Healthcare personnel statistics - nursing and caring professionals

Data extracted in November 2019.

Planned article update: November 2020.

Highlights

Among the EU Member States, Ireland, Luxembourg, Germany, Sweden and Finland each reported that in excess of 1.0 % of their total number of inhabitants in 2017 were nursing professionals.

Ireland recorded by far the highest number of midwives per inhabitant when compared with the other EU Member States.

In 2017, Belgium recorded the highest number of midwifery graduates per 100 000 inhabitants.

Infographic 1: Practising nurses, 2017

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.

Full article

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 EU Member States), in 2017 there were:

  • approximately 2.8 million practising nursing professionals in the EU Member States (no data for Belgium, Czechia, Latvia and the Netherlands);
  • some 200 000 practising midwives;
  • almost 1.2 million practising nursing associate professionals (no data for Belgium, Czechia, Latvia, the Netherlands and Sweden);
  • around 4.4 million practising healthcare assistants (no data for Cyprus and Sweden).
Table 1: Practising nurses and caring professionals, 2017
Source: Eurostat (hlth_rs_prsns)

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.

Ireland had the highest number of nursing professionals per inhabitant in the EU

The number of nurses may vary according to differences in healthcare systems and how nurses are classified (note for example that during the last year there has been a major reclassification of the nursing profession in France and that this has impacted upon the information shown by reducing the number of nursing professionals, most of which have been reclassified as nursing associate professionals). 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. That said, Ireland had 1 216 professionally active nursing professionals per 100 000 inhabitants in 2017, closely followed by Luxembourg with 1 173 practising nursing professionals per 100 000 inhabitants. Germany and Sweden (2016 data) both recorded more than 1 000 practising nursing professionals per 100 000 inhabitants. The number of practising nursing professionals was otherwise generally within the range of 400 to 1 000 per 100 000 inhabitants in most of the remaining Member States in 2017, with Slovenia (321), Greece (192; only nursing professionals working in hospitals), Croatia (153), Romania (70) and France (16; professionally active nursing professionals) recording much lower ratios. A comparison of the latest data for Ireland and France shows that there were 75 times as many nursing professionals per 100 000 inhabitants in the former. Expressed in a different way, each practising nursing professional in Ireland covered an average of 82 inhabitants, while in France the same ratio suggested that each nurse covered an average of 6 154 inhabitants; these figures may reflect, at least to some degree, differences in the qualifications of different categories of nurses between these EU Member States.

Figure 1: Practising nursing professionals, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

Of the 23 EU Member States for which data are available for 2012 and 2017 (alternative reference years for some countries, see Figure 1 for more details), the number of practising nursing professionals relative to population size fell in nine. The biggest reduction was experienced in Ireland (professionally active nurses), where the number of practising nurses fell by 82 per 100 000 inhabitants during the period under consideration (note that there is a break in series). There were also reductions recorded for Luxembourg, Poland (2013-2017), Slovakia (professionally active nurses), Sweden (2012-2016), Hungary, the United Kingdom (note that there is a break in series), Bulgaria and Denmark (2012-2016).

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 2017 was recorded in the United Kingdom (32 000), followed by Germany (24 000), France and Poland (both 23 000).

In 2017, Ireland had by far the highest ratio of midwives relative to its population size, 376 per 100 000 inhabitants (note that this figure is based on midwives who are licensed to practice; see Figure 2 for more information concerning the data coverage for individual EU Member States). Belgium (also midwives who are licensed to practice), Sweden (2016 data) and Poland were the only other Member States to record ratios of more than 50 practising midwives per 100 000 inhabitants.

Figure 2: Practising midwives, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

At the other end of the range, by far the lowest ratio of the number of midwives to population was recorded in Slovenia, where there were, on average, just 10 practising midwives per 100 000 inhabitants in 2017; Romania, Spain (licensed to practise), Latvia and the Netherlands each reported between 17 and 23 practising midwives per 100 000 inhabitants. A comparison of the latest data for Sweden (2016 data) and Slovenia (which, leaving aside the Irish and Belgian data for reasons of comparability, had the highest and lowest ratios) shows that there were 7.5 times as many midwives per 100 000 inhabitants in the former.

There was a general increase between 2012 and 2017 (alternative reference years for some countries, see Figure 2 for more details) in the number of practising midwives relative to population size in all but seven of the EU Member States. Those Member States which reported a decrease in their ratios included Poland (2013-2017), the United Kingdom (note that there is a break in series), Slovakia (professionally active midwives), Luxembourg and Romania — where the decreases were relatively small — as well as Czechia and Ireland (2014-2017; licensed to practise) where this ratio fell by a greater number.

