Healthcare personnel statistics - nursing and caring professionals

Data extracted in July 2018.

Planned article update: August 2019.

Highlights

Among the EU Member States, Luxembourg had the highest number of nursing professionals per inhabitant in 2016.

The number of health care assistants per inhabitant in Finland (2014 data) was considerably higher than in the other EU Member States.

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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 Member States), in 2016 there were:

  • 3.5 million practising nursing professionals in the EU Member States (no data for Belgium, Czechia, Latvia and the Netherlands);
  • around 200 thousand practising midwives;
  • more than 510 thousand practising nursing associate professionals (no data for Belgium, Czechia, Latvia, the Netherlands and Sweden);
  • around 3.6 million practising healthcare assistants (no data for Cyprus, Poland and Sweden).
Table 1: Practising nurses and caring professionals, 2016
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.

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

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. That said, Luxembourg had 1 172 practicing nursing professionals per 100 000 inhabitants in 2016, closely followed by Ireland with 1 161 professionally active nursing professionals per 100 000 inhabitants. Sweden (2015 data) [1], Germany, Finland (2014 data) and France (professionally active) each recorded more than one thousand practising nursing professionals per 100 000 inhabitants (see Figure 1 for more information concerning the data coverage for individual EU 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 (307), Greece (190; only nursing professionals working in hospitals), Croatia (144) and Romania (66) recording much lower ratios. A comparison of the latest data for Luxembourg and Romania shows that there were 18 times as many nursing professionals per 100 000 inhabitants in the former. Expressed in a different way, each practising nursing professional in Luxembourg covered an average of 85 inhabitants, while in Romania the same ratio suggested that each nurse covered an average of 1 526 inhabitants; these figures may reflect, at least to some degree, differences in age structures between these Member States.

Figure 1: Practising nursing professionals, 2011 and 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

Of the 24 EU Member States for which data are available for 2011 and 2016 (alternative reference years for some countries, see Figure 1 for more details), the number of practising nursing professionals relative to population size fell in just six. The biggest reduction was experienced in Ireland (professionally active nurses), where the number of practising nurses fell by 134 per 100 000 inhabitants during the period under consideration (note there is a break in series). There were also reductions recorded for Slovakia (professionally active nurses), the United Kingdom (note there is a break in series), Estonia (also a break in series), Hungary and Poland (2011-2015).

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 2016 was recorded in the United Kingdom (31 thousand), followed by Germany, France (both 23 thousand) and Poland (22 thousand).

In 2016, Ireland had by far the highest ratio of midwives relative to its population size, 382 per 100 000 inhabitants, but it should be noted that this figure is based on midwives who are licensed to practice (see Figure 2 for more information concerning the data coverage for individual Member States). Sweden (2015 data), Belgium (2014 data) and Poland (2015 data) each recorded ratios within the range of 59-75 practising midwives per 100 000 inhabitants [2].

Figure 2: Practising midwives, 2011 and 2016
(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 9 practising midwives per 100 000 inhabitants in 2016; Hungary, Austria (likely to be under-reported), Romania, Spain (licensed to practise), Latvia and the Netherlands each reported 17-22 practising midwives per 100 000 inhabitants. A comparison of the latest data for Sweden and Slovenia (which, leaving aside the Irish data for reasons of comparability, had the highest and lowest ratios) shows that there were 8.5 times as many midwives per 100 000 inhabitants in the former.

Among the 27 EU Member States for which data are available for 2011 and 2016 (alternative reference years for some countries, see Figure 2 for more details), there was an increase in the number of practising midwives relative to population size in all but six. The Member States which reported a decrease in their ratios included Luxembourg, Slovakia, the United Kingdom, Hungary and Romania — where the decreases were relatively small — and Czechia where the ratio fell from 42.7 to 37.0 per 100 000 inhabitants.

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. By contrast, among the 11 Member States for which data are available, 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 (118 thousand).

