The nursing shortage is a well-known problem throughout the world and has been exacerbated by the effect of the pandemic. According to a WHO report published in 2020, there are 28 million nurses in the world, constituting 59% of health professionals. Currently, the shortage of nurses is estimated at 5.9 million. The report highlights that if action is not taken, by 2030 there will be a shortage of 10.6 million nurses worldwide. In Spain, it is estimated that there are 120,000 missing and in Catalonia 24,000.
The age of the nurses shows that they are relatively young, but with disparities between countries, and that Europe and America are the two continents with the highest ageing rate. Having an ageing population of nurses increases the rate of abandonment of the profession, a factor to which must be added the forecast of annual retirements which, in turn, increases the structural deficit. It is expected that in the next ten years 17% of nurses worldwide will retire and that 4.7 million more will have to be trained and hired just to maintain the current numbers of professionals.
According to a report from the Nursing Council of Spain in 2020, in the member countries of the Organization for Economic Co-operation and Development (OECD), there is considerable disparity in the ratios of nurses per 1,000 inhabitants, a fact related to the nursing model, health system and the socio-economic level of each of the countries. Currently, the highest rate is in Norway, with more than 18 nurses per 1,000 inhabitants, while Spain is in eighth place from the bottom, with 5.9, while the average value is 9.
As for the different autonomous communities of the Spanish State, there is a big difference in the number of nurses per 1,000 inhabitants. Navarra has the highest ratio, with 8.6, Murcia the lowest, with 4.5, and Catalonia's is 6.2.
If we look at the ratio of nurses in primary care, Rioja is the best equipped, while Madrid is at the bottom with almost half the ratio.
What factors explain the lack of nurses in Spain?
- The economic crisis of 2008 led to cuts in health structures that considerably affected the ratios of nurses, which have never recovered.
- As of 2008, the Bachelor of Nursing (3 years) became a Bachelor of Science (4 years), leaving all universities without graduating new nurses for one year. This deficit was also not recovered and the cuts balanced supply with demand at the time.
- The emigration of nurses to other countries in search of more attractive working and professional conditions coincided with the 2008 crisis, so this was added to the moment of greater mobility of nurses to Europe, mainly to the United Kingdom. According to data from the SATSE nursing union, there are currently more than 8,000 Spanish nurses working in European countries.
- Little foresight on the part of governments in the offers of places in universities, both public and concerted, to study the degree in nursing. It must be taken into account that the actions that are started today will have effects four years from now, or six if a speciality is added.
- Given the progressive ageing of the population, the increase in chronicity and social changes, intensity and skill in care, the main function of nurses, are increasingly necessary.
- The rough calculation of the number of retirements that are taking place and that will take place in the next few years of nurses who entered the labour market 40 years ago.
- The abandonment of the profession, is a very worrying effect, especially if the reason is the precariousness of hiring and the lack of recognition in jobs.
To these, and possibly other, factors, the COVID-19 effect must be added, since according to a study by the International Council of Nursing (IIC), between 10% and 15% of nurses have left the profession due to the effect of the pandemic, a deficit that will affect all health services in the post-COVID-19 era to the extent that it may become the main determinant of health in the next decade.
What are the consequences of the lack of nurses?
- The impoverishment of care provision at all levels of care affects the care received by individuals, families and communities, especially the most vulnerable.
- Reduction of health prevention and promotion programs that affects people's long-term health. This is happening now.
- There are studies carried out in the hospital setting that show that the mortality rate and the improvement in health status are directly related to the number of patients attended by a nurse. More nurses equal less mortality and improved recovery.
- In the field of primary care, studies show that an increase in the contingent of people assigned to the referring nurse and cared for by her translates into a higher workload that significantly increases poor control of diabetes mellitus and hypertension arterial.
- There is currently an excess of competition in contracting between healthcare levels, providers, autonomous communities and even between countries. This struggle by employers to find nurses has not managed to improve the situation of the entire group, but on the contrary, it has harmed the residential and socio-healthcare spheres, rural areas and the hospitals farthest from the large urban centres – where working conditions are less attractive – who currently have serious problems finding staff.
How to alleviate the current situation?
In my opinion, there are three blocks of essential actions:
1. Increase university places to study a degree in nursing
According to the WHO report, to solve the shortage of nurses by 2030, the number of nursing graduates would have to be increased by 8% per year. This recommendation has to be adjusted according to the previous particular shortcomings of each country or region, as in the case of Spain and some autonomous communities with the greatest deficit. In Catalonia, an increase of 600 places is planned in public universities in the 2022-23 academic year, but this increase will not ease the historical deficit that we have if other measures are not implemented.
2. Improve working conditions
- Stable contracts loyalty jobs. This action would prevent some nurses from emigrating to other countries for contractual and instability reasons and, at the same time, the workforce would be stabilized and the plundering of nurses between providers, care levels, areas, autonomous communities and countries would be avoided.
- Go to category A1 as academic recognition of degree, equating nursing to the rest of university degrees for all purposes.
3. Recognize the specific competencies of both skills and recognized specialities, which would put an end to hiring linked to job banks. A change in the contractual model based on competencies is needed.
But, beyond concrete actions, it would now be essential to define what the current and future population needs. Government and nursing organizations have to work together to determine the roadmap for the most appropriate care model. For years patches have been put on a situation that requires a thoughtful, courageous and forward-looking commitment.
We have the diagnosis and know part of the solutions and the effects of not allocating resources to care. When shall we take action?
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