Healthcare personnel statistics - nursing and caring professionals

Data extracted in August 2020.

Planned article update: August 2021.

Highlights

Among the EU Member States, Ireland, Luxembourg, Germany, Sweden, France and Denmark each reported that in excess of 1.0 % of their total number of inhabitants in 2018 were nursing professionals.

Ireland recorded by far the highest number of midwives per inhabitant among the EU Member States.

In 2018, Belgium recorded the highest number of midwifery graduates per 100 000 inhabitants among the EU Member States.

Nurses 2018data SE.PNG

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 2018 there were:

  • approximately 3.1 million practising nursing professionals in the EU Member States (no data for Belgium, Czechia, Latvia and the Netherlands);
  • some 150 000 practising midwives;
  • some 390 000 practising nursing associate professionals (no data for Belgium, Czechia, Latvia, the Netherlands and Sweden);
  • around 3.4 million practising healthcare assistants (no data for Cyprus and Sweden).
Table 1: Practising nurses and caring professionals, 2018
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 extent 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. 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.

Ireland had 1 288 professionally active nursing professionals (including also midwives) per 100 000 inhabitants in 2018, followed by Luxembourg with 1 172 practising nursing professionals per 100 000 inhabitants (2017 data). Germany, Sweden (2017 data), France (professionally active) and Denmark all 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 2018 in most of the remaining Member States, with Slovenia (343), Greece (195; only nursing professionals working in hospitals), Croatia (166) and Romania (74) recording lower ratios. A comparison of the latest data for Ireland and Romania shows that there were 17 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 78 inhabitants, while in Romania the same ratio indicated that each nurse covered an average of 1 353 inhabitants. The differences in the ratios recorded for the EU Member States may reflect, at least to some degree, differences in the qualifications of different categories of nurses between Member States.

Figure 1: Practising nursing professionals, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

Of the 22 EU Member States for which data are available for 2013 and 2018 (alternative reference years for some countries, see Figure 1 for more details), the number of practising nursing professionals relative to population size fell in five. The biggest reduction was experienced in Luxembourg (2013-2017), where the number of practising nurses fell by 20 per 100 000 inhabitants during the period under consideration. There were also reductions recorded for Poland (2013-2017), Bulgaria, Sweden (2013-2017) and Slovakia (professionally active).

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 somewhat different to that for nursing professionals: the highest number of practising midwives in 2018 was again recorded in Germany (24 000) followed by France (23 000), but these were then followed by Poland (also 23 000; 2017 data).

Among the EU Member States, Ireland had by far the highest ratio of midwives relative to its population size, 221 per 100 000 inhabitants in 2017 (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). Sweden, Belgium (midwives who are licensed to practice) and Poland (all 2017 data) were the only other Member States to record ratios of more than 50 practising midwives per 100 000 inhabitants.

Figure 2: Practising midwives, 2013 and 2018
(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 11 practising midwives per 100 000 inhabitants in 2018. Romania, Spain (licensed to practise) and Latvia each reported between 17 and 21 practising midwives per 100 000 inhabitants. A comparison of the latest data for Sweden (2017 data) and Slovenia (which, leaving aside the Irish data for reasons of comparability, had the highest and lowest ratios) shows that there were 6.6 times as many midwives per 100 000 inhabitants in the former.

There was a general increase between 2013 and 2018 (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 six of the EU Member States. The Member States which reported a decrease in their ratios included Romania, Poland (2013-2017), Bulgaria, Slovakia (professionally active midwives) and Luxembourg (2013-2017) — where the decreases were relatively small — as well as Czechia (break in series) where this ratio fell by a greater number. The largest increases were reported for Belgium (2013-2017; definition differs), Hungary (break in series) and Malta.

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 in support of the implementation of health care, treatment and referral plans established by medical, nursing and other health professionals and under their supervision.

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 13 Member States where there were no practising nursing associate professionals and a further five for which no data are available. Among the 9 Member States for which non-zero data are available, the highest number of practising nursing associate professionals was recorded in Germany (179 000), while the only other Member State to record more than 100 000 practising nursing associate professionals was Romania (126 000).

Relative to population size, there were 672 practising nursing associate professionals per 100 000 inhabitants in Slovenia, 648 per 100 000 inhabitants in Romania and 499 per 100 000 inhabitants in Croatia. In Germany, Hungary and Greece (only those working in hospitals), this ratio ranged from 141 to 216 per 100 000 inhabitants, with Cyprus (10 per 100 000 inhabitants) and Austria (1 per 100 000 inhabitants) far below this range.

Figure 3: Practising nursing associate professionals, 2013 and 2018
(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), Italy (623 000), Spain (476 000) and Germany (404 000) had the highest number of practising health care assistants in 2018, followed at some distance by the Netherlands (225 000).

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

France had 1 715 professionally active health care assistants per 100 000 inhabitants in 2018, 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 Denmark (1 621 per 100 000 inhabitants) was the only other Member State (for which recent data are available) to record at least 1 600 health care assistants per 100 000 inhabitants in 2018. Otherwise, the number of practising health care assistants was generally within the range of 100 to 1 300 per 100 000 inhabitants, although the latest information for Greece (only people working in hospitals), Poland (2017 data), Croatia and Bulgaria showed that their ratios were below this range.