Relative to population size, there were 709 practising nursing associate professionals in Denmark per 100 000 inhabitants (2015 data), 658 per 100 000 inhabitants in Slovenia, 600 per 100 000 inhabitants in Romania, 488 per 100 000 inhabitants in Croatia and 403 per 100 000 inhabitants in Finland (2014 data). Elsewhere this ratio ranged from 121 to 199 per 100 000 inhabitants, with Cyprus (12 per 100 000 inhabitants) far below this range.

Figure 3: Practising nursing associate professionals, 2011 and 2016
(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), the United Kingdom (with an estimated 1.0 million), Italy (622 thousand) and Spain (436 thousand) had the highest number of practising health care assistants in 2016, followed by France (416 thousand; professionally active health care assistants) and Germany (371 thousand; 2015 data).

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

Finland had nearly 2 000 practising health care assistants per 100 000 inhabitants in 2014, 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 United Kingdom (1 584 per 100 000 inhabitants), the Netherlands (1 163 per 100 000 inhabitants), Belgium (1 095 per 100 000 inhabitants, professionally active) and Italy (1 026 per 100 000 inhabitants) were the only Member States (for which recent data are available) to record at least 1 000 health care assistants per 100 000 inhabitants in 2016. Otherwise, the number of practising health care assistants was generally within the range of 100-1 000 per 100 000 inhabitants, although the latest information for Greece, Austria (both likely to be under-reported), Croatia and Bulgaria (data refer to caring personnel working in hospitals only) showed that their ratios were below this range.

Figure 4: Practising health care assistants, 2011 and 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

Among the 24 EU Member States for which data are available for 2011 and 2016 (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 in a majority. By far the largest decrease in the ratio of practising health care assistants was recorded in the Netherlands, while there were also considerable reductions in Spain, Denmark (2011-2015), Finland (2011-2014), Ireland (note there is a break in series) and Greece, and smaller declines in Malta (2013-2016), Austria and Croatia. In both relative and absolute terms, the largest increases were recorded in Belgium and Italy: in the former there were 404 more professionally active health care assistants per 100 000 inhabitants in 2016 than in 2011, an overall increase of 59 % —largely due to the introduction of the registration of assistant nurses and paramedics; in the latter there were 348 more health care assistants, an increase of 51 %.

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 (450 thousand) and the second highest number of nursing associate professionals employed in hospitals (49 thousand) in 2016; the largest number of nursing associate professionals employed in hospitals was recorded in Romania — see Table 2. A similar analysis for health care assistants reveals the highest numbers of persons employed in hospitals were recorded in France (244 thousand; 2015 data) and Spain (119 thousand); 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, 2016
Source: Eurostat (hlth_rs_prshp1)

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 80 % of head counts for 11 of the 14 EU Member States for which data are available, falling below this range in the Netherlands (77.1 %), Germany (75.8 %) and Belgium (73.0 %; 2015 data). A similar pattern could be observed for the seven Member States with data for nursing associate professionals, as five of these reported ratios between full-time equivalents and head counts of at least 80 %, while Germany (69.4 %) and Belgium (50.0 %; 2015 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 the Netherlands (68.5 %), Belgium (59.9 %, 2015 data) and Denmark (42.5 %, also 2015 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 280 per 100 000 inhabitants in Hungary to 654 per 100 000 inhabitants in Denmark (2015 data), with Romania (51 per 100 000 inhabitants) well below this range. Among the 13 Member States with data for nursing associate professionals, six reported that there were no staff from this category working in hospitals. Five of the remaining seven Member States reported ratios between 41 per 100 000 inhabitants (Germany) and 278 per 100 000 inhabitants (Romania), while Cyprus (11 per 100 000 inhabitants) and Belgium (6 per 100 000 inhabitants, 2015 data) reported lower ratios. There are data for 13 Member States in relation to numbers of health care assistants in full-time equivalents: there were fewer than 50 health care assistants in hospitals per 100 000 inhabitants in Denmark (2015 data), Czechia and Austria, while the majority of the remaining Member States reported ratios between 66 and 212 health care assistants in hospitals per 100 000 inhabitants. At the top of the range, Malta and France reported 333 and 341 health care assistants in full-time equivalents per 100 000 inhabitants.

