Regional imbalance in nursing workforce: a system dynamics approach focusing on wages and job attractiveness.

PURPOSE: This study used a system dynamics approach to analyze the feedback structure underlying regional imbalance in the nursing workforce in Korea and to evaluate the projected effects of policy interventions through simulation. METHODS: A system dynamics model was developed using literature and public statistics from the Graduate Occupation Mobility Survey and the Korean Statistical Information Service for 2009-2024. Model validity was assessed through sensitivity analysis and comparison with historical data from 2018-2022. Policy simulations covering 2020-2035 were conducted to compare interventions targeting wages and working conditions in Seoul and Jeonnam. RESULTS: The analysis identified 16 feedback loops, comprising 13 reinforcing loops and three balancing loops, that formed a "success to the successful" structure dominated by a reinforcing cycle of high turnover. In the baseline simulation, the regional gap widened through 2035. Single-factor scenarios involving wage increases or improvements in working conditions had limited effects, whereas high-intensity combined scenarios showed a synergistic effect that could reverse the projected imbalance. CONCLUSION: Regional imbalance in the nursing workforce appears to be a structural problem that is unlikely to be resolved through single-factor policies. Sustained, high-intensity strategies that combine wage improvement with nonfinancial improvements in working conditions are likely needed to disrupt the reinforcing cycle and reduce the nursing workforce imbalance.