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 profession. Subject to data availability (see Table 1 for more information concerning the data coverage for individual Member States), there were 12 Member States where there were no practising nursing associate professionals and a further five for which no data are available. Among the 11 Member States for which non-zero data are available, the highest number of practising nursing associate professionals was recorded in France (690 000; professionally active), while the only other Member States to record more than 100 000 practising nursing associate professionals were Germany (168 000) and Romania (123 000).

Relative to population size, there were 1 032 active nursing associate professionals per 100 000 inhabitants in France, 671 practising nursing associate professionals per 100 000 inhabitants in Slovenia, 627 per 100 000 inhabitants in Romania, 504 per 100 000 inhabitants in Croatia and 403 per 100 000 inhabitants in Finland (2014 data). Elsewhere this ratio ranged from 139 to 203 per 100 000 inhabitants, with Cyprus (11 per 100 000 inhabitants) and Austria (less than 1 per 100 000 inhabitants) far below this range.

Figure 3: Practising nursing associate professionals, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

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 the 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 EU Member States), France (1.1 million; professionally active), the United Kingdom (1.1 million), Italy (624 000), Spain (454 000) and Germany (404 000) had the highest number of practising health care assistants in 2017, followed at some distance by the Netherlands (185 000).

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

Finland had 2 130 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 France (1 661 per 100 000 inhabitants; professionally active), the United Kingdom (1 645 per 100 000 inhabitants) and Denmark (1 637 per 100 000 inhabitants; 2016 data) were the only Member States (for which recent data are available) to record at least 1 600 health care assistants per 100 000 inhabitants in 2017. Otherwise, the number of practising health care assistants was generally within the range of 100 to 1 200 per 100 000 inhabitants, although the latest information for Slovenia, Greece (only people working in hospitals), Poland, Croatia and Bulgaria showed that their ratios were below this range.

Figure 4: Practising health care assistants, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

In a majority of the 24 EU Member States for which data are available for 2012 and 2017 (alternative reference years for some countries, see Figure 4 for more details), there was an increase in the number of practising health care assistants relative to population size. By far the largest decrease in the ratio of practising health care assistants was recorded in the Netherlands, while there was also a considerable reduction in Slovenia, and smaller declines in Greece, Spain, Ireland and Croatia. In both relative and absolute terms, the largest increases were recorded in Malta and Belgium: in the former there were 253 more professionally active health care assistants per 100 000 inhabitants in 2017 than in 2013, an overall increase of 62 %; in the latter, there were 399 more healthcare assistants per 100 000 inhabitants in 2017 than in 2012 — an increase of 51 % — 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 (463 000) and the second highest number of nursing associate professionals employed in hospitals (51 000) in 2017; the largest number of nursing associate professionals employed in hospitals was recorded in Romania (57 000) — see Table 2. A similar analysis for health care assistants reveals the highest numbers of persons employed in hospitals were recorded in France (245 000) and Spain (120 000); note that there are no data available for Germany, Italy or the United Kingdom, among others.

Table 2: Nurses and caring professionals employed in hospitals, 2017
Source: Eurostat (hlth_rs_prshp1)

The availability of data converted into full-time equivalent (FTE) 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 80 % of head counts for 11 of the 14 EU Member States for which data are available, falling below this range in the Netherlands (77.3 %), Germany (75.6 %) and Belgium (73.8 %; 2016 data). A similar pattern could be observed for the six Member States with data for nursing associate professionals, as four of these reported ratios between full-time equivalents and head counts of at least 80 %, while Germany (68.6 %) and Belgium (51.30 %; 2016 data) again reported 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 80 %. By contrast, in Denmark (78.2 %), the Netherlands (66.6 %) and Belgium (62.1 %, 2016 data), a smaller proportion of the workforce of health care assistants worked on a full-time basis.

