Healthcare personnel statistics - nursing and caring professionals
Data extracted in July 2022.
Planned article update: August 2024.
Highlights
Ireland reported that 1.6 % of its total number of inhabitants were nurses (1 617 per 100 000 inhabitants; licensed to practise); there were 10 other EU Member States where this share was at least 1.0 %.
Ireland recorded the highest number of midwives per inhabitant among the EU Member States (211 per 100 000 inhabitants; licensed to practise); the next highest ratios were recorded in Sweden and Belgium.
In 2020, Belgium recorded the highest number of midwifery graduates relative to population among the EU Member States, 5.6 per 100 000 inhabitants.
Graduates – nursing professionals, 2020
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 (including associate nurses that generally work under the supervision of other health professionals)
- midwives;
- caring personnel (personal care workers in health services, working in hospitals, private homes and independent residential settings).
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.
It should be noted that data are presented in this article for 2020: for the first time, this article includes data that show an impact from the COVID-19 pandemic and its related restrictions. For this reason, particular attention should be paid when comparing the 2020 data with data from earlier years.
Full article
Healthcare personnel
For nurses and midwives, Eurostat collects data for three concepts, with the first two of these also used for caring personnel:
- ‘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, including those for whom their nursing education is not a prerequisite for the execution of their job and those who are economically inactive (for example, unemployed or retired).
In this article, preference is given to the concept of ‘practising’ health care professionals, which is also used for the European Core Health Indicators (ECHI) on i) practising nursing and caring professionals and ii) practising qualified nurses and midwives. 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 2020 there were:
- approximately 3.9 million practising nurses in the EU Member States;
- some 162 000 practising midwives;
- around 3.7 million practising caring personnel (no data for Cyprus and Sweden).
Healthcare personnel – nurses
Practising nurses include nursing professionals and associate professional nurses.
- 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.
- 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.
The number of nurses may vary between EU Member States 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.
In 2020, Germany had the highest number of practising nurses among EU Member States, at just over one million; this was considerably higher than the second highest count recorded in France (764 000 professionally active nurses). In turn, the number of nurses in France was twice that recorded in Italy (373 000), while Spain (289 000; including midwives) was the only other Member State to report more than 200 000 nurses.
Ireland had the highest number of nurses per inhabitant in the EU
Ireland had 1 617 licensed nurses per 100 000 inhabitants, followed at some distance by Finland with 1 357 practising nurses per 100 000 inhabitants (2018 data). Germany, France (professionally active), the Netherlands, Belgium (2018 data), Sweden (2019 data), Austria, Slovenia and Denmark (2019 data) all recorded more than 1 000 practising nurses per 100 000 inhabitants; this was also the case in Luxembourg (where the most recent data available was for 2017; not shown in Figure 1). In other words, there were 11 EU Member States where at least 1.0 % of the population were nurses.
Elsewhere, the number of practising nurses was generally within the range of 500 to 900 per 100 000 inhabitants in 2020. Bulgaria (421), Latvia (418) and Greece (338; only people working in hospitals; 2019 data) recorded lower ratios. A comparison of the latest data for Ireland and Greece shows that there were 4.8 times as many nurses per 100 000 inhabitants in the former. Expressed in a different way, each nurse licensed to practise in Ireland covered an average of 62 inhabitants, while in Greece the same ratio indicated that each nurse working in a hospital covered an average of 296 inhabitants (2019 data).
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(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Of the 25 EU Member States for which data are available for 2015 and 2020 (alternative reference years for some countries, see Figure 1 for more details), the number of practising nurses relative to population size fell in three. The biggest decrease was experienced in Latvia (note there is a break in series), where the number of practising nurses fell by 50 per 100 000 inhabitants during the period under consideration. There were also decreases recorded for Bulgaria (down 17 per 100 000 inhabitants) and Sweden (down 12 per 100 000 inhabitants; 2015–2019).
Healthcare personnel – midwives
As with nurses, practising midwives (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 nurses: the highest number of practising midwives in 2020 was again recorded in Germany (26 000) followed by France (23 500), but these were then followed by Poland (22 700; 2017 data).
Among the EU Member States, Ireland had by far the highest ratio of midwives relative to its population size, 211 per 100 000 inhabitants in 2020 (note that this figure is based on midwives who are licensed to practice and includes nurses that also have midwifery qualifications) –see Figure 2 for more information concerning the data coverage for individual EU Member States. Sweden (2019 data), Belgium (2019 data) and Poland (2017 data) were the only other Member States to record ratios of more than 50 practising midwives per 100 000 inhabitants.