Figure 4: Practising health care assistants, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)

In a majority of the 23 EU Member States for which data are available for 2013 and 2018 (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 a smaller decline in Greece. In absolute terms, the largest increases were recorded in France (professionally active), Italy and Belgium (professionally active; break in series): respectively 208, 150 and 148 more health care assistants per 100 000 inhabitants in 2018 than in 2013. The large increase in Italy can, at least in part, be attributed to the introduction of the registration of assistant nurses and paramedics. In relative terms, the largest increase was in Bulgaria (up 180 % between 2014 and 2018), although the number of health care assistants relative to the size of the Bulgarian population remained the smallest among the EU Member States.

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: 2017 data) and the second highest number of nursing associate professionals employed in hospitals (51 000; 2017 data). The largest number of nursing associate professionals employed in hospitals in 2018 was recorded in Romania (57 400) — 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 (126 000); note that there are no data available for Germany or Italy, among others.

Table 2: Nurses and caring professionals employed in hospitals, 2018
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 (77.6 %), Germany (75.6 %; 2017 data) and Belgium (74.3 %). Among the six Member States with non-zero data for nursing associate professionals, three reported ratios between full-time equivalents and head counts in the range of 96.7-100.0 %, while Germany (68.6 %; 2017 data) and Belgium (54.3 %) again reported lower ratios, as did Austria (30.6 %). 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 (75.5 %), the Netherlands (67.5 %) and Belgium (64.9 %), a smaller proportion of the workforce of health care assistants appeared to work 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 294 per 100 000 inhabitants in Hungary to 640 per 100 000 inhabitants in Denmark, with Romania (58 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 (294 per 100 000 inhabitants), Hungary (59 per 100 000 inhabitants) and Germany (42 per 100 000 inhabitants; 2017 data), while Cyprus (9 per 100 000 inhabitants) and Belgium (4 per 100 000 inhabitants) reported lower ratios. Data in full-time equivalents are available 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 and the Netherlands, while the majority of the remaining Member States reported ratios between 100 and 227 health care assistants in hospitals per 100 000 inhabitants. At the top of the range, Malta and France reported respectively 323 and 340 health care assistants in full-time equivalents 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), there were 121 000 nursing professionals who graduated in 2018. There were considerably fewer nursing associate or midwifery graduates: 43 100 nursing associate graduates in 21 EU Member States and 6 300 midwifery graduates across 25 EU Member States.

Table 3: Graduates — nurses and caring professionals, 2013 and 2018
Source: Eurostat (hlth_rs_grd)

Between 2013 and 2018, 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 nearly doubled in Bulgaria, Croatia, the Netherlands and Hungary (increases between 83.8 % and 93.2 %). By contrast, the number of nursing professional graduates declined by three fifths in Romania (note that there is a break in series) and Cyprus and fell by nearly one third in Poland.

A similar analysis for midwifery graduates shows a comparable picture, as between 2013 and 2018 there were 12 EU Member States which recorded a decrease in their number of graduates, while there were 11 which recorded increases and one — Cyprus — where there was no change as it had no graduates in either year; no data or incomplete data for France, Portugal and Romania. By far the highest increases (in relative terms) were recorded in Slovenia and Luxembourg: in both cases the number of midwifery graduates at least doubled, although the actual number of graduates remained low. 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 Greece (2013-2017), Belgium and Bulgaria.

Figure 5 presents a comparison between 2008, 2013 and 2018 for the number of nursing professionals graduating per 100 000 inhabitants. This ratio rose between 2008 and 2018 in a majority (14 out of 22) of the EU Member States for which data are available; note that in some cases 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 2008 and 2018 were recorded in Croatia, Hungary, Bulgaria, the Netherlands and Malta.

Figure 5: Graduates — nursing professionals, 2008, 2013 and 2018
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)

When expressed per 100 000 inhabitants, the number of midwifery graduates in 2018 peaked in Belgium (6.9 per 100 000 inhabitants), Poland (3.9 per 100 000 inhabitants), Finland (3.8 per 100 000 inhabitants) and Sweden (3.7 per 100 000 inhabitants) — see Figure 6. There was a very rapid expansion in the number of midwifery graduates per 100 000 inhabitants between 2008 and 2018 in Malta, Latvia, Slovenia and Hungary. By contrast, this ratio fell by around two thirds in Croatia.

Figure 6: Graduates — midwives, 2008, 2013 and 2018
(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 2018, this ratio peaked at 90 per 100 000 inhabitants in Romania, which was 2.1 times as high as the ratio recorded in 2008 (43 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, Germany and Hungary, with overall increases within the range of 21 % to 37 %. Greece also recorded a large increase between 2008 and 2017, although it should be noted that there is a break in series. The two other EU Member States with graduate data for nursing associate professionals recorded falls in this ratio, down 22 % in Slovenia and 78 % in Croatia.

Figure 7: Graduates — nursing associate professionals, 2008, 2013 and 2018
(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-27 is forecast to increase by 44 % between 2019 and 2050 (Eurostat baseline projections 2019); during this period the share of the elderly in the total population is projected to increase from 20.3 % in 2019 to 29.5 % 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)