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Background: Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends., Methods: We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR)., Results: There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives., Conclusions: The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.

There is little debate that the health workforce is a key component of the health care system. Since the training of doctors and nurses takes several years, and the building of new schools even longer, projections are needed to allow for the development of health workforce policies. Our work develops a projection model for the demand of doctors and nurses by Organisation for Economic Co-operation and Development (OECD) countries in the year 2030. The model is based on a country's demand for health services, which includes the following factors: per capita income, out-of-pocket health expenditures and the ageing of its population. The supply of doctors and nurses is projected using country-specific autoregressive integrated moving average models. Our work shows how dramatic imbalances in the number of doctors and nurses will be in OECD countries should current trends continue. For each country in the OECD with sufficient data, we report its demand, supply and shortage or surplus of doctors and nurses for 2030. We project a shortage of nearly 400,000 doctors across 32 OECD countries and shortage of nearly 2.5 million nurses across 23 OECD countries in 2030. We discuss the results and suggest policies that address the shortages.

Background: The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor's degree, and inter-professional education., Purpose: The purpose of this paper is to report the progress toward achievement of these recommendations., Methods: We used a longitudinal, multi-state data from four cohorts of nurses newly licensed in 2004 to 2005, 2007 to 2008, 2010 to 2011, and 2014 to 2015 to examine and compare the trends., Finding: The percentage of males who became licensed increased, from 8.8% in 2004 to 2005 cohort to 13.6% in the 2014 to 2015 cohort. The percentage of white-non-Hispanic nurses who were licensed decreased from 78.9% in 2007 to 2008 to 73.8% in 2014 to 2015. These differences primarily reflect an increase in white-Hispanic nurses. More nurses are obtaining a bachelor's degree as their first professional degree, from 36.6% in 2004 to 2005 cohort to 48.5% in 2014 to 2015 cohort. About 40% of the 2014 to 2015 cohort reported that they learned to work in inter-professional teams. Collegial nurse-physician relations had an upward positive trajectory over time increasing almost 7%., Discussion: The diversity and education of new nurses have increased, but are short of meeting the IOM recommendations., (Copyright © 2017. Published by Elsevier Inc.)

Background: After an unprecedented increase in nursing school enrollment and graduates in the past 10 years, projected shortages of nurses have been erased at a national level. However, nursing markets are local, and an uneven distribution of health care providers of all types is a longstanding feature of health care in the United States., Purpose: The purpose of this study was to understand how the outlook for future registered nurse (RN) supply varies regionally across the United States., Methods: We apply our nursing supply model to the nine U.S. Census Divisions to produce separate supply forecasts for each region., Discussion: We find dramatic differences in expected future growth of the nursing workforce across U.S. regions. These range from zero expected growth in the number of RNs per capita in New England and in the Pacific regions between 2015 and 2030 to 40% growth in the East South Central region (Mississippi, Alabama, Tennessee, Kentucky) and in the West South Central region (Texas, Oklahoma, Arkansas, Louisiana)., Conclusion: Assuming growth in the demand for RNs per population, some regions of the United States are expected to face shortfalls in their nursing workforce if recent trends do not change., (Copyright © 2016 Elsevier Inc. All rights reserved.)

RNs today are younger, more diverse, and more highly educated than before.

This article assesses professional development trajectories in top-, middle- and basic-level health workforce groups (doctors, nurses, care assistants) in different European Union countries using available international databases. Three theoretical strands (labour market, welfare state, and professions studies) were connected to explore ideal types and to develop a matrix for comparison. With a focus on larger EU-15 countries and four different types of healthcare systems, Germany, Italy, Sweden and the United Kingdom serve as empirical test cases. The analysis draws on selected indicators from public statistics/OECD data and micro-data from the EU Labour Force Survey. Five ideal typical trajectories of professional development were identified from the literature, which served as a matrix to compare developments in the three health workforce groups. The results reveal country-specific trajectories with uneven professional development and bring opportunities for policy interventions into view. First, there is a need for integrated health labour market monitoring systems to improve data on the skills mix of the health workforce. Second, a relevant number of health workers with fixed contracts and involuntary part-time reveals an important source for better recruitment and retention strategies. Third, a general trend towards increasing numbers while worsening working conditions was identified across our country cases. This trend hits care assistants, partly also nurses, the most. The research illustrates how public data sources may serve to create new knowledge and promote more sustainable health workforce policy., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Immigration as a solution to staff and skill shortages in the health system is increasingly on the agenda in the European Union. This article highlights the related social and policy dilemmas by comparing a new destination country with an old destination country: Spain and the United Kingdom. After describing the challenges met by the United Kingdom, we ask how well-prepared Spain is to face the same issues. In particular, attention is paid to the occupational mobility of health workers after entry and to how immigration as a staffing solution poses new political and social challenges. Through a review of background information regarding the immigration of health workers in the two countries and the preliminary analysis of 15 exploratory interviews, we aim to identify the primary trends and key concerns for future analysis. Although our interviews only allow us to draw tentative conclusions, they do highlight emerging issues to be explored in the near future. Our conclusions show that many of the problems traditionally encountered in the United Kingdom are now emerging in Spain, suggesting scope for further collaboration among government, employers, and other stakeholders across the European Union., (© The Author(s) 2015 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.)

