Overview

Key messages:

The numbers of nurses (and the ratios of nurses to patients and to doctors) vary widely across Europe but there are shortages everywhere and everywhere nurses feel dissatisfied. Policy action is needed urgently.

• Nurse numbers impact on patient outcomes.
• A lack of fully trained (and well-supported) registered nurses compromises patient safety and satisfaction.
• The answer is not simply to introduce nurse associate roles. Increasing the proportion of less-well trained nurses increases patient mortality and nurse burnout.
• Recruiting more nurses makes sense but takes time and resources. Recruiting internationally is ‘quick’ but has its own challenges and ethical problems.
• Retaining staff is a crucial strategy. Prioritizing retention keeps nurses in their jobs is good for patient outcomes, reduces the costs of high turnover and can break the cycle of overload and burnout that sees nurses leave the profession early.
• Staff retention requires systematic action at an organizational (not just an individual) level with interlinked actions reinforcing each other.
• Creating supportive working conditions makes a significant difference. Retention is improved by all the following and by combing them to enhance job satisfaction:
• Ensuring adequate and safe staffing levels and manageable workloads
• Investing in education and training
• Offering career progression pathways with opportunities for nurses to develop and enhance their role
• Providing competitive remuneration and recognizing and rewarding excellence.

• Effective nursing leadership is crucial. Managers need to empower nurses and:
• Foster an organizational culture that shares information and allows nurses some autonomy and flexibility
• Align individual and organizational needs and values while avoiding excessive ‘red tape’
• Address how teamwork and changing skill mix can support nurses and enrich their jobs
• Utilize the opportunities of new technologies to reduce pressures while recognizing that digital cannot replace nursing and that new practices may increase workload.
• Planning needs to accommodate demographics.
• Nurses, like the population, are ageing – adjusting to their needs can keep skilled professionals in the workforce longer.
• Most nurses are women – more could be done to support them and to facilitate their return after career breaks (to care for family).
• Mental health is an increasing challenge. Addressing issues early pays dividends.
• Retaining nurses in primary care needs special attention if nursing is to fill the gaps, particularly in rural areas.

• Better data on who leaves nursing and why will give insights that support retention.