Healthcare personnel statistics - nursing and caring professionals

Data extracted in November 2016. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: January 2018.

This article presents an overview of European Union (EU) statistics on nursing and caring professionals. It provides information on specialist healthcare personnel, as well as data pertaining to nursing and midwifery graduates. Nursing and caring professionals provide services directly to patients in hospitals, ambulatory care and patients’ homes. These professionals include, among others:

  • qualified nurses and midwives;
  • associate nurses;
  • other caring personnel (aids and assistants).

This article is one of a set of statistical articles concerning healthcare resources in the EU which forms part of an online publication on health statistics.

Table 1: Practising nurses and caring professionals, 2014
Source: Eurostat (hlth_rs_prsns)
Figure 1: Practising nursing professionals, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Figure 2: Practising midwives, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Figure 3: Practising nursing associate professionals, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Figure 4: Practising health care assistants, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Table 2: Nurses and caring professionals employed in hospitals, 2014
Source: Eurostat (hlth_rs_prshp1)
Table 3: Graduates — nurses and caring professionals, 2009 and 2014
Source: Eurostat (hlth_rs_grd)
Figure 5: Graduates — nursing professionals, 2004, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)
Figure 6: Graduates — midwives, 2004, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)
Figure 7: Graduates — nursing associate professionals, 2004, 2009 and 2014
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

Main statistical findings

Healthcare personnel

For nurses and caring professionals, Eurostat collects data for three concepts:

  • practising’, in other words, health care professionals providing services directly to patients;
  • professionally active’, in other words, ‘practising’ professionals plus health care professionals for whom their medical education is a prerequisite for the execution of their job;
  • licensed’, in other words, health care professionals who are registered and entitled to practise as health care professionals.

In this article preference is given to the concept of ‘practising’ health care professionals, which is also used for the European core health indicator (ECHI) on practising nurses. For some EU Member States data are not available for this concept and data are therefore presented for one of the alternative concepts instead: footnotes indicate these exceptions in each table and figure.

Based on a sum of the available data (see Table 1 for more information concerning the data coverage for individual Member States), in 2014 there were:

  • 3.4 million practising nursing professionals in the EU Member States (no data for Belgium, the Czech Republic and the Netherlands);
  • 2.9 million practising healthcare assistants (no data for Germany, Cyprus, Poland and Sweden);
  • almost 510 thousand practising nursing associate professionals (no data for Belgium, the Czech Republic, the Netherlands and Sweden);
  • almost 171 thousand practising midwives (no data for Ireland).


Healthcare personnel — nursing professionals

Practising nursing professionals (International Standard Classification of Occupations (ISCO 08) code 2221) assume responsibility for the planning and management of patient care, including the supervision of other healthcare workers, working autonomously or in teams with medical doctors and others in the application of preventive and curative care. Although nurses have traditionally provided care to patients under the guidance of a physician, they are increasingly permitted in many EU Member States to practise independently as professionals. This however depends to some degree on their qualifications and level of training, with an increasing proportion of nurses following university courses to degree level. The number of nurses may vary according to differences in healthcare systems. Equally, the number of nurses compared with other personnel (such as physicians) also varies between different providers of healthcare, for example between hospitals and long-term nursing care facilities.

Luxembourg had the highest average number of nursing professionals per inhabitant in the EU

Luxembourg had 1 197 practicing active nursing professionals per 100 000 inhabitants in 2014. Ireland (professionally active), Sweden (2013 data) and Germany recorded more than one thousand practising nursing professionals per 100 000 inhabitants, which were the next highest ratios among the EU Member States (see Table 1 and Figure 1 for more information concerning the data coverage for individual Member States). The number of practising nursing professionals was otherwise generally within the range of 400–1 000 per 100 000 inhabitants in most of the remaining Member States, with Slovenia (244), Greece (182), Croatia (120) and Romania (56) recording lower ratios. A comparison of the latest data for Luxembourg and Romania shows that there were 21 times as many nursing professionals per 100 000 inhabitants in the former. Expressed differently, each professionally active nursing professional in Luxembourg covered an average of just over 84 inhabitants, while in Romania each practising nursing professional covered an average of more than 1 800 inhabitants.