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 293 per 100 000 inhabitants in Hungary to 645 per 100 000 inhabitants in Denmark, with Romania (55 per 100 000 inhabitants) well below this range. Among the 13 Member States with data for nursing associate professionals, seven reported that there were no personnel from this category working in hospitals and the ratio for Austria was also close to zero. Among the remaining five Member States the highest ratios were reported in Romania (291 per 100 000 inhabitants), Hungary (64 per 100 000 inhabitants) and Germany (42 per 100 000 inhabitants), while Cyprus (11 per 100 000 inhabitants) and Belgium (6 per 100 000 inhabitants, 2016 data) reported lower ratios. There are data in full-time equivalents for 13 Member States in relation to the number of health care assistants employed in hospitals: there were fewer than 100 health care assistants in hospitals per 100 000 inhabitants in Czechia, Belgium (2016 data), the Netherlands, Ireland and Austria, while the majority of the remaining Member States reported ratios between 100 and 250 health care assistants in hospitals per 100 000 inhabitants. At the top of the range, Malta and France reported respectively 273 and 340 health care assistants in hospitals in full-time equivalents 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 that there are no data for the United Kingdom), there were 121 000 nursing professionals who graduated in 2017. There were considerably fewer nursing associate or midwifery graduates: almost 37 000 nursing associate graduates in 20 EU Member States (in particular no data available for the United Kingdom) and just under 9 000 midwifery graduates across 26 EU Member States (no data available for Portugal and no recent data available for Romania).

Table 3: Graduates — nurses and caring professionals, 2012 and 2017
Source: Eurostat (hlth_rs_grd)

Between 2012 and 2017, there was an increase in the number of nursing professionals graduating in a majority of the EU Member States (see Table 3 for more information concerning the data coverage). Several of these recorded very high growth rates, as the number of graduates more than tripled in Hungary and more than doubled in Croatia (2012-2016). By contrast, the number of nursing professional graduates declined by almost two thirds in Romania (note that there is a break in series) and fell by more than half in Cyprus and by around one third in Poland and Malta.

A similar analysis for midwifery graduates shows a comparable picture, as between 2012 and 2017 there were eight EU Member States which recorded a decrease in their number of graduates, while there were 15 which recorded increases and two — Cyprus and Luxembourg — where there was no change (both of these had very few, if any, midwifery graduates); no data or incomplete data for Portugal and Romania. By far the highest increases (in relative terms) were recorded in Hungary, Austria and Greece: in Hungary the number of midwifery graduates almost tripled, while it more than doubled in Austria and Greece (both 2012-2016). There were also notable increases in relative terms (overall growth of 50 % or more during the period under consideration) in the number of midwifery graduates in Bulgaria and Malta.

Figure 5 presents a comparison between 2007, 2012 and 2017 for the number of nursing professionals graduating per 100 000 inhabitants. This ratio rose in a majority (14 out of 22) of the EU Member States for which data are available; 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 (in relative terms) between 2007 and 2017 were recorded in Bulgaria, Malta, Hungary (2008-2017) and Croatia (2008-2016).

Figure 5: Graduates — nursing professionals, 2007, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

When expressed per 100 000 inhabitants, the number of midwifery graduates in 2017 peaked in Belgium (5.4 per 100 000 inhabitants), Finland (4.4 per 100 000 inhabitants; 2016 data), Poland (3.6 per 100 000 inhabitants) and Estonia (3.4 per 100 000 inhabitants) — see Figure 6. There was a very rapid expansion in the number of midwifery graduates per 100 000 inhabitants between 2007 and 2017 in Bulgaria and Latvia (note that there is a break in series) as well as in Luxembourg (which had no midwifery graduates in 2007). By contrast, this ratio fell by around 50 % in Croatia (2008-2016) and Malta.

Figure 6: Graduates — midwives, 2007, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

Figure 7 presents a similar comparison for the number of nursing associate professionals graduating per 100 000 inhabitants. In 2017, this ratio peaked at 92 per 100 000 inhabitants in Romania, which was 2.6 times as high as the ratio recorded in 2007 (34 per 100 000 inhabitants). The ratio of nursing associate professionals graduating per 100 000 inhabitants also rose at a relatively fast pace in the Netherlands, Hungary (2008-2017) and Germany, with overall increases within the range of 29 % to 38 %. Among the three other EU Member States with nursing associate professionals graduates, this ratio fell, most notably in Croatia (2008-2016) and Greece (2012-2016).

Figure 7: Graduates — nursing associate professionals, 2007, 2012 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

Source data for tables and graphs

Data sources

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:

Symbols

Note on tables:

  • a colon ‘:’ is used to show where data are not available;
  • a dash ‘–‘ is used to show where data are not applicable/relevant.

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 years or more) in the EU-28 is forecast to increase by 48 % between 2018 and 2050 (Eurostat baseline projections 2018); during this period the share of the elderly in the total population is projected to increase from 19.8 % in 2018 to 28.5 % by 2050. This ageing of the EU’s population is likely to result in considerable demands for a range of 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 requirements for health professionals — in particular, nurses and caring professionals — so these may be matched against the demands of an increasingly aged society, for example, a likely shift away from care in hospitals towards care in the home.

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Health care (t_hlth_care)
Health care (hlth_care)
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 graduates (hlth_rs_grd)