold of risk directly tied to patient safety and quality of care.

In practice, that risk is already evident. At a general hospital in the Seoul metropolitan area, two nurses working a night shift in an internal medicine ward are often responsible for nearly 40 patients. In one case, an elderly patient complained of breathing difficulties during the early morning hours. At the same time, a fall occurred in another room, delaying the response. The patient's condition worsened significantly before intensive care was initiated. The nurse later expressed regret, saying that earlier intervention might have changed the outcome; the issue was not individual error but structural constraint embedded in the system.

Conditions in intensive care units are even more precarious. At a university hospital, a nurse assigned more patients than recommended due to staffing shortages had to respond simultaneously to changes in two patients' conditions. While one patient experienced a sharp drop in blood pressure, the nurse could not immediately detect a decline in another patient's oxygen saturation. The situation escalated into a full emergency response involving the entire medical team. Such incidents are not isolated but reflect a system in which staffing standards have eroded over time.

The situation is even more severe in community nursing. About 80 percent of visiting nurses leave their positions, while nursing homes report attrition rates of around 60 percent. Many enter expecting flexible work arrangements, but instead face low reimbursement rates, irregular schedules and isolated working conditions. One visiting nurse described managing high-risk patients alone across multiple locations each day, often without adequate backup or institutional support.

Korea has already entered a super-aged society, with more than 20 percent of its population aged 65 or older as of late 2024. Sustaining the health care system through the sacrifice and dedication of skilled workers alone is neither realistic nor sustainable in the long run.

Continuing to recruit new staff without addressing this pattern of departure is akin to pouring water into a leaking bucket. The focus must shift from recruitment to retention. First, legal limits on the number of patients per nurse are urgently needed. This is not only a labor issue but a minimum standard for patient safety. Second, flexible work arrangements tailored to different life stages should be introduced to reduce career interruptions and help experienced staff remain in the field.

Third, the compensation system for community nursing must be fundamentally redesigned. Visiting nurse fees should be adjusted to reflect actual working conditions, and safety allowances and psychological support systems should be established. Fourth, guidelines for a rational wage system that reflects experience and expertise are necessary. When professionalism and responsibility are properly rewarded, sustainability becomes possible.

Inactive nurses are not merely a reserve work force. They are trained professionals who can be deployed immediately. Yet many cannot return, and those who do often leave again. This reflects a system that fails to accommodate their value and expertise.

The central question must change. Instead of asking how to recruit more nurses, policymakers must ask why nurses are compelled to leave. Creating conditions in which nurses can work, rather than merely endure, is the starting point for sustaining Korea's health care system.

This article was originally written in Korean and translated by a bilingual reporter with the help of generative AI tools. It was then edited by a native English-speaking editor. All AI-assisted translations are reviewed and refined by our newsroom.