The size of the registered nurse (RN) workforce has surpassed forecasts from a decade ago, growing to 2.7 million in 2012 instead of peaking at 2.2 million. Much of the difference is the result of a surge in new nursing graduates. However, the size of the RN workforce is particularly sensitive to changes in retirement age, given the large number of baby-boomer RNs now in the workforce. We found that in the period 1969-90, for a given number of RNs working at age fifty, 47 percent were still working at age sixty-two and 9 percent were working at age sixty-nine. In contrast, in the period 1991-2012 the proportions were 74 percent at age sixty-two and 24 percent at age sixty-nine. This trend, which largely predates the recent recession, extended nursing careers by 2.5 years after age fifty and increased the 2012 RN workforce by 136,000 people. Because many RNs tend to shift out of hospital settings as they age, employers seeking RNs for nonhospital roles may welcome (and seek to capitalize on) the growing numbers of experienced RNs potentially able to fill these positions., (Project HOPE—The People-to-People Health Foundation, Inc.)

Providing regional projections of the RN workforce will allow underlying differences in the age structure of the RN workforce to become more visible. By providing regional-level projections, it will also be possible to identify those regions whose RN workforce is expected to grow at a slower rate relative to other regions. States in the South and Midwest have a greater supply of younger-aged RNs available to replace fewer numbers of older-age RNs compared to other regions. In contrast, the Northeast and West have fewer younger RNs currently in their workforce yet a relatively larger number of older age RNs to replace. These differences in age structure may be partly due to differences in nursing school enrollment and expansion in nursing education capacity across regions. This information can help guide national and state health workforce planners, employers, educators, and others in developing policies and initiatives that may impact nursing supply in their states.

The intensified nurse migration leads to severe problems for the health care systems in many developing countries. Using the Philippines as an example, this paper will address the question of global nurse migration from a philosophical perspective. John Rawls' liberal and Michael Walzer's communitarian theory of justice will be examined in view of the ethical problem of nurse migration. In line with Rawls' A Theory of Justice, nurse migration undermines the ability of the people in developing countries to make use of their basic rights and liberties. Walzer's communitarian assessment of nurse migration, on the other hand, will stress the shared 'thin' morality, as well as the shared history between the 'donating' and receiving countries. This paper argues that the commonality of a shared history and common values implies the moral obligation to ensure a fairer distribution of nurses., (© 2010 Blackwell Publishing Ltd.)

The worldwide shortage of nurses which results from a global undersupply and high attrition rates affects developed countries in the West the same way as it affects developing countries in Asia, Africa and Latin America. The difference lies in the fact that developing countries serve as a readily available source of trained nurses for developed countries in Europe, North America and parts of Oceania. Strong "pull" and "push" factors favour wealthier nations in the West in their efforts to deal with domestic shortages through overseas recruitment. Thus, the ongoing nursing shortage in developing countries is worsened by a loss of thousands of trained nurses every year to emigration. This paper brings into focus the magnitude of the problem in terms of the number of nurses migrating to and from various countries and its impact on developing countries. The paper also examines some of the ongoing efforts in developing countries to mitigate the problem and sheds light on the prospects for improvement in the foreseeable future.