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At the other end of the range, the lowest ratio of the number of midwives to population was recorded in Slovenia, where there were, on average, 15 practising midwives per 100 000 inhabitants in 2020. 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 (2019 data) and Slovenia which – leaving aside the Irish data for reasons of comparability – had the highest and lowest ratios, shows that there were 5.2 times as many midwives per 100 000 inhabitants in the former.
Healthcare personnel – caring personnel
Caring personnel include health care assistants in institutions (ISCO 08 code 5321) and home-based personal care workers (ISCO 08 code 5322).
- Health care assistants in institutions 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 need 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.
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), Germany (629 000; 2019 data), Italy (609 000) and Spain (519 000) had the highest number of caring personnel in 2020, followed at some distance by the Netherlands (232 000).
The number of caring personnel per 100 000 inhabitants in Finland was considerably higher than in the other EU Member States
Finland had 2 147 caring personnel per 100 000 inhabitants in 2018, which was the highest ratio among the EU Member States (see Figure 3 for more information concerning the data coverage for individual Member States). France (1 624 per 100 000 inhabitants in 2020; professionally active), Denmark (1 590 per 100 000 inhabitants in 2019) and the Netherlands (1 330 per 100 000 inhabitants) were the only other Member States (for which recent data are available) to record at least 1 250 caring personnel per 100 000 inhabitants. Elsewhere, the number of caring personnel was generally within the range of 100 to 1 100 per 100 000 inhabitants, although the latest information for Greece (only people working in hospitals; 2019 data), Poland (2017 data), Croatia and Bulgaria showed that their ratios were below this range.
_Health2022.png)
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_prsns)
Employment in hospitals
Table 2 focuses on nursing professionals, midwives and health care assistants employed in hospitals. This coverage of healthcare personnel differs from Table 1 in that it does not include associate professional nurses (only nursing professionals) nor, by definition, are there are any home-based personal care workers.
Among the EU Member States, Germany recorded the highest absolute number of nursing professionals and midwives employed in hospitals (534 000), while France (386 000; 2019 data) and Italy (274 000) were the only other Member States (for which recent data are available) to record more than 200 000 nursing professionals and midwives in 2020. A similar analysis for health care assistants working in hospitals reveals the highest counts were in France (245 000; 2019 data) and Spain (141 000); none of the other Member States (for which there are recent data; note that there are no data available for Italy, among others) recorded more than 70 000 health care assistants working in hospitals.
Source: Eurostat (hlth_rs_prshp1)
The availability of data converted into full-time equivalent (FTE) units indicates that employment in hospitals was generally 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 were the Netherlands (78.2 %), Belgium (78.1 %; 2018 data) and Germany (75.5 %). For health care assistants, both of these measures are available for 13 Member States, nine of which recorded ratios between full-time equivalents and head counts of at least 80 %. By contrast, in Germany (74.2 %), the Netherlands (72.5 %), Denmark (71.0 %) and Belgium (58.7 %; 2018 data), a smaller proportion of health care assistants employed in hospitals appeared to work on a full-time basis.
Relative to population size, among the 15 EU Member States for which recent data are available, the number of nursing professionals and midwives (in full-time equivalents) employed in hospitals generally ranged from 289 per 100 000 inhabitants in Hungary to 643 per 100 000 inhabitants in Denmark, with Romania (63 per 100 000 inhabitants) well below this range.
Data in full-time equivalents are available for 14 Member States in relation to the number of health care assistants employed in hospitals. In 2020, there were fewer than 100 health care assistants in hospitals per 100 000 inhabitants in Belgium (2019 data), Germany, the Netherlands and Austria, while the majority of the remaining Member States reported ratios between 100 and 241 health care assistants in hospitals per 100 000 inhabitants. At the top of the range, France (2019 data) and Malta reported respectively 338 and 376 health care assistants in full-time equivalents in hospitals per 100 000 inhabitants.
Health graduates
Table 3 focuses on graduates for the two most qualified occupations covered by this article, namely nursing professionals and midwives.
Among the 23 EU Member States for which data are available, there were 121 000 nursing professionals who graduated in 2020 (2018 or 2019 data for some Member States) – see Table 3 for more information concerning the data coverage for individual Member States. There were considerably fewer midwifery graduates: 6 800 across 25 Member States (note the difference in terms of those Member States for which data are not available).
