the nursing workforce: past trends, future developments
TRANSCRIPT
OECD WORK ON HEALTH OECD WORK ON HEALTH
The nursing workforce: Past trends, future developments
Francesca Colombo, Head of OECD Health Division All Party Parliamentary Group on Global Health London, 25 February 2016
The number of nurses has increased since 2000 in nearly all OECD countries
17.4
16.7
16.3
15.5
14.1
13.0
12.4
12.1
11.9
11.5
11.2
11.1
10.5
10.0
9.5
9.5
9.4
9.1
8.3
8.2
8.0
7.9
6.4
6.2
6.1
6.1
5.8
5.6
5.3
5.2
5.1
4.9
3.6
2.6
1.8
0
2
4
6
8
10
12
14
16
18
20
2013 2000Per 1 000 population
Source: OECD Health at a Glance 2015
From 8.3 million in 2000 up to 10.8 million in 2013
The increase in the number of nurses means that the inflows exceed the outflows
50
75
100
125
150
175
200
225
250
Australia
50
75
100
125
150
175
200
225
250
Canada
50
75
100
125
150
175
200
225
250
Belgium
50
75
100
125
150
175
200
225
250
Finland
Most OECD countries have increased student intakes in nursing education programmes…
Student intake in nursing education (Index: Baseline year = 100)
Source: OECD (2016)
… with the exception of the UK (England) where the numbers were going down until recently
Student intake (or graduate) in nursing education (Index: Baseline year = 100)
Source: • UK: Health Education England and Department of Health. • US: National League for Nursing. The data relate to graduates.
50
75
100
125
150
175
200
225
250
United Kingdom (England)
50
75
100
125
150
175
200
225
250
United States
Greater domestic training efforts generally associated with fewer recruitment abroad
0
5 000
10 000
15 000
20 000
25 000
30 000
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Number Domestic graduates Foreign-trained
… Unless there is a sudden big increase in the demand for nurses
United Kingdom (nurses)
0
20 000
40 000
60 000
80 000
100 000
120 000
140 000
160 000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Number Domestic graduates Foreign-trained
United States (nurses)
Source: UK : Nursing and Midwifery Council; U.S. Nursing Workforce: Trends in Supply and Education, Health Resources Services Administration (HRSA), 2013
• Philippines • India
followed by • UK • Germany
0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000
Iran
Kenya
Cuba
Trinidad and Tobago
Guyana
New Zealand
Romania
South Africa
Ghana
Viet Nam
Zimbabwe
France
Ireland
Poland
Korea
Mexico
China
Haïti
Nigeria
Canada
Jamaica
Germany
United Kingdom
India
Philippines
2010/11 2000/01
//221 344 (2010/11) and 110 774 (2000/01)
Main origin countries of foreign-born nurses working in OECD countries in 2010/11:
Source: OECD (2015), International Migration Outlook
The number of Filipino nurses migrating to the US and the UK has plummeted
Annual flow of nurses trained in the Philippines who migrated to the US and the UK
Source: OECD (2016)
0
2 000
4 000
6 000
8 000
10 000
12 000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number United States United Kingdom
EU countries are now the main origin of foreign-trained nurses in the UK
Philippines 26%
India 19%
South Africa 4%
Nigeria 4%Other
Africa 8%Other 10%
Spain 6%
Portugal 5%
Romania 5%
Poland 3%
Other EU 10%
EU countries
29%
United Kingdom, 2014
Main countries of training of foreign-trained nurses
Source: OECD Health at a Glance 2015
All countries need to make a more efficient use of the skills of nurses
A large proportion of nurses report being over-skilled for some of the work they do… and this is particularly the case for higher-educated nurses.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Physicians Nurses Others
Source: OECD 2011-12 PIAAC Survey (all 23 participating countries)
Reported over-skilling , 2011-12
Skills mismatch by level of education Multinomial logistic regression, odds ratios
11.08
1.98
0
0.5
1
1.5
2
Overskilled
Lower than bachelor's degreeBachelor or equivalentMaster or equivalent
• More advanced roles
• More support from lower-
skilled “nursing associates”
• Train in competences,
not in position
Future of Nursing
Movement towards advanced practice nursing
NP role now exists in over 50 countries
(Advanced) Nurse Practitioner
Clinical Nurse Specialist
Expert Nurse
Certified Registered Nurse Practitioner
Nurse Consultant Primary Healthcare Nurse Etc.
Began with Nurse Practitioners (NPs) in the U.S. and Canada in the mid-1960s
Expanded greatly to many other categories of nurses:
Nurse practitioners could grow more
Country Category Year Number % of all RN
Australia Nurse Practitioners 2010 400 0.2%
Canada Nurse Practitioners 2013 3 477 (up from
825 in 2005) 1.4%
Ireland Advanced Nurse
Practitioners 2009 121
(incl. midwives) 0.2%
England
Advanced Nurse Practitioners
? ?
Nurse Consultants 2009 971 0.2%
United States Nurse Practitioners 2012 132 368 4.7%
Positive impacts of NPs on access and quality of care
Access: NPs can improve access to services and reduce waiting times
Quality: NPs can deliver same quality of care as doctors for a range of services (first contact for people with minor illness, routine follow-up of patients with chronic conditions, patient education/counselling)
Patient satisfaction: At least equal, if not higher (because of quicker access and longer consultations)
1. Standardising the definition of APN roles 2. Improving educational curriculum for APNs, while respecting
each country’s unique cultural and political context 3. Increasing access to primary and preventive health care
services by removing barriers that prevent APNs from practicing to the full extent of their education and training
4. Reforming healthcare funding mechanisms to allow for APN-based practice models
5. Continuing the collection of data and sharing of information on APN quality and outcomes in a variety of countries/settings.
Source: US National Nursing Centers Consortium (2014), The Future of Nursing (2014)
Recommendations to promote advanced practice nursing (APN)
Supporting nurses with health care assistants (“nursing associates/aids”)
34.8 31.2
28.0 25.6 24.6
18.8 17.7 17.3 17.3 16.0 15.9 14.6
0
10
20
30
40
Health care assistants ("nursing associates" and others) Total
Per 1 000 population
Source: OECD Health Statistics 2015
• Proper skill mix can help reduce training cost and time and allow nurses to work at their full scope of practice
Some general reflections
• Nurses are the most numerous category of health care providers in most countries
• Functions and responsibilities need to evolve to better respond to population health needs, demand for greater teamwork: • Remove barriers to effective use of skills: barriers for more advanced
practice nurses so that they can work at their full scope of practice • Support nurses with lower-skilled/health care assistants so that nurses
don’t do tasks for which they are over-qualified
• Countries need to train sufficient number of nurses to respond to need, without unduly relying on training efforts of other countries
• Lower-income countries may need support to increase their training capacity
• Training decisions need to based on more robust data and health workforce planning models
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