The past three decades have seen the number of international migrants double, to reach the unprecedented total of 175 million people in 2003. National health systems are often the biggest national employer, responsible for an estimated 35 million workers worldwide. Health professionals are part of the expanding global labour market. Today, foreign-educated health professionals represent more than a quarter of the medical and nursing workforces of Australia, Canada, the United Kingdom and the United States. Destination countries, however, are not limited to industrialised nations. For example, 50 per cent of physicians in the Namibia public services are expatriates and South Africa continues to recruit close to 80% of its rural physicians from other countries. International migration often imitates patterns of internal migration. The exodus from rural to urban areas, from lower to higher income urban neighbourhoods and from lower-income to higher-income sectors contributes challenges to the universal coverage of the population. International migration is often blamed for the dramatic health professional shortages witnessed in the developing countries. A recent OECD study, however, concludes that many registered nurses in South Africa (far exceeding the number that emigrate) are either inactive or unemployed. These dire situations constitute a modern paradox which is for the most part ignored. Shared language, promises of a better quality of life and globalization all support the continued existence of health professionals' international migration. The ethical dimension o this mobility is a sensitive issue that needs to be addressed. A major paradigm shift, however, is required in order to lessen the need to migrate rather than artificially curb the flows.

This literature review analysed both published and unpublished scientific and professional studies on the nursing labour market in Canada within the period of 1985 to 1999. The goal was to conduct a situational analysis utilising statistical data and canvassing all concerned parties to extract their points of view. The analysis revealed significant cyclical variations in the evolution of the workforce, particularly with respect to auxiliary nurses, such as the perceived existence of major problems in recruiting new professionals in the field and retaining existing professionals in their organisations, the lack of homogeneity in educational training programmes, and the co-existence of several operational structures for organising nursing care, of which there is a lack of evaluation on their effectiveness. The results of the literature review identify the necessity to further develop the knowledge base on such a relevant dimension of the nursing labour market.

The US and many other countries are in the midst of a severe shortage of registered nurses (RNs). Labor supply models for currently trained RNs are estimated by gender and marital status using the 1992, 1996, and 2000 data from the National Sample Surveys of Registered Nurses. This analysis extends earlier work by Link (Res. Labor Econ. 13 (1992) 287) which provided labor supply estimates for 1960, 1970, 1977, 1980, 1984, and 1988. Since the methodology and variables employed in the present study are the same as those used by Link, the empirical literature on RN labor supply is brought together for the last 40 years. Moreover, comparisons are made with other studies in the literature of the labor supply of nurses and females in the general population. Results for the key variables are consistent over the different data sets and consistent with earlier work by Link. The RN's own wage had minor effects on both labor force participation and hours worked given participation. The RN wage is still an important variable since it has a significant and positive effect on the number of people who enter first-degree nursing programs in the US. These results are important to policy-makers in light of the current shortage of RNs.

Over the past several years, the expanding shortage of nurses in Michigan has prompted some health care providers to find their own means of filling vacancies. According to an article in The Detroit News, many Detroit area health systems have expressed the need for 5 percent to 10 percent more nursing staff, an equivalent of 150 open positions.

Data Benchmarks: A new study shows the decline in younger women choosing nursing as a career during the last 20 years has been a major factor in the aging of the RN workforce. The researchers predict a worsening shortage unless the trend is reversed.

Context: The average age of registered nurses (RNs), the largest group of health care professionals in the United States, increased substantially from 1983 to 1998. No empirically based analysis of the causes and implications of this aging workforce exists., Objectives: To identify and assess key sources of changes in the age distribution and total supply of RNs and to project the future age distribution and total RN workforce up to the year 2020., Design and Setting: Retrospective cohort analysis of employment trends of recent RN cohorts over their lifetimes based on US Bureau of the Census Current Population Surveys between 1973 and 1998. Recent workforce trends were used to forecast long-term age and employment of RNs., Participants: Employed RNs aged 23 to 64 years (N = 60,386)., Main Outcome Measures: Annual full-time equivalent employment of RNs in total and by single year of age., Results: The average age of working RNs increased by 4.5 years between 1983 and 1998. The number of full-time equivalent RNs observed in recent cohorts has been approximately 35% lower than that observed at similar ages for cohorts that entered the labor market 20 years earlier. Over the next 2 decades, this trend will lead to a further aging of the RN workforce because the largest cohorts of RNs will be between age 50 and 69 years. Within the next 10 years, the average age of RNs is forecast to be 45.4 years, an increase of 3.5 years over the current age, with more than 40% of the RN workforce expected to be older than 50 years. The total number of full-time equivalent RNs per capita is forecast to peak around the year 2007 and decline steadily thereafter as the largest cohorts of RNs retire. By the year 2020, the RN workforce is forecast to be roughly the same size as it is today, declining nearly 20% below projected RN workforce requirements., Conclusions: The primary factor that has led to the aging of the RN workforce appears to be the decline in younger women choosing nursing as a career during the last 2 decades. Unless this trend is reversed, the RN workforce will continue to age, and eventually shrink, and will not meet projected long-term workforce requirements. JAMA. 2000.