Health graduates

Among the 20 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 2016. There were considerably fewer nursing associate or midwifery graduates in 2016: almost 42 thousand nursing associate graduates in 19 EU Member States (in particular no data available for the United Kingdom) and just under 9 thousand midwifery graduates across 26 EU Member States.

Table 3: Graduates — nurses and caring professionals, 2011 and 2016
Source: Eurostat (hlth_rs_grd)

Between 2011 and 2016, there was an increase in the number of nursing professionals graduating in a small majority of the EU Member States (subject to data availability). Several of these recorded very high growth rates, as the number of graduates nearly tripled in Croatia and nearly doubled in Hungary and Malta. By contrast, the number of nursing professionals graduates fell by more than two thirds in Romania (note there is a break in series) and also declined by one fifth to one quarter in Poland (2011-2015), Portugal, Cyprus and Ireland.

The same analysis for midwifery graduates shows a similar picture, as between 2011 and 2016 there were 12 EU Member States which recorded a decrease in their number of graduates, while there were 12 which recorded increases and two where there was no change (Cyprus and Luxembourg; both of these had very few — if any — midwifery graduates); no comparable data were available for Greece and Portugal. Hungary, Lithuania and Malta recorded by far the highest increases (in relative terms): in Hungary the number of midwifery graduates more than quadrupled, while it more than doubled in Lithuania and doubled in Malta. There were also notable increases in relative terms (50 % or more overall) in the number of midwifery graduates in Latvia, Slovenia and Austria (2011-2015; break in series).

Figure 5 presents a comparison between 2006, 2011 and 2016 for the number of nursing professionals graduating per 100 000 inhabitants. This ratio rose in a small majority 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 between 2006 and 2016 were recorded in Malta and Croatia (2008-2016).

Figure 5: Graduates — nursing professionals, 2006, 2011 and 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

When expressed per 100 000 inhabitants, the number of midwifery graduates in 2016 peaked in Belgium (5.1 per 100 000 inhabitants), Finland (4.4 per 100 000 inhabitants), Poland (4.2 per 100 000 inhabitants; 2015 data), and Malta (4.0 per 100 000 inhabitants) — see Figure 6. There was a relatively rapid expansion in the number of midwifery graduates per 100 000 inhabitants between 2006 and 2016 in Finland and Lithuania, while there was a relatively strong decrease observed in Estonia and Croatia (2008-2016).

Figure 6: Graduates — midwives, 2006, 2011 and 2016
(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 2016, this ratio peaked at 103 per 100 000 inhabitants in Romania, which was more than twice as high as the ratio recorded in 2006 (40 per 100 000 inhabitants). The number of nursing associate professionals graduates per 100 000 inhabitants also grew at a rapid pace in Germany (increasing by more than half over the period under consideration), while in Denmark (2006-2015) and the Netherlands this ratio increased by 28 % and 22 %. Among the four other EU Member States with nursing associate professionals graduates, this ratio fell, most notably in Croatia (2008-2016).

Figure 7: Graduates — nursing associate professionals, 2006, 2011 and 2016
(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:

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 or over) in the EU-28 is forecast to increase by 57 % between 2015 and 2080 (Eurostat baseline projections 2015); during this period the share of the elderly in the total population is projected to increase from 18.9 % in 2015 to 29.1 % by 2080. This 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 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 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)

Notes

  1. In Sweden there were 1 965 licensed nursing professionals per 100 000 inhabitants in 2016, as shown in Table 1 which is based on the latest available data. In Figure 1, data for Sweden are shown for practising nursing professionals as there is better time series than for licensed physicians: in 2015 in Sweden, there were 1 106 practicing nursing professionals per 100 000 inhabitants.
  2. In Belgium and Sweden there were 104 and 122 licensed midwives per 100 000 inhabitants respectively in 2016, as shown in Table 1 which is based on the latest available data. In Figure 2, data for Belgium and Sweden are shown for practising nursing professionals as there is better time series than for licensed physicians: in Belgium (2014 data) and Sweden (2015 data), there were 62 and 75 practicing nursing professionals per 100 000 inhabitants.