Excluding those with a break in series, for 21 EU Member States data are available for 2009 and 2014 (nearest year for some Member States, see Figure 1) for the number of practising nursing professionals relative to population size. Three of the Member States reported a decrease in this ratio: Ireland, Slovakia (both professionally active) and Poland. For comparison, a similar analysis for practising physicians (see Figure 1 in the healthcare personnel statistics article on physicians) showed increases in all Member States for which data are available. By far the largest increase in the number of nursing professionals was reported for Malta, where there were 180 more professionally active nurses per 100 000 inhabitants in 2014 than five years earlier.

Healthcare personnel — midwives

As with professional nurses, practising midwifery professionals (ISCO 08 codes 2222 and 3222) plan, manage, provide and evaluate care services. Midwives do so before, during and after pregnancy and childbirth, providing delivery care for reducing health risks to women and new-born children; they may work autonomously or in teams with other healthcare providers.

The distribution of midwives across the EU Member States was quite different to that for nursing professionals: the highest number of practising midwives in 2014 was recorded in the United Kingdom (over 32 thousand), followed by Germany (23 thousand), Poland and France (both around 22 thousand).

In 2014, Belgium (licensed to practise), Sweden (2013 data) and Poland had the highest ratios of practising midwives relative to their populations, at 94, 75 and 59 per 100 000 inhabitants (see Figure 2 for more information concerning the data coverage for individual Member States). The United Kingdom, Bulgaria and Malta each recorded ratios within the range of 45–50 practising midwives per 100 000 inhabitants.

At the other end of the range, by far the lowest ratio of midwives to population was recorded in Slovenia, where there were, on average, just 7 practising midwives per 100 000 inhabitants; Austria (likely to be under-reported), Hungary, Romania the Netherlands (2013 data) and Spain (licensed to practise) each reported 17–18 practising midwives per 100 000 inhabitants. A comparison of the latest data for Belgium and Slovenia (which had the highest and lowest ratios) shows that there were 14 times as many midwives per 100 000 inhabitants in the former.

Excluding those with a break in series, for 23 EU Member States data are available for 2009 and 2014 (nearest year for some Member States, see Figure 2) for the number of practising midwives relative to population size. Six Member States reported a decrease in this ratio between these years, the United Kingdom, Romania, the Czech Republic and Luxembourg and to a lesser extent Latvia and Hungary while the remainder increased.

Healthcare personnel — nursing associate professionals

Practising nursing associate professionals (ISCO 08 code 3221) provide basic nursing and personal care to people suffering from the effects of ageing, illness, injury, or other physical or mental impairment; they may also provide health advice to patients and families, or monitor patients’ conditions. Nursing associate professionals generally work under the supervision of, and in support of implementation of health care, treatment and referral plans established by medical, nursing and other health professionals.

Health care is organised in different ways across the EU Member States and this is reflected in the data for nursing associate professionals insofar as some countries do not recognise this type of professional. Subject to data availability (see Table 1 for more information concerning the data coverage for individual Member States), there were 13 Member States where there were no practising nursing associate professionals. By contrast, among the 11 Member States for which a value above zero was reported in 2014, the highest number of practising nursing associate professionals was recorded in Germany (164 thousand), while the only other Member State to record more than 100 thousand practising nursing associate professionals was Romania.

Relative to population size, there were 667 practising nursing associate professionals in Denmark per 100 000 inhabitants (2013 data), 612 per 100 000 inhabitants in Slovenia, 561 per 100 000 inhabitants in Romania, 460 per 100 000 inhabitants in Croatia and 456 per 100 000 inhabitants in Finland (2012 data). Elsewhere this ratio ranged from 121 to 203 per 100 000 inhabitants, with Cyprus (16 per 100 000 inhabitants) far below this range.

