European Commission - Public Health: healthindicators.org

Nurses employed

Definition of indicator

Number of nursing and caring professionals (nurses, midwives and caring personnel) per 100.000 population. Divided into sub-categories of: i) practising, ii) professionally active, iii) economically active and iv) licensed to practice.

Calculation (numerator, denominator)

The indicator is calculated as the ratio of nursing and caring professionals (practising, professionally active, economically active, licensed to practice) per 100.000 population.

EU Member States use different concepts for reporting the number of health care professionals - both for national purposes and for international comparison. In the context of comparing health care services across Member States, Eurostat gives preference to the concept "immediately serving patients", as it best describes the availability of health care resources. Not all Member States are currently able to provide data based on this definition. Detailed information on which specific definitions are used in MS is provided in the NewCronos database.

The data for nurses presented here refers to: “Definitions and data collection specifications on health care statistics (non-expenditure data) Version 31 July 2007” http://circa.europa.eu/Public/irc/dsis/health/library?l=/methodologiessandsdatasc/health_care/estat-oecd-definitions-c/_EN_1.0_&a=i )

Categories of nursing care staff

The nursing care staff consists of the following four categories:

i) midwives, ii) qualified nurses, iii) associate nurses and iv) caring personnel (e.g. nursing aids, assistants).

These can be grouped into following categories:

a) Total number of qualified nurses and midwives = midwives (i) and qualified nurses (ii)

b) All nurses (qualified and associate nurses) = qualified (ii) and associate nurses (iii)

c) Total number of nursing professionals = midwives (i) and qualified (ii) and associate nurses (iii)

d) Total number of nursing and caring professionals = midwives (i), qualified (ii), associate nurses (iii) and caring personnel (e.g. nursing aids, assistants) (iv)

The following provides a set of basic definitions for allocation of national professions to the above categories for international use:

Definitions of nursing care staff

A midwife is a person who has completed a midwifery educational programme duly recognised in the country in which he/she is located and who has acquired the requisite qualifications to be registered and/or legally licensed to practise midwifery. A nurse is a person who has completed a programme of basic nursing education and is qualified and authorised in his/her country to practise nursing in all settings. (This definition refers to the category '2+3 All nurses' in the above table).

The International Standard Classification of Occupations, 1988 version (ISCO 88) classifies health professions according to occupation and skills required for performing the job. The differences between Major Groups in ISCO are based on differences in the level of education. The following definitions are given:

Qualified nurses and midwives as defined by ISCO 88 (code 2230). Nursing and midwifery professionals assist medical doctors in their tasks, deal with emergencies in their absence, and provide professional nursing care for the sick, injured, physically and mentally disabled, and others in need of such care, or they deliver or assist in the delivery of babies, provide antenatal and post-natal care and instruct parents in baby care.

Associate nurses cover Nursing and midwifery associate professionals as defined by ISCO 88 (code 323). Nursing associate professionals (3231) provide nursing care for the sick, injured, and others in need of such care, and, in the absence of medical doctors or professional nurses, deal with emergencies. Midwifery associate professionals (3232) deliver or assist doctors or midwifery professionals in the delivery of babies, provide antenatal and post-natal care and instruct parents in baby care.

Caring personnel as defined by ISCO 88 (code 5132)

Institution-based personal care workers (5132) perform simple tasks to assist medical, nursing, midwifery and dental professionals or associate professionals in their duties.

Homebased personal care workers (code 5133) attend to various personal needs and in general provide personal care for persons in need of such care at their own homes because of physical or mental illness or disability or because of impairment due to old age. They should possibly also be included.

Definitions of practising, professionally active, economically active and licensed to practice:

Practising nurses, midwives and caring personnel provide services directly to patients.

Professionally active nurses, midwives and caring personnel are practising nurses, midwives and caring personnel plus other nurses, midwives and caring personnel for whom their education is a prerequisite for the execution of the job.

Eurostat currently does not collect data for this definition; the definition is rather provided for completeness.

Economically active nurses, midwives and caring personnel are practising nurses, midwives and caring personnel, professionally active nurses, midwives and caring personnel as well as nurses, midwives and caring personnel who do NOT use their education for the purpose of the actual job.

Nurses, midwives and caring personnel licensed to practise are practising nurses, midwives and caring personnel, professionally active and economically active nurses, midwives and caring personnel as well as all nurses, midwives and caring personnel being registered and entitled to practise their profession.

Please note: The above data collection specifications do not reflect the current OECD data collection on nurses.

Additional underlying concepts

Absolute number of posts (PP) versus number of full time equivalent (FTE) posts. The number of working hours per week varies between countries, but normally should not be less than 35 hours. The number of FTE should be calculated by adding the full and appropriate proportion of part-time occupied posts.

Relevant dimensions (subgroups)

Country, region, calendar year

Preferred data sources

As of 2005 Eurostat, OECD and WHO collect data on resources for health care services with a common questionnaire. The data collection is performed under a “gentlemen’s agreement” as there is no legal framework for the delivery of health care data to European institutions.

Rationale

Indicator widely used in assessments of accessibility and/or efficiency of health care services. It describes staff needs for the whole country and the distribution of staff across the country. It describes staff needs for the whole country and the distribution of staff across the country. Time trends may help to identify eg. staff shortages due to migration.

Data availability, quality and periodicity

Eurostat, OECD and WHO annually collect data on health care statistics (non-expenditure data). However, the timing, variables and indicators as well as countries covered by the different data collections vary. The aim is to provide common definitions for a set of nonexpenditure data regularly collected by Eurostat, OECD and WHO. Definitions specified in the section “Calculation of the indicator” relate to the data collection on: health employment ('manpower').

OECD reports figures per 1000 (head counts).

References

- Definitions and data collection specifications on health care statistics (non-expenditure data)

- Eurostat

- WHO, Counting health workers: definitions, data, methods and global results

- 2004 Eurostat Task Force 'European data on nurses'

Work to do

• The WP Indicators should decide, which of the above listed grouping is relevant for the ECHI shortlist. The ECHIM group recommends practising nursing and caring professionals. Is it so?
• Head count or FTE? WHO also has data for: Physicians, full-time equivalent (FTE). FTE if possible. But seldom available?
• Check Manpower project?