Part of our Nursing Councils of the World series. Last checked: November 2026.
China has one of the largest nursing workforces in the world, with millions of registered nurses working in hospitals, community health centres and long-term care. Yet with a rapidly ageing population, the country still aims to increase the number of nurses per 1,000 people and to expand community and home care. This guide explains how nurses qualify and register in mainland China, the national nurse qualification examination, the Chinese Nursing Association, and what foreign nurses should know.
Hong Kong and Macau have separate systems. See our guide to the Nursing Council of Hong Kong.
Imagine a young nurse from rural Sichuan who has just finished her diploma. She sits the national qualification exam in a provincial city alongside thousands of others, passes, registers with the provincial health commission and joins a large hospital in Chengdu. Within five years she has specialised in geriatric nursing, a field China urgently needs as its population ages. Her path shows how China’s nursing system works.
Who regulates nursing in China?
Nursing in mainland China is regulated by the National Health Commission (NHC) under the Nurses Regulations (护士条例), first issued in 2008 and since revised. Provincial health commissions handle practice registration for nurses working in their province.
Becoming a registered nurse
- Education: complete a recognised nursing programme, usually a secondary vocational programme (中专), a three-year diploma (大专) or a four-year bachelor’s degree, including clinical practice.
- National Nurse Qualification Examination (护士执业资格考试): pass the national exam, usually held once a year in spring.
- Practice registration (护士执业注册): apply to the health authority where you will work, with your qualification certificate, health certificate and employer’s documents.
- Renewal: registration is generally valid for five years and must be renewed, with evidence of continuing practice and education.
The national nurse qualification examination
- Organised by: the National Health Commission, with exam management by the national medical examination authorities.
- Format: computer-based multiple-choice exam with two units, professional practice and practical skills, each of which must be passed.
- Content: fundamentals of nursing, medical-surgical, maternal and child, paediatric, psychiatric and community nursing, nursing ethics and laws.
- Language: Chinese.
- Eligibility: graduates (or final-year students, as allowed) of recognised full-time nursing programmes with the required clinical training.
After passing, candidates receive a qualification certificate, but they may practise only after practice registration.
Specialist and advanced nursing
China has expanded specialist nurse training in areas such as intensive care, emergency, operating theatre, oncology, wound and stoma care, diabetes, geriatrics and infection control, often through provincial programmes and certification by professional bodies. Postgraduate nursing education, including master’s and doctoral programmes, has grown rapidly. National nursing development plans emphasise community and home nursing, elderly care, and “Internet plus nursing services”, which allow nurses from hospitals to provide home visits booked through online platforms.
The Chinese Nursing Association (CNA)
The Chinese Nursing Association (中华护理学会), founded in 1909, is one of the oldest nursing organisations in Asia and a member of the International Council of Nurses. It:
- Organises academic conferences and continuing education.
- Develops nursing standards and practice guidelines.
- Supports specialist nurse training and certification.
- Publishes nursing journals, including the Chinese Journal of Nursing.
- Represents Chinese nursing internationally.
Provincial and municipal nursing associations carry out similar work locally.
Working conditions
- Large tertiary (Grade A) hospitals in cities such as Beijing, Shanghai, Guangzhou and Chengdu offer the most training and higher pay, but workloads are heavy.
- Nurse-to-patient ratios and night-shift burdens are frequent concerns, and staffing standards have been set for some wards.
- Contract types vary; some nurses have permanent establishment posts (编制), while others are on contracts with different benefits.
- Demand is growing in elderly care, community health and rehabilitation.
Can foreign nurses work in China?
Opportunities for foreign nurses to practise as registered nurses in mainland China are limited. In general, practising as a nurse requires passing the Chinese national exam in Chinese and completing practice registration. Some international hospitals and clinics in major cities employ foreign nurses in roles such as patient coordination, education or management, under specific arrangements and work permits, but rules are strict. Anyone considering this route should confirm requirements with the employer, the local health commission and immigration authorities before moving.
Chinese nurses increasingly work abroad, for example in Japan, Singapore, the Gulf, Europe and North America, after meeting those countries’ licensing requirements.
A short history of Chinese nursing
- Modern nursing was introduced to China in the late nineteenth and early twentieth centuries, largely through mission hospitals and nursing schools.
- The Chinese Nursing Association was founded in 1909, making it one of the oldest national nursing associations in Asia.
- Higher nursing education was interrupted for decades in the mid-twentieth century and restored from the 1980s, when bachelor’s programmes reopened.
- Since then, nursing education has expanded rapidly, with master’s and doctoral programmes and a growing research community.
Nursing in China’s health system
China’s health system is organised around hospitals graded by level (primary, secondary and tertiary, with Grade A tertiary hospitals at the top) and a growing network of community health service centres and township health centres. Nurses work across all levels, but the best-resourced posts are concentrated in large urban hospitals. Government plans have focused on:
- Increasing the number of registered nurses per 1,000 people.
- Strengthening primary and community care, including chronic disease management and health education.
- Developing elderly care and long-term care insurance pilots.
- Expanding home nursing services, including “Internet plus nursing”, where patients book nurse home visits through approved online platforms.
- Improving nursing quality, patient safety and responsible-nurse care models, in which each nurse takes holistic responsibility for a group of patients.
Continuing education and career progression
Chinese nurses progress through professional titles, from nurse to senior nurse, supervisor nurse and associate and full chief nurse, based on qualifications, years of practice, examinations, continuing education and research or publications. Continuing education credits are required, and specialist certification has become increasingly important for promotion and for roles in intensive care, emergency, oncology and other specialties.
Tips for international nurses working with Chinese colleagues
- Recognise that Chinese nurses may have trained under different models, with strong emphasis on technical skills and protocols.
- Value bilingual colleagues as cultural and language bridges for Chinese-speaking patients.
- Ask about family involvement in care, which is often significant in Chinese culture.
- Be aware of traditional Chinese medicine practices that some patients may use alongside prescribed treatment, and ask about them sensitively.
Frequently asked questions
How often is China’s nurse qualification exam held?
Usually once a year, in spring.
How long is nurse registration valid in China?
Practice registration is generally valid for five years and must be renewed.
When was the Chinese Nursing Association founded?
In 1909.
Can I take China’s nursing exam in English?
No. It is in Chinese.
But what does China’s nursing future look like?
With one of the world’s fastest-ageing populations, China will need many more nurses in community, home and long-term care. National plans aim to increase nurse numbers, improve working conditions and expand advanced roles. For nurses inside China, specialist and community skills are likely to be increasingly valuable. For nurses elsewhere, China’s experiments with internet-based home nursing are worth watching.
Your next step: If you work with Chinese patients or colleagues, learn how their training and registration differ from yours, and consider exploring the Chinese Nursing Association’s published guidelines in your specialty.
Related: Nursing in Japan · Nursing in South Korea
Sources: National Health Commission of the People’s Republic of China; Nurses Regulations (护士条例); Chinese Nursing Association; International Council of Nurses. Rules change; check official sources.
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