Healthcare personnel — health care assistants

Practising health care assistants, or caring professionals, include health care assistants in institutions (ISCO 08 code 5321), but not home-based personal care workers (ISCO 08 code 5322). The former provide direct personal care and assistance with activities of daily living to patients and residents in a variety of health care settings such as hospitals, clinics, and residential nursing care facilities; they generally work under the direct supervision of medical, nursing or other health professionals or associate professionals. Home-based personal care workers provide routine personal care and assistance with activities of daily living to persons who are in need of such care due to effects of ageing, illness, injury, or other physical or mental conditions and are living in private homes and other independent residential settings. The data on health care assistants presented in this article only cover health care assistants in institutions.

Subject to data availability (see Table 1 for more information concerning the data coverage for individual Member States), the United Kingdom (with an estimated 676 thousand), Italy (625 thousand; professionally active health care assistants) and Spain (427 thousand) had the highest number of practising health care assistants in 2014, followed by France (417 thousand; professionally active health care assistants) and the Netherlands (243 thousand).

The number of health care assistants per 100 000 inhabitants in Finland and the Netherlands was considerably higher than in the other EU Member States

Finland had more than 2 000 practising health care assistants per 100 000 inhabitants in 2012, which was the highest ratio among the EU Member States (see Figure 4 for more information concerning the data coverage for individual Member States), while the Netherlands (1 441 per 100 000 inhabitants), the United Kingdom (1 046 per 100 000 inhabitants) and Italy (1 029 per 100 000 inhabitants, professionally active) were the only other Member States (for which recent data are available) to record at least 1 000 health care assistants per 100 000 inhabitants in 2014. Otherwise, the number of practising health care assistants was generally within the range of 200–1 000 per 100 000 inhabitants in the remaining Member States, with Latvia, Slovakia, Greece, Austria (likely to be under-reported), Croatia and Bulgaria below it. A comparison of the latest data for Finland and Bulgaria (which had the highest and lowest ratios) shows that there were more than 1 072 times as many practising health care assistants per 100 000 inhabitants in the former. Expressed another way, each practising health care assistant in Finland covered an average of just under 50 inhabitants, while in Bulgaria each practising health care assistant covered an average of nearly 52 000 inhabitants.

Excluding those with a break in series, for 17 EU Member States data are available for 2009 and 2014 (nearest year for some Member States, see Figure 4) for the number of practising health care assistants relative to population size. Six reported a decrease in this ratio between these years, most notably the Netherlands and Denmark (2009–13) and to a lesser extent Slovakia, Greece, Portugal and Spain, while there was almost no change in the ratios of Austria and Croatia; the remainder of the Member States reported increases. In both relative and absolute terms, the largest increase was recorded in Belgium, as there were 366 more professionally active health care assistants per 100 000 inhabitants in 2014 than in 2009, an increase of 66 %; this is largely due to the introduction of the registration of assistant nurses and paramedics.

Nurses and caring professionals employed in hospitals

Among the EU Member States, Germany recorded both the highest absolute number of nursing professionals and midwives employed in hospitals (475 thousand) and nursing associate professionals employed in hospitals (61 thousand) in 2014. A similar analysis for health care assistants — see Table 2 — reveals the highest numbers of persons employed in hospitals were recorded in France (245 thousand) and Spain (114 thousand); note that there are no data available for Germany, Italy or the United Kingdom.

