Availability of nurses
Nurses make up the most numerous category of health workers in nearly all EU countries. The key role they play in providing care in hospitals, long-term care facilities and the community was highlighted again during the COVID-19 pandemic. Pre-existing shortages of nurses were exacerbated during the peaks of the epidemic, particularly in intensive care units but also in other hospital units and long-term care facilities (OECD, forthcoming[1]).
The demand for nurses is expected to continue to rise in the coming years due to population ageing while many nurses are approaching retirement age. Increasing the retention rate of nurses in the profession is a growing concern to avoid exacerbating current and future shortages. Concerns about growing shortages have prompted many countries to increase the number of students in nursing education programmes, although it will take a few years before the impact is felt. Some countries continue to rely on international recruitment to address nurse shortages, although this may exacerbate shortages in those countries where these nurses are recruited.
On average across EU countries, there were 8.3 nurses per 1 000 population in 2020, a rise from 7.5 in 2010 (Figure 7.16). Among EU countries, the number of nurses per capita was highest in 2020 in Finland, Ireland and Germany. Outside the EU, the number was highest in Norway, Switzerland and Iceland, although about one-third of nurses in these latter two countries are trained at a lower level than general nurses and perform lower tasks. In some countries that have relatively low numbers of nurses such as Italy and Spain, a large number of health care assistants (or nursing aids) provide assistance to nurses. Greece has the lowest number of nurses per capita among EU countries, but the data only include nurses working in hospitals.
Between 2010 and 2020, the number of nurses per capita has increased in most EU countries, but not in some that already had a low density in 2010 (e.g. Latvia and the Slovak Republic), thereby widening the gap relative to other countries and the EU average.
Nurses greatly outnumber physicians in most EU countries. In 2020, there were more than two nurses per doctor on average across EU countries, with the nurse-to-doctor ratio reaching about four in Luxembourg and Finland (Figure 7.17). The ratio was much lower in Southern European countries and in Latvia.
Several countries have started to implement more advanced roles for nurses to improve access to care, including “nurse practitioner” roles. Evaluations of nurse practitioners in primary care in Finland, Ireland and the United Kingdom show that advanced practice nurses can improve access to services and reduce waiting times, while delivering the same quality of care as doctors for a range of patients, including those with minor illnesses and those needing routine follow-ups. These evaluations also find a high patient satisfaction rate (Maier, Aiken and Busse, 2017[2]).
The number of nurses includes those providing services for patients (“practising”), but in some countries also those working as managers, educators or researchers (“professionally active”). In countries where there are different levels of nurses, the data include both “professional” nurses (including general and specialist nurses) and “associate professional” nurses who have a lower level of qualifications but are nonetheless recognised and registered as nurses in their country. Health care assistants (or nursing aids) who are not recognised as nurses are excluded. Greece reports only nurses working in hospitals (resulting in an underestimation).
References
[2] Maier, C., L. Aiken and R. Busse (2017), “Nurses in advanced roles in primary care: Policy levers for implementation”, OECD Health Working Papers, No. 98, OECD Publishing, Paris, https://doi.org/10.1787/a8756593-en.
[1] OECD (forthcoming), Ready for the Next Crisis? Investing in Resilient Health Systems, OECD Health Policy Studies, OECD Publishing, Paris.
Note: The EU average is unweighted. 1. Data include not only nurses providing direct care to patients, but also those working in the health sector as managers, educators, researchers, etc. 2. Associate professional nurses with a lower level of qualifications make up 70% or more of nurses in Croatia, Romania and Serbia; about 60% in Slovenia; about 33% in Switzerland and Iceland; and about 20% in the United Kingdom. In Switzerland, most of the growth since 2010 has been in this category. 3. Greece reports only nurses employed in hospitals. 4. The latest data refer to 2017 only. 5. The latest data refer to 2014 only.
Source: OECD Health Statistics 2022; Eurostat Database; WHO National Health Workforce Accounts for Moldova and Ukraine.
Note: The EU average is unweighted. 1. For countries that have not provided data for practising nurses and/or practising doctors, the numbers relate to “professionally active” nurses and doctors. 2. The ratio for Portugal is underestimated (professionally active nurses / all doctors licensed to practise). 3. For Greece, the data refer to nurses and doctors employed in hospitals.
Source: OECD Health Statistics 2022; Eurostat Database.