Source: Eurostat (hlth_rs_grd)
Between 2010 and 2020, 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 was more than 2.5 times as high in 2020 (compared with 2010) in Croatia (2010–2018), Malta and Hungary. By contrast, the number of nursing professional graduates declined in nine Member States, falling by almost one third in Luxembourg, approximately two fifths in Romania (note that there is a break in series) and by more than half in Cyprus (2010–2019).
A similar analysis for midwifery graduates shows a comparable picture, as between 2010 and 2020 there were 13 EU Member States which recorded an increase in their number of graduates, while there were 10 which recorded decrease and two – Belgium and Cyprus – where there was no change (note that in Cyprus this was because it had no graduates in either year); no data or incomplete data for Portugal and Romania. By far the highest increases (in relative terms) were recorded in Hungary (where it was 4.4 times as high in 2020 compared with 2010), Latvia (where it more than trebled) and Bulgaria (where the number doubled). At the other end of the range, the biggest decreases in midwifery graduates between 2010 and 2020 were recorded in Malta (down 42 %), Italy (down 43 %) and Croatia (down 57 %; 2010–2018).
When expressed per 100 000 inhabitants, the number of nursing professionals graduating in 2020 peaked in Denmark (44.1 per 100 000 inhabitants; 2019 data), Sweden (43.5 per 100 000 inhabitants) and Germany (43.1 per 100 000 inhabitants) – see Figure 4. The lowest ratios of nursing professionals graduating per 100 000 inhabitants were recorded in Bulgaria (6.9 per 100 000 inhabitants) and Romania (6.4 per 100 000 inhabitants). The number of nursing professionals graduating per 100 000 inhabitants rose between 2010 and 2020 in a majority (13 out of 23) of the EU Member States for which data are available; note that for each of these, there was also an increase in the overall number of graduates (irrespective of changes in population numbers).
_Health2022.png)
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)
When expressed per 100 000 inhabitants, the number of midwifery graduates in 2020 peaked in Belgium (5.6 per 100 000 inhabitants), Poland (3.9 per 100 000 inhabitants; 2018 data), Finland (3.5 per 100 000 inhabitants) and Sweden (3.3 per 100 000 inhabitants) – see Figure 5. By contrast, the number of midwifery graduates per 100 000 inhabitants was less than 1.0 in Germany, the Netherlands, Austria, Luxembourg, Italy, Spain and Cyprus (2019 data).
_Health2022.png)
(per 100 000 inhabitants)
Source: Eurostat (hlth_rs_grd)
Source data for tables and graphs
Data sources
Key concepts
Practising nurses, midwives and caring personnel 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), health care assistants and home-based personal care workers.
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 health professionals.
Data on 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 for associate professional nurses are not shown in this article. 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 Organization (WHO) with respect to the employment of various health care professionals. Three main concepts are used to present these data; Eurostat gives preference to the concept of ‘practising’ nurses, midwives and caring personnel:
- ‘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, midwives and caring personnel 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 which are annexes to the metadata on health care resources:
In particular, note that:
- data for nurses and graduate nursing professionals for Spain include midwives;
- data for nurses for Cyprus include midwives in the public sector and all private sector nurses are assumed to be practicing;
- data for personnel employed in hospitals in Lithuania are in full-time equivalents compiled relative to the number of contractual hours; some personnel may work 1.25 or 1.5 times the contractual hours and consequently the data in full-time equivalents may exceed data based on head counts;
- data for graduates for Poland count graduates at each level of ISCED;
- data for nurses for Portugal include nurses who hold a post/job for which a nursing education is not required.
Symbols
Tables in this article use the following notation:
| Value in italics | estimate or provisional data; |
| Value is – | not relevant or not applicable; |
| Value is : | 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 years or more) in the EU is forecast to increase by 37 % between 2022 and 2050 (Eurostat baseline projections 2019); during this period the share of the elderly in the total population is projected to increase from 21.2 % in 2022 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.
On 7 September 2022, the European Commission proposed a European care strategy. The Commission is proposing concrete actions to support Member States in improving working conditions and work-life balance for carers and to ensure quality, affordable and accessible care services across the European Union.
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European Union, OECD and WHO
- European Commission - A European Care Strategy
- European Commission – Public Health – European core health indicators (ECHI)
- European Commission – Directorate-General for Health and Food Safety – Health workforce
- OECD – Health policies and data
- World Health Organization (WHO) – Health workforce
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