The availability of data converted into full-time equivalent units indicates that nursing and caring professionals employed in hospitals generally worked close to full-time. For nursing professionals and midwives the number in full-time equivalents was equal to at least 85 % of the number as a head count in 11 of the 14 Member States for which data are available, falling below this range in 2014 in Germany (77.3 %), the Netherlands (76.3 %) and Belgium (73.7 %; 2013 data). A similar pattern could be observed for the seven Member States with data for nursing associate professionals, where five reported ratios between full-time equivalents and head counts of at least 85 %, with Germany (70.5 %) and Belgium (53.2 %; 2013 data) again reporting lower ratios. For health care assistants both of these measures are available for 12 Member States, nine of which recorded ratios between full-time equivalents and head counts of at least 88.5 %, the Netherlands (69.2 %), Belgium (62.8 %, 2013 data) and Denmark (44.8 %, 2013 data) all reported lower ratios.

Relative to population size, among the 15 EU Member States for which data are available, the number of nursing professionals and midwives (in full-time equivalents) employed in hospitals ranged from 286 per 100 000 inhabitants in Hungary to 655 per 100 000 inhabitants in Denmark (2013 data), with Romania (45 per 100 000 inhabitants) well below this range. Among the 13 Member States with data for nursing associate professionals, six reported no staff from this category working in hospitals (it did not exist in these Member States). Five of the remaining seven Member States with data available reported ratios between 53.1 per 100 000 inhabitants (Germany) and 257.1 per 100 000 inhabitants (Romania), while Cyprus (14.0 per 100 000 inhabitants) and Belgium (8.1 per 100 000 inhabitants, 2013 data) reported lower ratios. For 13 Member States there are data for health care assistants in terms of the number of full-time equivalents per 100 00 inhabitants: Austria, the Czech Republic (estimate) and Denmark (2013 data) reported 50 or fewer health care assistants in hospitals per 100 000 inhabitants; France and Malta reported almost 350 health care assistants in hospitals per 100 000 inhabitants; the remaining eight Member States reported between 71 and 231 health care assistants in hospitals per 100 000 inhabitants.

Health graduates

Among the 22 EU Member States for which data are available (see Table 3 for more information concerning the data coverage for individual Member States; note there are no data for the United Kingdom), there were 123 thousand nursing professionals who graduated in 2014. There were considerably fewer nursing associate or midwifery graduates in 2014: a total of 44 thousand nursing associate graduates in 21 EU Member States (in particular no data available for the United Kingdom) and 8 thousand midwifery graduates across 26 EU Member States (in particular no data available for Spain).

Between 2009 and 2014, there was an increase in the number of nursing professionals graduating in most of the EU Member States for which data are available. Several of these recorded very high growth rates: the number of graduates more than tripled in Malta, and increased by more than 50 % in Croatia (2009–12), Hungary and Cyprus. By contrast, there were declines in excess of 10 % in the number of nursing professionals graduating in Portugal, Bulgaria, Romania, Lithuania and Greece (2009–13) and smaller declines in Estonia, Sweden and Denmark (2009–12).

A similar analysis for midwifery graduates shows a similar picture, as between 2009 and 2014 there were 11 EU Member States which recorded a decrease in their number of graduates, while there were 13 others which recorded increases. Hungary and Latvia recorded by far the highest increase (in relative terms), although there was a break in series in Latvia. There were also notable increases in relative terms (20 % or more) in the number of midwifery graduates in Lithuania, Estonia, the United Kingdom, Malta and the Czech Republic.

Figure 5 presents a comparison between 2004, 2009 and 2014 for the number of nursing professionals graduating per 100 000 inhabitants. This ratio tended to rise in most of the EU Member States; note that in some countries this may have reflected a fall in the population, as opposed to an increase in the number of graduates. The biggest increases between 2004 and 2014 were recorded in Poland and Cyprus.

When expressed per 100 000 inhabitants, the number of midwifery graduates peaked in Estonia (4.4 per 100 000 inhabitants), Poland (4.3  per 100 000 inhabitants), Belgium (4.2  per 100 000 inhabitants) and Finland (3.3  per 100 000 inhabitants ) — see Figure 6. There was a rapid expansion in the number of midwifery graduates per 100 000 inhabitants between 2004 and 2014 in Poland, Malta and Denmark.

