In the context of the pandemic, the need to address staff shortages has become more stringent than ever. Even before the crisis[1], understaffing in the health sector has had major negative implications on health indicators such as safety, mortality and morbidity.

Dolors Montserrat, Member of the European Parliament, Chair of the PETI Committee and a former Spanish Minister of Health, underlined that in spite of its catastrophic impacts the Covid-19pandemic nevertheless opens a window of opportunity to reassess public spending for healthcare: For each 10% increase in the number of nurses, the mortality rate of a hospitalised patient could decrease by 10%[2]. In terms of morbidity, studies reveal that an increase of the number of nurses could potentially lead to cost reductions for the health system through preventing adverse effects. For example, in the case of critical care nurses (intensive –care units) a 1 to 1 nurse-patient ratio is more cost efficient than a 1 to 2 ratio[3].

Simona Guagliardo from the European Policy Center presented the European Health Union initiatives made by the European Commission under the EU4Health programme. She highlighted the in light of the € 5.1 billion allocation for EU health policies, governments should support increased public health spending and investments in staff. She based her arguments on the findings of the  PULSER study and in the context of the current European trends in terms of shortage of health professionals, an ageing population and workforce, a gender gap for the nursing and caring professions. According to her, the financing and equipment of public services and their personnel have to remain high on the agenda.

Manuel Cascos Fernandez, President of the most representative trade union of nurses in Spain – SATSE, showcased the citizen’s legislative proposal on a patient/ nurse ratio at national level and announced that the proposal will be voted in the coming weeks.

Esther Reyes, President of CESI´s former Trade Council Health, gave insights into the impact of Corona on the health workers. Although many signs of symbolic appreciation were made towards the medical staff, more action is needed to address the long-term effects of understaffing, i.e. the bad working conditions, accumulated stress and tiredness, as well as the lack of effective protective equipment.

Oliver Krzywanek (dbb, Germany) presented the situation in Germany where a patient/ nurse quota was introduced recently. Since the practice of ‘importing’ staff is not considered an option anymore due to brain-drain effects, Germany hopes that the introduction of quota will improve the working conditions for nurses. This could bring approximately 200 000 workers to return to exercise their profession.

Milena Popovic, an epidemiologist from Montenegro and President of the SDMCG, highlighted the immense problems linked to the emigration of doctors from the public to the private health sector where both working conditions and pay are higher. This emigration has caused many shortages in the public health sector in the Western Balkans, putting the provision of health services dangerously at risk.

Anneke Westerlaken from CNV-Connectief in the Netherlands focused her presentation on solutions to prevent understaffing of nurses: an increase of working time for part-time work, more attractive employment conditions, better pay, further improved possibilities for the unemployed to enter the labour market, and not least the easing of administrative pressure.

All trade union representatives in the meeting underlined the crucial importance of sufficient investment in healthcare. Klaus Heeger, CESI Secretary General, closed by concluding ‘The establishment of a target for nurse-patient quota in all EU Member States would be very concrete a step forward to address shortages. Of course, they would need flanking measures such as improved working conditions, reduced working hours and better pay. The public health care systems need more investment, otherwise all recruitment and retention strategies will fail.’

This event is part of CESI’s ongoing EU co-funded PULSER project which focuses on capacity-building and support for performing public services and public services personnel in Europe.

Photo credits: ReSurge-International (Flickr)

[1] https://www.who.int/bulletin/volumes/86/7/07-046474/en/

[2] Aiken LH, Sloane DM, Bruyneel L, et al. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet, 2014.

[3] Rothchild JM, Bates DW, Franz C, Soukup JR, Kaushal R., The costs and savings associated with prevention of adverse events by critical care nurses.