Nurses, the strategies countering the talent crunch
The shortage of nurses is more a labor market problem than a spending-constraint issue. Few people want to enter the profession and enroll in nursing degree programs, even fewer sit for public hiring competitions, and a significant number of those who pass leave the profession early. The problem must be addressed by rethinking the entire professional pathway: from career guidance in high schools to onboarding in the first months of work, with more timely selection procedures and leadership capable of valuing people.
In Italy there are 6.5 nurses per 1,000 inhabitants, compared with an EU average of 8.4, and over the next 15 years about 10,000 nurses a year will retire (considering only National Health Service employees). Against this backdrop, the profession’s appeal is declining: in 2022, fewer than 1 percent of Italian 15-year-olds said they wanted to become nurses.
The chapter of the 2025 OASI Report devoted to the recruitment and selection of nurses argues that, in a context of “talent crunch,” healthcare organizations have room for maneuver to increase nurses’ attractiveness and early retention only if they are able to collaborate with schools and universities and broaden their focus to the entire onboarding process, rather than concentrating on the hiring competition itself.
A problem that starts much earlier
The problem begins upstream. Places in nursing degree programs in 2024/25 totaled 20,400, but at many universities, enrollment was below available capacity and dropout rates were high. In addition, some graduates do not choose the National Health Service or leave it after a few years. From this come the study’s key questions:
- How can the profession be made more attractive already in high school?
- How much does the public hiring model really matter?
- Which onboarding practices reduce early turnover?
Attraction, selection, onboarding
The research combines five organizational case studies (ASL CN2, ASST Cremona, AOU Padua, AUSL Piacenza, AUSL Toscana Centro), 12 in-depth interviews with executives and coordinators, and a questionnaire administered to nurses hired less than two years ago.
Attraction. The authors observed that organizations are no longer limiting themselves to recruiting graduates: they are investing in career guidance in schools, open days, hands-on workshops, and professional testimonials.
The Veneto Region has introduced a voucher worth €1,000 a year for three years for students enrolled in nursing.
During the university pathway, initiatives aimed at reducing dropouts and transition shock are multiplying, such as Clinical Learning Care Units and the transition internship in Piacenza.
Selection. Between February and August 2025, at least 60 competitive hiring processes were announced. In the procedures that were completed, 9 out of 10 candidates who showed up were deemed eligible; the real issue is that only 6 out of 10 actually showed up for the exam.
The competition phase is highly standardized and not very flexible. For this reason, organizations are introducing agile tools: fixed-term notices aligned with graduation periods, “open” competitions, and remote selection procedures.
Onboarding. The questionnaire shows a polarized picture: more than 40 percent of newly hired nurses are absolutely not thinking of leaving their position, but more than one in four consider leaving likely, and 16 percent expect to do so within a year.
Among the strengths observed: high professional standards (90 percent agree), competent colleagues (94 percent), and good physician-nurse relationships (81 percent).
Among the critical issues perceived by those considering leaving are limited organizational involvement, restricted career opportunities, and the perception of understaffing.
On the “transition shock” front, 60 percent feel overwhelmed by workloads, 69 percent say there is not enough time, and 54 percent report too many administrative tasks.
In an experiment conducted by the researchers, newly hired nurses were presented with different alternative onboarding program scenarios, and the findings showed that what motivates them most is:
- constant support from a dedicated professional (preceptorship);
- regular feedback;
- blended training (ward-based + digital);
- short programs (4–12 weeks).
Bargaining power has shifted to the other side
The study suggests that attractiveness is built together with universities and schools; selection is increasingly a matter of timing and flexibility; and retention depends on onboarding, frontline leadership, and professional recognition.
The hiring competition phase remains necessary, but it is standardized and not easily adaptable. The real room for autonomy for healthcare organizations lies in onboarding policies and in coordination between the Health Professions Directorates and Human Resources Offices to ensure professional development and specialization pathways that can overcome the risk of “feeling like a number.” Looking ahead, there will also be a need to redefine professional profiles at the system level, making explicit the activities that can be carried out with partial or full autonomy by modifying skill mixes. In addition, at least in the short term, international recruitment policies will remain unavoidable, although they will need to be properly coordinated at the regional, if not national, level.
In a market in which bargaining power has shifted to professionals, organizations must design workplace experiences capable of turning a crisis of numbers into an opportunity for innovation.
Claudio Buongiorno Sottoriva, Roberta Montanelli, Marco Sartirana, Francesco Vidè, “Recruitment and selection of nursing staff: which organizational levers?” In Rapporto OASI 2025 (in Italian).