Data sources and availability

Key concepts

Practising nurses and caring professionals provide services directly to patients. They include professional nurses and midwives, associate professional nurses (who generally work under the supervision of medical, nursing and other health professionals), as well as health care assistants.

Employment data cover the number of health care staff (head counts) and the number of full-time equivalent (FTE) persons directly employed in hospitals (both general and specialised hospitals); the self-employed working in hospitals are also included, for example, those working with service contracts as non-employed health professionals.

Data on medical graduates for any given year cover the number of students who have graduated in either nursing or midwifery, so they may become a professional or associate professional nurse or midwife. The data exclude those who have graduated in other fields of studies which do not provide a recognised foundation for the practice of nursing or midwifery. Within the EU, Directive 2005/36/EC of the European Parliament and of the Council defines the training of nurses responsible for general care as comprising at least three years of study or 4 600 hours of theoretical and clinical training.

Healthcare resources

Statistics on healthcare resources (such as personnel and medical equipment) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Common definitions have been agreed between Eurostat, the OECD and the World Health Organisation (WHO) with respect to the employment of various health care professionals. Three main concepts are used to present this data; Eurostat gives preference to the concept of ‘practising’ nurses and caring professionals:

  • practising’, in other words, health care professionals providing services directly to patients;
  • professionally active’, in other words, ‘practising’ professionals plus health care professionals for whom their medical education is a prerequisite for the execution of their job;
  • licensed’, in other words, health care professionals who are registered and entitled to practise as health care professionals.

Data on nurses and caring professionals are classified according to the International Standard Classification of Occupations (ISCO); they are defined under ISCO 08 as codes 222, 322 and 532:

  • 222 Nursing and midwifery professionals;
    • 2221 Nursing professionals;
    • 2222 Midwifery professionals;
  • 322 Nursing and midwifery associate professionals;
    • 3221 Nursing associate professionals;
    • 3222 Midwifery associate professionals;
  • 532 Personal care workers in health services;
    • 5321 Health care assistants;
    • 5322 Home-based personal care workers;
    • 5329 Personal care workers in health services not elsewhere classified.

For country specific notes please refer to these background information documents:


Note on tables: the symbol ‘:’ is used to show where data are not available.

Context

According to the European Commission’s Directorate-General for Health and Food Safety, there are growing concerns about a shortage of nursing and caring professionals in the EU and these may become exacerbated as the population continues to age and a relatively high proportion of nurses and caring professionals move from employment into retirement.

One consequence of future demographic developments is that the number of elderly persons (aged 65 and over) in the EU-28 is forecast to increase by almost 53 % during the period 2015–50 (Eurostat; EUROPOP 2013 main scenario[1] ). The ageing of the EU’s population is likely to result in considerable demands for a range of new services, as an increasing proportion of the population becomes frail and suffers from declining physical and mental health. European healthcare systems will therefore need to anticipate future skills in order to match the supply of health professionals — in particular, nurses and caring professionals — to the demands of an increasingly aged society, for example, a likely shift away from care in hospitals towards care in the home.

See also

Online publications

Healthcare human and physical resources

Methodology

General health statistics articles

Further Eurostat information

Main tables

Database

Health care resources (hlth_res)
Health care staff (hlth_staff)
Health personnel employed in hospital (hlth_rs_prshp1)
Nursing and caring professionals (hlth_rs_prsns)
Health personnel by NUTS 2 regions (hlth_rs_prsrg)
Health graduates (hlth_rs_grd)

Dedicated section

Methodology / Metadata

Source data for tables and figures (MS Excel)


External links

European Union, OECD and WHO

Other external links


  1. Calculated using the 2015 estimate from the ‘Population in 1 January by age and sex’ (demo_pjan) and the 2050 projection from ‘Main Scenario- population on 1 January by age and sex’ (proj_13npms).