As the 21st century begins, Americans can expect to see changes across the health care spectrum. With the drive toward market parity in the management of health care resources, it is easy to lose sight of some critical elements of the health care system that may affect the quality and delivery of care. Specifically, the work force that cares for patients in the hospital, the home, or other care settings will shift. The nursing profession will not be immune to this shift and, as nurses reach retirement age and leave the profession, their departure may leave a void that could take years to fill and profoundly alter the quality of care available.

Objectives: To identify recent national trends in the employment and earnings of nursing personnel and determine whether managed care is associated with changes in the employment and wage growth of nursing personnel., Design: Retrospective analysis of trends in data on employment and earnings of nursing personnel based on monthly US Bureau of the Census Current Population Surveys between 1983 and 1994, and comparison of trends between states with high and low rates of enrollment in health maintenance organizations (HMOs)., Population: Registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides/assistants, orderlies, and attendants (referred to collectively as aides) between the ages of 21 and 64 years., Outcome Measures: Full- and part-time employment, unemployment, percentage of nursing personnel employed in key sectors of the nurse labor market, and inflation-adjusted hourly wages., Results: From 1983 through 1994, there was strong overall growth in both RN employment (37%) and inflation-adjusted wages (22%). Beginning in the early 1990s, however, RNs experienced stagnant wages and a small but steady shift toward employment in lower-paying nonhospital settings, particularly in home health care. In states with high HMO enrollment, RN and LPN employment has grown more slowly since 1990, and the shift of RN employment out of the hospital was strongest. For aides and LPNs, the shift out of hospital employment occurred years before that of RNs and at a much greater rate. Since 1990 the employment of aides has grown rapidly in nursing homes and in home health care settings, whereas employment of LPNs has shifted primarily into physician offices and nursing homes. Overall, the movement toward nonhospital employment has had a modest negative impact on wages for all nursing personnel., Conclusions: Managed care is associated with slower employment growth for RNs in hospitals and a shift toward employment in nonhospital settings, but its effect on earnings has been overshadowed by other forces impacting nurse wages.

The interrelations between the changing supplies of health professional personnel and the evolving health care system have been conspicuously underresearched and underevaluated. In part this reflects the relative independence of the two sectors--health education and training, and health services--in ambulatory and hospital settings. In part it reflects the strong guild arrangements that make it difficult for health care managers to exercise much initiative/discretion in developing new patterns of personnel utilization aimed at greater efficiency and economy. Considering the fact that personnel costs account for about 60 percent of all health care costs, this relative neglect of improved personnel utilization is that much more costly. This article sets out the major dimensions of the three critical personnel groups--physicians, nurses, and allied health workers--and reviews the forces affecting their numbers and utilization. Finally, it raises some issues related to the near- and middle-term changes that lie ahead.

Using 1980 membership data made available by the provincial nurses' association, a simple, age-specific projection model was developed that comprised two submodels: a Markovian one to monitor yearly movements from one membership state to another and a linear submodel for the infusion of new members. The model assumes that the likelihood of moving to any membership state depends only on the nurse's current age and membership state. A comparison of actual/projected data for 1981-1984 indicates a fairly high level of accuracy, despite the oscillatory pattern of the nurse labor market in the Province of British Columbia since 1982. The details of the projections of labor force over time show a particular age cohort's characteristic behavior and delineate the effect of childbearing and aging on the supply of nurses. As well as projecting future manpower, the age-specific transition matrices were used to estimate the professional life expectancy of registered nurses. This information includes the average number of continuous years of practice for each age, as well as the average total number of years of practice until being deleted from the system at the age of 75. The forecasting capability developed from this work attempts to address two questions central to manpower planning: how many nurses will there be in the province in the next 5 years? and what is the time-frame involved in nurses' life-cycle activity patterns?